| Backgroud and objective Urinary Incontinence(UI),refers to the bladder in filling or not filling state,increased abdominal pressure,such as cough,sneeze,lifting,even standing case,urine uncontrollably through the urethra.It is one of the most common pelvic floor disorders,the most common among middle-aged and older women.Urinary incontinence is mainly divided into three types,namely: stress urinary incontinence,urge incontinence and mixed urinary incontinence,there is also a kind of called hidden urinary incontinence,among them,the highest in all types of the disease incidence in SUI.Under the serious impact on the disease in patients with urinary tract function,at the same time can lead to patients’ psychological anxiety and depression,cause great negative impact,also to our society has brought huge economic burden,therefore,the disease has been some scholars known as "social cancer".Studies have found that pregnancy,childbirth,constipation is a important cause of the disease,however,lead to the disease specific precise mechanism is still unclear,but with the aging of the population increased in recent years and people living standard rise,the more severe forms of the prevention and treatment of the disease.BAK protein(BAK)was discovered in 1995,it is apoptosis gene Bcl-2 one of the new members of the family,on chromosome 6 of people,there are three or more exons,long approximately 6 KB,apoptosis pathway or as part of death is the activation and promote cell apoptosis.The cell-associated death domain-like interleukin-converting enzyme inhibitory protein(c FLIP)is in the 3 area with 3 and 3 area 4 regions of the long arm of human chromosome 2,although the m RNA of this protein is composed of many subtypes,and the expression of this protein is only Two subtypes,one long(c FLIP1)and the other short(c FLIPs).At this stage,it is known that the relatively thorough apoptotic pathway is the Fas-Fas L pathway.Apoptosis is a process of programmed cell death controlled by genes to regulate body development and maintain normal metabolism.At present,studies on pelvic floor disorders in other members of the BAK family have been reported,suggesting that apoptosis-associated proteins may play a role in the development of pelvic floor disorders,but BAK proteins are among such diseases.Although not reported,both BAK and c FLIP are related to caspase in their apoptotic mechanisms.Therefore,this study examined the expression of BAK and c FLIP proteins in the vaginal wall tissue,to understand the relationship between SUI and BAK and c FLIP.To provides new biological indicators for the diagnosis,treatment and early prevention of the disease.Materials and Methods 1.Study object The research object of this article is to select 80 surgical patients admitted from December 2016 to October 2017 in the four gynecological wards of the Third Affiliated Hospital of Zhengzhou University,including 30 cases of simple SUI with pelvic organ detachment.30 cases of Pelvic organ prolapse(POP).Twenty patients who had undergone hysterectomy for other gynecological diseases(such as CINIII,adenomyosis,uterine fibroids,etc.)served as controls.The diagnosis of SUI was based on the patient’s medical history,gynecological examinations,acupressure tests,and urodynamic findings,and the POP-Q score was <II;the SUI+POP group was diagnosed on a POP-Q score of ≥ II.In terms of age,parity,and body mass index,there was no statistically significant difference between the three groups(P>0.05),and there was good comparability.All cases had no rheumatoid arthritis,parathyroid disease,emphysema,and liver fibrosis disease,in half a year of operation,no use of oral or topical hormone drugs,no functional ovarian tumor,no urinary reproductive system infection,there is no history of pelvic floor operation.In the experimental group,about 0.5 cm x 0.5 cm was removed from the anterior vaginal wall or the bladder neck ligament.After the hysterectomy,the vaginal wall of the vaginal stump was used as a control group.2.Methods(1)q RT-PCR was used to detect the expression of BAK and c FLIP in the vaginal anterior wall tissues of the simple SUI group,SUI+POP group and control group.(2)Immunohistochemical SP method was used to detect the expression and localization of BAK and c FLIP in the vaginal anterior wall tissues of the simple SUI group,SUI+POP group and control group.3.Statistical analysis SPSS 21.0 software was used for statistical analysis.The normal distribution in the measurement data is denoted by `χ±s and the independent sample t-test is used to compare the quantitative data between the two groups.One-way ANOVA is used to compare the quantitative data between multiple groups.Count data analysis usingχ2 test.The Pearson method was used for correlation analysis.α=0.05,P<0.05 The difference was statistically significant.Result 1.The basic data of patients in the two groups were compared with that of SUI group,SUI+POP group and control group,and the basic data of pregnancy history,BMI and age of the three groups were not statistically significant(P>0.05).2.BAK’s expression positive rate in SUI group,SUI+POP group and control group was 20(66.67%),18(60.00%)and 2(10.00%)respectively,and the gene expression levels in the three groups were 0.0045 + 0.0042,0.0048 + 0.0045,0.0011 + 0.0009.The positive rate of c FLIP in the three groups was 8(26.67%),6(20.00%)and 17(85.00%)respectively,and the gene expression levels in the three groups were 0.0012 + 0.0011,0.0010 + 0.0011,0.0056 + 0.0048.Comparison between groups.3.The expression of BAK observation group was significantly higher than that in the control group,and the difference was statistically significant(P < 0.05).4.In BAK observation group,there was no significant difference in expression between SUI group and SUI+POP group(P >0.05)。 5.The expression of the c FLIP in the observation group and the control group was the opposite of BAK.6.BAK was negatively correlated with the expression level of c FLIP(r =-0.793,P < 0.05).Conclusion 1.In the vaginal wall tissue of patients with stress urinary incontinence,BAK expression is increased,and c FLIP expression is decreased,suggesting that these two factors may be involved in the change of the tissue structure of the vaginal wall.2.BAK and c FLIP may be involved in the development of stress urinary incontinence by regulating apoptosis of the surrounding muscles of the urethra. |
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