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目的探讨产妇子宫平滑肌组织中丝裂原激活蛋白激酶(MAPK)信号转导通路及连接蛋白43(CX43)表达与产后出血的相关性。方法 30例行剖宫产产后宫缩乏力出血的产妇作为实验组,30例行剖宫产无产后出血的产妇作为对照组。利用等长张力测定的方式对产妇离体子宫下段平滑肌收缩功能以及缩宫素诱导的收缩潜能进行检测;利用荧光定量反转录聚合酶链反应(RT-PCR)技术对产妇子宫下段平滑肌组织中的CX43 m RNA表达进行检测;利用蛋白免疫印迹技术对产妇子宫下段平滑肌组织中MAPK信号转导通路中细胞外信号调节激酶1/2(ERK1/2)、p38磷酸化蛋白、c-Jun氨基端激酶1/2(JNK1/2)以及CX43蛋白水平进行检测。结果实验组产妇离体子宫平滑肌自发性收缩活动力以及收缩频率均低于对照组(P<0.05);实验组收缩幅度低于对照组,但差异无统计学意义(P>0.05);在使用缩宫剂之后,实验组产妇离体子宫平滑肌的收缩活动力、收缩幅度、收缩频率以及收缩潜能均低于对照组(P<0.05)。实验组CX43 m RNA(0.72±0.33)、p-ERK1/2(2.18±0.41)、p-p38(0.77±0.19)、p-JNK1/2(0.81±0.20)、CX43蛋白(0.08±0.02)均低于对照组(1.02±0.73)、(13.10±4.51)、(0.93±0.23)、(1.10±0.50)、(0.12±0.05)(P<0.05)。结论子宫乏力性产后出血产妇离体子宫平滑肌收缩功能以及收缩潜能显著衰退,子宫平滑肌组织中MAPK信号转导通路水平及CX43表达水平显著下降,并且两者之间关系密切,宫缩乏力性产后出血很大程度上是由于提示MAPK信号通路活化受阻以及CX43表达下降造成的,MAPK信号转导通路及CX43表达相互调节以及共同作用之下产妇产后出血形成以及发展。
Objective To investigate the relationship between mitogen - activated protein kinase (MAPK) signal transduction pathway and expression of connexin 43 (CX43) and postpartum hemorrhage in uterine smooth muscle. Methods 30 cases of postpartum uterine bleeding with maternal genital bleeding as experimental group, 30 cases of cesarean section without postpartum hemorrhage as a control group. The contractile function of contralateral uterine smooth muscle and the contractile potential induced by oxytocin were detected by isometric tension measurement. The mRNA expression levels of uterine smooth muscle in the uterine segment of maternal uterus were measured by RT-PCR (fluorescence quantitative reverse transcription-polymerase chain reaction) CX43 m RNA expression was detected by Western blotting. The expressions of extracellular signal-regulated kinase 1/2 (ERK1 / 2), p38 phosphorylation protein, c-Jun amino terminal end of MAPK signal transduction pathway in maternal uterine smooth muscle were detected by Western blotting. Kinase 1/2 (JNK1 / 2) and CX43 protein levels were detected. Results The spontaneous contractile activity and contractile frequency of isolated uterine smooth muscle in experimental group were lower than those in control group (P <0.05). The contractile amplitude in experimental group was lower than that in control group, but the difference was not statistically significant (P> 0.05) After contracting uterus, contractile activity, contraction amplitude, systolic frequency and contractile potential of isolated uterine smooth muscle in experimental group were lower than those in control group (P <0.05). In the experimental group, CX43 m RNA (0.72 ± 0.33), p-ERK1 / 2 (2.18 ± 0.41), p-p38 (0.77 ± 0.19), p-JNK1 / 2 (1.02 ± 0.73), (13.10 ± 4.51), (0.93 ± 0.23), (1.10 ± 0.50) and (0.12 ± 0.05) respectively (P <0.05). Conclusions The uterine bleeding in postpartum hemorrhage maternal uterine smooth muscle contractile function and shrinkage potential decline significantly, the level of the MAPK signal transduction pathway in uterine smooth muscle tissue and CX43 expression decreased significantly, and the relationship between the two closely, uterine atony postpartum hemorrhage Largely due to hindered the activation of MAPK signaling pathway and CX43 expression decreased, MAPK signal transduction pathway and the expression of CX43 regulate each other as well as the role of maternal postpartum hemorrhage and development.