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目的探讨良性前列腺增生(benign prostatic hyperplasia,BPH)合并膀胱过度活动症(overactive bladder,OAB)患者膀胱黏膜毒蕈碱型胆碱能受体(muscarinic cholinergic receptor,M受体)M2、M3亚型表达水平的变化及临床意义。方法分析2012年5月~2013年3月20例BPH患者的国际前列腺症状评分(international prostate syndrome scoring,IPSS)、生活质量评分(quality of life,QOL)、膀胱过度活动症症状评分(OAB syndrome scoring,OABSS)和尿动力学检查。根据OABSS评分结果将其分为BPH组(9例)及BPH并OAB组(11例)。2组均在膀胱镜下钳取膀胱黏膜,经逆转录聚合酶链式反应(reverse transcription-polymerase chain reaction,RT-PCR)检测M受体M2、M3亚型mRNA的表达水平。M2、M3受体mRNA表达水平采用相对于内参基因mRNA表达的相对值ΔCt值表示。比较2组M2、M3受体表达水平及相关性。结果 M2、M3受体表达的ΔCt值BPH组明显低于BPH并OAB组(M2的ΔCt值:-0.154±0.641 vs.0.562±0.762,t=-2.241,P=0.038;M3的ΔCt值:2.534±0.816 vs.3.639±1.019,t=-2.630,P=0.017),说明BPH组M2、M3表达水平均高于BPH并OAB组。2组M2∶M3分别为中位数6.5206(2.35~17.33)和7.9447(2.10~23.83)(Z=-1.102,P=0.271)。同组比较,2组M2表达水平均高于M3(t=-7.776,P=0.000;t=-8.018,P=0.000)。M3表达水平与OABSS和QOL评分呈负相关(r=-0.466,P=0.039;r=-0.496,P=0.026)。结论 BPH合并OAB症状的患者,其膀胱黏膜M2、M3表达水平下降,且M2∶M3比例在合并OAB后有升高的趋势,在OAB发病中起一定作用。M3表达的下降,加重了OAB的程度,降低了患者的生活质量。
Objective To investigate the expression of M2 and M3 subtypes of muscarinic cholinergic receptor (M receptor) in benign prostatic hyperplasia (BPH) patients with overactive bladder (OAB) Level changes and clinical significance. Methods The data of international prostate syndrome scoring (IPSS), quality of life (QOL), OAB symptom score (OAB syndrome scoring) in 20 BPH patients from May 2012 to March 2013 were analyzed. , OABSS) and urodynamic examination. The patients were divided into BPH group (n = 9) and BPH plus OAB group (n = 11) according to OABSS score. The bladder mucosa were harvested by cystoscopy in both groups. The mRNA expression of M and M2 subtypes was detected by reverse transcription-polymerase chain reaction (RT-PCR). The M2 and M3 receptor mRNA expression levels are expressed as relative ΔCt values relative to the reference gene mRNA expression. The M2 and M3 receptor expression levels and their correlations were compared between the two groups. Results The ΔCt values of M2 and M3 receptors in BPH group were significantly lower than those in BPH and OAB groups (ΔCt value of M2: -0.154 ± 0.641 vs.0.562 ± 0.762, t = -2.241, P = 0.038; ΔCt value of M3: 2.534 ± 0.816 vs.3.639 ± 1.019, t = -2.630, P = 0.017), indicating that the expression levels of M2 and M3 in BPH group were higher than those in BPH and OAB group. The M2: M3 of the two groups were 6.5206 (2.35-17.33) and 7.9447 (2.10-23.83) respectively (Z = -1.102, P = 0.271). Compared with the same group, M2 expression levels in both groups were higher than those in M3 (t = -7.776, P = 0.000; t = -8.018, P = 0.000). The expression level of M3 was negatively correlated with OABSS and QOL scores (r = -0.466, P = 0.039; r = -0.496, P = 0.026). Conclusions The expression of M2 and M3 in bladder mucosa of BPH patients with OAB symptoms decreased, and the ratio of M2: M3 increased after the combination of OAB and played a role in the pathogenesis of OAB. The decrease of M3 expression aggravates the degree of OAB and reduces the patient’s quality of life.