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目的观察BPH膀胱逼尿肌平滑肌细胞的凋亡和凋亡相关基因FAS、FASL的表达及它们之间的相互关系。方法对25例BPH患者和15例同龄无膀胱流出道梗阻(BOO)患者的膀胱逼尿肌,用末端脱氧核糖核酸转移酶(TUNEL)法检测凋亡指数,免疫组化方法检测FAS、FASL蛋白的表达水平。并用光镜和透射电镜观察了逼尿肌结构改变,电镜下的细胞凋亡情况。结果 BPH组膀胱逼尿肌平滑肌细胞凋亡指数(AI)为 19．07±4．52,较对照组8．57±3．20显著升高(P<0．01)。BPH组FAS的阳性表达率为96．0％,较对照组73．3％明显增加(P<0．01)。BPH组FASL的阳性表达率为96．0％,较对照组66．7％明显增加。(P<0．01)。光镜和电镜下BPH组逼尿肌细胞形态紊乱,细胞间结缔组织增生,电镜下BPH组凋亡细胞相对增多。结论 BPH患者逼尿肌较同龄正常逼尿肌细胞凋亡率上升,凋亡基因FAS和FASL的表达升高,提示此改变是引起凋亡上升的原因。除去超微结构的改变等影响了BPH患者膀胱逼尿肌功能外,逼尿肌细胞凋亡增加也可能是导致逼尿肌功能减退的原因。
Objective To observe the apoptosis of bladder detrusor smooth muscle cells (BPH) and the expression of FAS and FASL, as well as their correlations. Methods Twenty-five patients with BPH and 15 patients with bladder outflow obstruction (BOO) of the same age were tested for detrusor deformity. The apoptosis index was detected by TUNEL method. The expressions of FAS and FASL protein were detected by immunohistochemistry The level of expression. The changes of detrusor structure and cell apoptosis under electron microscope were observed with light microscope and transmission electron microscope. Results The apoptosis index (AI) of bladder detrusor smooth muscle cells in BPH group was 19.07 ± 4.52, which was significantly higher than that in control group (8.57 ± 3.20, P <0.01). The positive rate of FAS in BPH group was 96.0%, which was significantly higher than 73.3% in control group (P <0.01). The positive rate of FASL in BPH group was 96.0%, which was significantly higher than 66.7% in control group. (P <0.01). Under the light and electron microscope, the detrusor muscle cells in BPH group were disordered and the connective tissue cells were proliferated. The number of apoptotic cells in BPH group was increased under electron microscope. Conclusion The apoptosis rate of detrusor normal detrusor cells in BPH patients is higher than that of normal detrusor cells, and the expression of FAS and FASL is higher than that of normal detrusor in BPH patients, suggesting that this change is the cause of apoptosis. In addition to the changes in the ultrastructure affect the bladder detrusor function in BPH patients, increased detrusor cell apoptosis may also be the reason leading to detrusor dysfunction.