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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 516 -521. doi: 10.3877/cma.j.issn.1674-392X.2023.05.005

论著

Ⅰ、Ⅲ型胶原蛋白在成人腹股沟斜疝及直疝患者腹横筋膜和疝囊的表达
张升敏, 黄健斌, 陈亮, 马克强†()   
  1. 510317　广州市花都区人民医院肝胆胰和疝外科
  • 收稿日期:2023-03-04 出版日期:2023-10-18
  • 通信作者: 马克强
  • 基金资助:
    广州市花都区医疗卫生一般科研专项项目(21-HDWS-042)

The expression of type Ⅰ and Ⅲ collagen between in transversalis fascia and hernia sac of between adult patients with indirect inguinal hernia and direct inguinal hernia

Shengmin Zhang, Jianbin Huang, Liang Chen, Keqiang Ma†()   

  1. Liver and Hernia Surgery, Huadu District People's Hospital of Guangzhou, Guangzhou 510317, China
  • Received:2023-03-04 Published:2023-10-18
  • Corresponding author: Keqiang Ma
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引用本文：

张升敏, 黄健斌, 陈亮, 马克强. Ⅰ、Ⅲ型胶原蛋白在成人腹股沟斜疝及直疝患者腹横筋膜和疝囊的表达[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 516-521.

Shengmin Zhang, Jianbin Huang, Liang Chen, Keqiang Ma. The expression of type Ⅰ and Ⅲ collagen between in transversalis fascia and hernia sac of between adult patients with indirect inguinal hernia and direct inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(05): 516-521.

目的

探究Ⅰ、Ⅲ型胶原蛋白在斜疝及直疝患者腹横筋膜和疝囊中的表达情况。

方法

选取2020年12月至2022年12月于广州市花都区人民医院行腹腔镜经腹腹膜前腹股沟疝修补术（TAPP）患者74例，依腹股沟疝类型分为腹股沟斜疝组（n=30）与腹股沟直疝组（n=44）。采用苏木精-伊红染色法（HE）观察斜疝和直疝患者腹横筋膜和疝囊组织形态学，实时荧光定量PCR（RT-qPCR）和免疫组化法（IHC）检测2组患者腹横筋膜及疝囊中Ⅰ、Ⅲ型胶原蛋白的表达和分布。

结果

腹股沟斜疝组与腹股沟直疝组患者性别、年龄、体重指数、病史、疝环缺损、疝部位以及疝类型等临床资料比较，差异均无统计学意义（P>0.05）。HE染色显示，腹股沟直疝组患者腹横筋膜和疝囊胶原排列紊乱，腹股沟斜疝组较腹股沟直疝组排列较整齐，呈连续分布。RT-qPCR和IHC结果显示，Ⅰ型胶原蛋白在腹股沟直疝组较腹股沟斜疝组显著低表达，差异有统计学意义（P<0.05）；Ⅲ型胶原蛋白在腹股沟直疝组较腹股沟斜疝组显著上调（P<0.05）；同时Ⅰ/Ⅲ胶原蛋白含量比值在腹股沟直疝组显著降低（P<0.05）。

结论

与腹股沟斜疝患者比较，腹股沟直疝患者Ⅰ型胶原蛋白含量减少，Ⅲ型胶原蛋白含量增加，胶原代谢在腹股沟直疝发生发展中的作用可能比在斜疝中更为重要。

关键词: 疝，腹股沟, 斜疝, 直疝, Ⅰ型胶原蛋白, Ⅲ型胶原蛋白
Objective

To analyze the expression of type Ⅰ and Ⅲ collagen in transversalis fascia and hernia sac between patients with indirect inguinal hernia and direct inguinal hernia.

Methods

A total of 74 patients who underwent laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) at Huadu District People's Hospital of Guangzhou from December 2020 to December 2022 were selected and divided into indirect hernia group (n=30) and direct hernia group (n=44) based on the type of inguinal hernia. Using the Hematoxylin and Eosin (HE) staining method, we observed the morphological characteristics of the transversalis fascia and hernia sac tissues in patients with the indirect inguinal hernia and direct inguinal hernia. And real-time fluorescence quantitative PCR (RT-qPCR) and immunohistochemistry (IHC) were used to detect the expression and distribution of type I and Ⅲ collagen in the abdominal transverse fascia and hernia sac of patients in two groups.

Results

There was no significant difference in clinical data such as age, sex, and disease location between indirect inguinal hernia group and direct inguinal hernia group (P>0.05). The results of hematoxylin-eosin staining (HE), RT-qPCR and IHC showed that the expression of type I collagen was significantly lower in direct inguinal hernia group than that in indirect inguinal hernia group (P<0.05). Type Ⅲ collagen was significantly up-regulated in direct inguinal hernia group compared with indirect inguinal hernia, with statistical significance (P<0.05). The ratio of Ⅰ/Ⅲ collagen content in direct inguinal hernia group was significantly decreased (P<0.05).

Conclusion

Compared with patients with indirect inguinal hernia, the content of type I collagen decreases and the content of type Ⅲ Collagen increases in direct inguinal hernia. The collagen metabolism plays a more important role in the occurrence and development of direct inguinal hernia than that of indirect hernia.

Key words: Hernia, inguinal, Indirect hernia, Direct hernia, Type I collagen, Type Ⅲ collagen
表1 RT-qPCR检测各基因引物序列
基因 正向(5'-3') 反向(3'-5') 产物大小(bp)
Ⅰ型胶原蛋白 CCTCCAGGTCTTCAGGGAATG AGGACCAGGAGGTCCAACTT 201
Ⅲ型胶原蛋白 CTTCGACTTCTCTCCAGCCG TAGTCTCACAGCCTTGCGTG 249
β-actin AGATCAAGATCATTGCTCCTCCT ACGCAGCTCAGTAACAGTCC 174
表2 2组患者一般资料比较（±s）
组别 例数 年龄(岁) 病史(月) 疝环缺损(mm) 体重指数(kg/m2) 性别[例(%)] 疝部位[例(%)] 疝类型[例(%)]
男性 女性 单侧 双侧 原发 复发
腹股沟斜疝组 30 55.37±12.04 12.06±12.70 23.73±7.47 20.81±2.01 27(90.00) 3(10.00) 22(73.33) 8(26.67) 29(96.67) 1(3.33)
腹股沟直疝组 44 54.52±11.11 13.40± 9.43 22.34±7.20 21.58±1.86 40(90.01) 4( 0.09) 30(68.18) 14(31.82) 41(93.18) 3(6.82)
t/χ2   0.310 0.588 1.317 1.703 0.017 0.227 0.424
P   0.757 0.558 0.193 0.093 0.896 0.634 0.515
图1 胶原在腹股沟直疝及斜疝患者腹横筋膜和疝囊的分布（HE染色，400×）
图2 Ⅰ型胶原蛋白和Ⅲ型胶原蛋白在2组患者腹横筋膜及疝囊中mRNA表达水平（n=5）注：2A为2组患者腹横筋膜和疝囊中Ⅰ型胶原的mRNA表达水平；2B为2组患者腹横筋膜和疝囊中Ⅲ型胶原的mRNA表达水平；2C为2组Ⅰ型胶原和Ⅲ型胶原PCR产物的电泳比较。与腹股沟斜疝组比较，***P<0.001。
图3 Ⅰ型胶原蛋白和Ⅲ型胶原蛋白在2组患者腹横筋膜中的蛋白表达注：3A为2组患者腹横筋膜Ⅰ型胶原蛋白的表达；3B为2组腹横筋膜中Ⅲ型胶原蛋白的表达。
表3 2组患者腹横筋膜中Ⅰ型胶原蛋白和Ⅲ型胶原蛋白的蛋白表达统计分析比较[M（P25，P75）]
组别 例数 Ⅰ型胶原蛋白 Ⅲ型胶原蛋白(±s) Ⅰ/Ⅲ胶原蛋白比值
腹股沟斜疝组 30 20.5(14.25,24.75) 46.0± 9.2 0.298(0.24,0.59)
腹股沟直疝组 44 15.5(13.00,18.00) 54.7±11.8 0.250(0.22,0.33)
t/z   2.984 0.455 2.502
P   0.008 0.032 0.011
图4 Ⅰ型胶原蛋白和Ⅲ型胶原蛋白在2组患者疝囊中的蛋白表达注：4A为腹股沟斜疝和直疝患者疝囊中Ⅰ型胶原蛋白的表达；4B为腹股沟斜疝和直疝患者疝囊中Ⅲ型胶原蛋白的表达。
表4 2组患者疝囊中Ⅰ型胶原蛋白和Ⅲ型胶原蛋白的蛋白表达统计分析[M(P25, P75)]
组别 例数 Ⅰ型胶原蛋白 Ⅲ型胶原蛋白(±s) Ⅰ/Ⅲ胶原蛋白比值
腹股沟斜疝组 30 25.7(17.43, 27.76) 43.0±5.4 0.328(0.26, 0.51)
腹股沟直疝组 44 16.7(14.25, 17.32) 51.3±7.2 0.250(0.20, 0.35)
t/z   3.012 0.653 2.713
P   0.004 0.012 0.009
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