Influencing Factors Of Pelvic Floor Dysfunction In Postmenopausal Women And Proteomics Study Of Uterosacral Ligament

Part ? analysis of influencing factors of pelvic dysfunction in postmenopausal womenObjective:To investigate the status of pelvic floor disorder in community postmenopausal women,analyze the related influencing factors,and explore the strategies for preventing pelvic floor disorder diseases in postmenopausal womenMethods:Twelve communities in Hangzhou were selected by stratified random sampling.The pelvic floor distress Inventory-Short Form 20,PFDI-20 and the Asia-Pacific Urinary Control Association Urinary Incontinence Epidemiology Questionnaire were used to investigate the pelvic floor disorder symptoms scores and related factors among postmenopausal women over 55 years old in the sample community.A total of 359 valid questionnaires were obtained,and EpiData 3.0 was used to input and compare the two questionnaires.SPSS 19.0 was used to analyze the data,describing the distribution of pelvic floor disorder symptom scores,and analyzing the influencing factors.Results:A total of 359 valid questionnaires were obtained.Among the three types of pelvic floor disorder,the incidence of urinary distress(UD)was the highest,reaching 40.1%,followed by colorectal-anal distress(CRAD)of 32.3%,and pelvic organ prolapse(POP)of 20.1%.Multivariate analysis of pelvic organ prolapse distress inventory(POPDI)scores showed that the OR value of POP symptoms in constipation group was 9.108(95%CI:5.030-16.493,P<0.001)compared with that in non-constipation group.The results of cultural level analysis showed that the OR value of the non-attending group was 0.324(95%Cl:0.132-0.795,P=0.014)compared with the group with the highest educational level.Multivariate analysis showed that constipation and BMI were related to Urinary distress inventory(UDI)scores.Compared with normal BMI group,the OR value of overweight and obesity group was 1.839(95%Cl:1.150-2.942,P=0.011).Compared with non-constipation group,the OR value of constipation group was 5.482(95%Cl:3.224-9.174,P<0.001).The correlation factors of colorectal-anal distress inventory(CRADI)scores were screened by multivariate logistic regression analysis.The results showed that only age group was related to the occurrence of symptoms.The OR value of CRAD symptoms was 1.991(95%Cl:1.127-3.517,P=0.018)when compared with the group aged less than 75 years.Conclusions:?Constipation is not only a common symptom of PFD,but also an important risk factor for UD and POP symptoms in postmenopausal women.Chronic constipation should not be underestimated.Appropriate assessment and management may improve the quality of life of PFD patients.CDOverweight and obesity and age are important risk factors for PFD in postmenopausal women.Weight control is an important aspect of prevention and treatment of PFD.Part ? Proteomics of uterosacral ligament connective tissue from women with and without pelvic organ prolapseObjective:Damage to the uterosacral ligaments is an important contributor to uterine and vaginal prolapse.The aim of this study was to identify differentially expressed proteins in the uterosacral ligaments of women with and without pelvic organ prolapse and analyze their relationships to cellular mechanisms involved in the pathogenesis of pelvic organ prolapse.Methods:Eight patients with postmenopausal pelvic organ prolapse(POP)in Hangzhou Obstetrics and Gynecology Hospital were selected as POP group.Eight patients with benign postmenopausal gynecological diseases without POP in the same period were selected as control group.The uterosacral ligaments were taken during hysterectomy.Quantitative proteomics based on mass spectrometry(iTRAQ)showed that there were differences in the protein expression profiles of uterosacral ligaments between the two groups.underwent iTRAQ analysis followed by Ingenuity Pathway Analysis of differentially expressed proteins.Differentially expressed proteins were validated using western blot analysis.Results:?A total of 1789 unique protein sequences were identified in the uterosacral ligament connective tissues.The expression levels of 88 proteins were significantly different between prolapse and control groups(?1.2-fold,P<0.05).There were 30 up-regulated and 58 down-regulated expressions in POP group compared with control group.?Ingenuity pathway analysis demonstrated the association of 14 differentially expressed proteins with "Connective Tissue Function".Among them,fibromodulin(FMOD),Collagen alpha-1(XIV)chain(COL14A1),Calponin-1(CNN-1),Tenasein(TNC),and Galectin-1(LGALS1)appeared most likely to play a role in the etiology of pelvic organ prolapse.?The three proteins FMOD,myosin light chain 6(MYL6),macrophage migration inhibitory factor(MIF)were verified by Western blot,and the results were consistent with those of proteomics.?Differential protein network analysis revealed that the nuclear factor protein family NFkB,ERK1/2 and APP protein were in the axes.It is suggested that related pathways may play an important role in the pathogenesis of POP.Conclusions:?The decrease of FMOD,COL 14A1,TNC and LGALS1 in pelvic floor connective tissue support structure may be an important cause of POP.?Upregulation of MYL6 and MIF suggests that POP may be related to compensatory stress and chronic inflammation in pelvic floor connective tissue.?The pathway of NFkB?ERK1/2 and APP protein may play a role in the pathogenesis of POP.