目的:分析宫缩乏力性产后出血产妇离体子宫平滑肌自发性收缩功能和收缩潜能的变化,并探讨子宫平滑肌组织中丝裂原激活蛋白激酶(MAPK)信号转导通路活化水平和连接蛋白( CX43)表达变化与宫缩乏力性产后出血的关系.方法:选择2009年11月至2010年12月在福建省妇幼保健院产科择期剖宫产分娩的宫缩乏力性产后出血产妇30例为病例组,另选同期无产后出血产妇30例为对照组.采用等长张力测定方法检测产妇离体子宫下段平滑肌收缩功能和缩宫素诱导的收缩潜能；采用蛋白免疫印迹技术检测产妇子宫下段平滑肌组织中MAPK信号转导通路中的细胞外信号调节激酶( ERK1/2)、c-Jun N端蛋白激酶(JNK1/2)、p38磷酸化蛋白和CX43蛋白水平；采用RT-PCR技术检测产妇子宫下段平滑肌组织中CX43 mRNA表达.结果:①病例组离体子宫平滑肌自发性收缩的收缩频率、收缩活动力均低于对照组(P＜0.05)；缩宫素诱导后病例组的离体子宫平滑肌收缩频率、收缩幅度、收缩活动力和收缩潜能均低于对照组(P ＜0.05,P＜0.01).②以子宫平滑肌自发性收缩活动力72.66g·次/h作为诊断点,评估宫缩乏力性产后出血的ROC曲线下面积(AUC)为0.802.③病例组产妇子宫平滑肌组织中p-ERK1/2、p-JNK1/2、p-P38、CX43蛋白的表达量和CX43 mRNA的表达水平均分别低于对照组(P＜0.05).④两组产妇子宫平滑肌组织中p-ERK1/2、p-JNK1/2、p-P38、CX43蛋白表达量以及CX43 mRNA表达水平分别与其离体子宫的自发性收缩活动力呈正相关关系(P＜0.05).⑤两组产妇子宫平滑肌组织中p-ERK1/2、p-JNK1/2、p-P38、CX43蛋白和CX43 mRNA表达量相互两两之间均呈正相关关系(P＜0.05).结论:宫缩乏力性产后出血产妇离体子宫平滑肌收缩功能和收缩潜能明显降低,其子宫平滑肌组织中MAPK信号通路活化水平及CX43表达水平明显降低,且两者密切相关,提示MAPK信号通路活化受阻和CX43表达降低可能是宫缩乏力性产后出血发病的重要因素之一,两者相互调控共同参与该病的发生发展.%Objective:To investigate the contractility and contract potentiality of myometrium from parturient women with postpartum hemorrhage by uterine atony,and to determine the expression and significance of mitogen-activated protein kinase (MAPK) pathway and CX43 in the pathogenesis of postpartum hemorrhage ( PPH). Methods:30 parturient with PPH, who presented to Fujian Maternity and Child Health Hospital for regular prenatal care and parturition from November 2009 to December 2010, were selected as the study group. 30 health parturient at the same period were chosen as control. Isometric tension recording was used to detect the contractility and its potentiality induced by oxytocin. The levels of CX43, phosphorylation of ERKi/2,JNK1/2 and p38MAPK in myometrium of study group and control were determined by western blotting: The mRNA of CX43 was detected by Real-time fluorescent quantitative reverse transcription PCR. Results : (1)The spontaneous contractility and frequency of myometriums in the study group were significanctly lower than those of control(P＜0.05). The frequency,range ,contractility and potentiality of the constriction induced by oxytocin in study group were lower than those of control( P＜0.05, P＜0.01). (2) When contractility of 72.66 g · times per hour was chosen as diagnostic point of postpartum hemorrhage by uterine atony , the area under curve of ROC was 0.802. (3)In the study group,the expressions of p-ERK1/2,p-JNK1/2, p-P38,CX43mRNA and their protein levels in myometrium were significantly lower than those of control (P＜ 0.05). (4)There were positive correlations between the expressions of p-ERK1/2, p-JNK1/2, p-P38, CX43mRNA and the protein levels in myometrium and the contraction activity in both groups(P＜0.05). (5) The CX43mRNA levels and its protein quantum were siginificantly correlated with the expression of p-ERK1/ 2,p-JNK1/2 and p-P38 in uterine smooth muscle in both groups( P＜0. 05). Conclusions:The contractility and contract potentiality of myometrium in PPH women were much lower than those of control. The expressions of MAPKs and CX43 in myometrium of PPH women were also much lower than those of control,and they are closely correlated. So the interruption of MAPK signal pathway and the decreased exprssion of CX43 in myometrium may be involved in the pathogenesis and development of PPH.
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