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目的观察先天性尿道下裂和单纯性阴茎下曲患者阴茎皮肤组织中雄激素受体(androgen receptor,AR)的表达情况,探讨其在不同程度尿道下裂和阴茎下曲中的表达特征及规律。方法以2005年8月-2007年1月行矫正术的25例先天性尿道下裂和4例单纯性阴茎下曲患者为研究对象,采集阴茎背侧包皮、尿道口腹侧皮肤和尿道板组织。尿道下裂患者年龄1岁11个月～19岁,平均3岁7个月;阴茎下曲患者年龄3岁6个月～16岁,平均7岁1个月。以18例行包皮环切术患者的正常背、腹侧包皮作为对照。免疫组织化学染色观察并检测标本AR的表达水平和分布情况,行统计学分析。结果先天性尿道下裂、单纯性阴茎下曲和正常包皮组织中均有AR表达。正常阴茎背、腹侧包皮AR表达核阳性细胞率分别为62.94%±5.40%、62.87%±5.33%;先天性尿道下裂阴茎背侧包皮、尿道口腹侧皮肤及尿道板组织分别为59.00%±3.75%、58.46%±4.14%、52.30%±3.53%,AR表达均低于正常背、腹侧包皮(P<0.05);且尿道板组织AR表达显著低于自身背、腹侧包皮皮肤(P<0.05),自身背、腹侧包皮皮肤间差异无统计学意义(P>0.05)。与正常背、腹侧包皮比较:远、中段型尿道下裂阴茎背侧包皮AR表达差异无统计学意义(P>0.05),但尿道板组织AR表达显著降低(P<0.05);近段型背侧包皮、尿道口腹侧皮肤及尿道板组织AR表达均降低(P<0.05);下曲<45°者阴茎背侧包皮、尿道口腹侧皮肤AR表达差异无统计学意义(P>0.05),下曲≥45°者比较差异均有统计学意义(P<0.05),两组尿道板组织AR表达均降低(P<0.05)。单纯性尿道下曲患者阴茎背侧包皮、尿道口腹侧皮肤及尿道板组织AR表达核阳性细胞率分别为59.69%±2.73%、55.71%±1.67%、51.92%±1.87%,与正常包皮组织比较,AR表达呈减弱趋势。结论先天性尿道下裂及单纯性阴茎下曲阴茎皮肤组织AR表达低于正常阴茎,尿道板组织AR缺陷突出。
Objective To observe the expression of androgen receptor (AR) in the penis skin tissue of patients with congenital hypospadias and simple penile hypohygmosis and to investigate the expression characteristics and regularity of hypospadias in different degree hypospadias . Methods Twenty-five patients with congenital hypospadias and 4 patients with simple penile subatase undergoing orthopedic surgery from August 2005 to January 2007 were enrolled in this study. The penis dorsal prepuce and urethral ventral skin and urethral plate tissues were collected. Patients with hypospadias 1 year of age from 11 months to 19 years, an average of 3 years and 7 months; patients with penile curvature 3 years 6 months to 16 years, an average of 7 years 1 month. 18 cases of circumcision patients with normal dorsal and ventral foreskin as a control. Immunohistochemical staining was used to observe the expression and distribution of AR in the specimens, and the results were statistically analyzed. Results Congenital hypospadias, simple penile curvature and normal foreskin have AR expression. The positive rates of nuclear positive cells in normal penis and ventral foreskin were 62.94% ± 5.40% and 62.87% ± 5.33%, respectively. The incidence of congenital hypospadias penis dorsal prepuce, urethral ventral skin and urethral plate were 59.00% ± (P <0.05). The AR expression in urethral plate tissue was significantly lower than that in the dorsal and ventral foreskin (P <0.05) <0.05). There was no significant difference between the back and ventral prepuce skin (P> 0.05). Compared with normal dorsal and ventral foreskin, there was no significant difference in AR expression between far and middle urethra (P> 0.05), but the AR expression in urethral plate was significantly decreased (P <0.05) There was no significant difference in AR expression between dorsal prepuce, urethral ventral skin and urethral plate tissue (P <0.05) (P <0.05). The AR expression of urethral plate in both groups was decreased (P <0.05). The nuclear positive rate of AR expression in the penis dorsal prepuce, urethral ventral skin and urethral plate of patients with simple hypospadias was 59.69% ± 2.73%, 55.71% ± 1.67% and 51.92% ± 1.87% respectively, which was significantly higher than that in normal prepuce , AR expression showed a decreasing trend. Conclusions The expression of AR in congenital hypospadia and penile penile skin is lower than that in normal penis. The AR defect in urethral plate is prominent.