目的　观察神经性膀胱逼尿肌平滑肌细胞的凋亡现象 ,凋亡相关基因Bcl 2与bax的表达及二者之间的关系。方法　分别应用末端脱氧核糖核酸转移酶 (TUNEL)法、免疫组化方法 ,观察2 1例神经性膀胱和 12例正常膀胱逼尿肌平滑肌细胞凋亡和凋亡相关基因bcl 2和bax的表达。结果　病例组逼尿肌中bcl 2的阳性表达率和高表达率 (80 .9% ,33.3% )与正常组 (75 .0 % ,41.7% )相比无明显变化 (χ2 =1.2 ,P >0 .0 5 )。病例组逼尿肌中bax的阳性表达率和高表达率 (90 .5 % ,5 7.1% )较正常组 (6 6 .7% ,16 .7% )明显增加 (χ2 =7.6 ,P <0 .0 5 )。病例组平滑肌细胞凋亡指数为 9.4± 2 .5 /HP ,较正常对照组 4.7± 1.2 /HP明显增加 (P <0 .0 1) ,Spearman秩相关分析表明 ,凋亡指数与bcl 2的表达成负相关 (r =- 0 .6 ,P <0 .0 1) ,与bax表达成正相关 (r =0 .5 ,P <0 .0 5 )。结论　神经性膀胱逼尿肌平滑肌细胞凋亡较正常逼尿肌增加 ,Bcl 2 /bax参与凋亡的调控 ,bax表达增加 ,Bcl 2与bax之间的平衡破坏 ,是导致逼尿肌平滑肌细胞凋亡的主要因素。逼尿肌平滑肌细胞凋亡增加可能是逼尿肌功能减退的一个重要原因 Objective To observe the apoptosis of neuronal detrusor smooth muscle cells and the expression of apoptosis related genes Bcl 2 and bax and the relationship between the two. Methods TUNEL and immunohistochemistry were used to detect the apoptosis and expression of bcl - 2 and bax in 21 cases of bladder and 12 cases of normal bladder detrusor. Results The positive expression rate and high expression rate of bcl 2 in detrusor muscle of patients (80.9%, 33.3%) were not significantly different from those in normal group (χ2 = 1.2, P> 0 .0 5). The positive expression rate and high expression rate of bax in the detrusor muscle of patients in the study group (90.5%, 51.1%) were significantly higher than those in the normal group (χ2 = 7.6, P0.01 .0 5). The apoptotic index of smooth muscle cells in the case group was 9.4 ± 2.5 / HP, which was significantly higher than that in the normal control group (4.7 ± 1.2 / HP) (P <0.01). Spearman rank correlation analysis showed that apoptotic index and bcl 2 (R = - 0.6, P <0.01), which was positively correlated with bax expression (r = 0.5, P <0.05). Conclusion Bcl 2 / bax is involved in the regulation of apoptosis, the increase of bax and the imbalance of Bcl 2 and bax in detrusor smooth muscle cells of neurogenic bladder detrusor. Death of the main factors. Increased detrusor smooth muscle cell apoptosis may be an important cause of detrusor dysfunction