Moalli P A, Talarico L C, Sung V W, Klingensmith W L, Shand S H, Meyn L A, Watkins S C
Magee-Womens Research Institute and Department of Obstetrics and Gynecology at Magee Womens Hospital, Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA, USA.
Am J Obstet Gynecol. 2004 Mar;190(3):620-7. doi: 10.1016/j.ajog.2003.08.040.
The arcus tendineous fasciae pelvis (ATFP) provides support to the anterior vagina. The objective of this study was to determine the impact of menopause on the structural components of the ATFP.
Biopsy specimens of the ATFP were obtained from 10 premenopausal, 5 postmenopausal, and 12 postmenopausal women on hormone therapy. Scanning confocal microscopy of fluorescent micrographs was used to define the amount of collagen subtypes, smooth muscle, and elastin. Collagen fiber orientation was determined by scanning electron microscopy.
The ATFP is comprised primarily of parallel bundles of type III collagen fibers (84%), an intermediate amount of elastin (13%), and very little smooth muscle. The ratio of collagen I/(III+V) was decreased in postmenopausal not on hormones relative to premenopausal women (P=.04) due to a 75% decrease in collagen I (P=.046). The decrease in collagen I and change in collagen ratios was not present in women on hormone therapy. Comparison of the amounts of elastin and smooth muscle showed no difference in the ATFP of premenopausal and postmenopausal women.
Menopause in the absence of hormone therapy is associated with a decrease in quantity of collagen I in the ATFP resulting in a decrease in the ratio of collagen I/(III+V). This may compromise the tensile strength and an increase susceptibility to anterior vaginal wall prolapse.
盆筋膜腱弓（ATFP）为阴道前壁提供支撑。本研究的目的是确定绝经对ATFP结构成分的影响。
从10名绝经前、5名绝经后以及12名接受激素治疗的绝经后女性获取ATFP活检标本。利用荧光显微镜扫描共聚焦显微镜来确定胶原亚型、平滑肌和弹性蛋白的含量。通过扫描电子显微镜确定胶原纤维的方向。
ATFP主要由平行排列的III型胶原纤维束（84%）、中等量的弹性蛋白（13%）和极少的平滑肌组成。与绝经前女性相比，未接受激素治疗的绝经后女性中I型胶原/（III + V型胶原）的比例降低（P = 0.04），这是由于I型胶原减少了75%（P = 0.046）。接受激素治疗的女性中未出现I型胶原减少及胶原比例的变化。弹性蛋白和平滑肌含量的比较显示，绝经前和绝经后女性的ATFP无差异。
未接受激素治疗的绝经与ATFP中I型胶原量减少有关，导致I型胶原/（III + V型胶原）比例降低。这可能会损害抗张强度，并增加阴道前壁脱垂的易感性。
