目的：检测Donnahoo Ⅳ型阴茎弯曲畸形阴茎皮肤及纤维性尿道组织中雄激素受体(androgen receptor，AR)的表达情况，探讨AR异常在疾病发病中的作用及临床意义。方法：以Ⅳ型阴茎弯曲患者25例作为研究对象，手术治疗纠正弯曲畸形，术中收集阴茎背、腹侧皮肤和纤维性尿道组织。以包皮过长患者18例作为正常对照，行包皮环切术收集正常阴茎背、腹侧包皮组织。组织标本经免疫组化LSAB法染色后观测AR表达规律，行统计学分析。结果：AR在正常阴茎包皮和Ⅳ型阴茎弯曲标本中有阳性表达。正常对照阴茎背、腹侧包皮AR阳性表达率为(62.94±5.40)%、(62.87±5.33)%；Ⅳ型阴茎弯曲背、腹侧皮肤和纤维性尿道AR阳性表达率为(58.63±2.66)%、(57.23±2.04)%、(53.71±2.15)%，AR表达较正常对照均显著减少(P<0.05)；Ⅳ型阴茎弯曲自身背、腹侧皮肤间相比，AR表达无统计学差异(P>0.05)，AR在纤维性尿道的表达较自身皮肤显著减少(P<0.05)。分层分析发现，轻中度弯曲背、腹侧皮肤及纤维性尿道AR阳性表达率为：(59.37±3.11)%、(58.75±3.20)%、(55.48±2.86)%，AR表达较正常对照无统计学差异(P>0.05)；重度弯曲背、腹侧皮肤及纤维性尿道AR阳性表达率为：(55.21±3.32)%、(53.69±4.09)%、(46.17±3.65)%，AR表达较正常对照均显著减少(P<0.05)；与轻中度弯曲比较，重度弯曲纤维性尿道AR表达显著减少(P<0.05)。结论：Donnahoo Ⅳ型阴茎弯曲畸形阴茎皮肤及纤维性尿道组织中AR表达显著减少，自身背、腹侧皮肤间AR表达并无差异，重度弯曲纤维性尿道AR表达减少更为明显。
The expression and clinical significance of androgen receptor in genital tissue and fibrotic urethra of patients with chordee of Donnahoo type IV
Objective: To investigate the expression characteristics and clinical significance of androgen receptor (AR) in genital tissue and fibrotic urethra of patients with chordee of Donnahoo type IV. Methods: Dorsal prepuce, ventral perimeatal skin and fibrotic urethra from 25 patients with chordee of Donnahoo type IV were harvested in surgery. Prepuce from 18 boys in circumcision was used as control. The expression intensity of AR was assessed with immunohistochemistry. Results: AR expression was positive in specimens from group of chordee of Donnahoo type IV and control. The positive ratio of the cellular nucleus of AR expression in normal dorsal, ventral prepuce were 62.94%±5.40%, 62.87%±5.33%; in dorsal prepuce, ventral perineatal skin and fibrotic urethra of chordee were 58.63%±2.66%, 57.23%±2.04%, 53.71%±2.15%. AR expression was decreased in dorsal, ventral skin and fibrotic urethra compared to normal control(P<0.05). No significant difference was detected between dorsal and ventral specimens (P>0.05), and significant decrease of AR expression was noted in fibrotic urethra when compared to that in dorsal and ventral skin (P<0.05). In mild to moderate chordee group, no significant difference was shown when dorsal prepuce, ventral skin and fibrotic urethra skin specimens were compared to that in normal control (P>0.05); In severity chordee group, AR expression diminished in dorsal prepuce, ventral skin and fibrotic urethra (P<0.05); AR expression was significant decreased in fibrotic urethra of severity chordee compared to mild to moderate chordee (P<0.05). Conclusion: AR expression was decreased in penile skin in chordee of Donnahoo type IV, especially in fibrotic urethra.