摘要
目的:研究子痫前期胎盘床滋养细胞的浸润程度及螺旋动脉和微血管的变化情况。方法:选择子痫前期轻度,子痫前期重度及正常妊娠产妇各20例。通过HE染色及免疫组织化学方法观察胎盘床底蜕膜和子宫浅肌层中滋养细胞的浸润程度及螺旋动脉和微血管的变化。结果3组滋养细胞的浸润程度的差异主要在子宫浅肌层,子痫前期重度组明显浅于子痫前期轻度组和正常对照组(均P<0.01);滋养细胞浸润密度自>1/2底蜕膜层及肌层内,子痫前期重度组明显低于子痫前期轻度组和正常对照组(均P<0.01)。胎盘床底蜕膜、子宫浅肌层螺旋动脉平均管腔面积在子痫前期重度组明显小于子痫前期轻度组及正常对照组,组间比较均有统计学意义(均P<0.01)。螺旋动脉平均管壁厚度在子痫前期重度组明显大于子痫前期轻度组及正常对照组(均P<0.05)。螺旋动脉生理性变化及病理性变化主要发生在子宫浅肌层:螺旋动脉有生理性变化的发生率在子痫前期重度组明显低于子痫前期轻度组和正常对照组(均P<0.01);病理性变化的发生率在子痫前期重度组高于子痫前期轻度组和正常对照组(均P<0.01)。子痫前期组中螺旋动脉的生理性变化与滋养细胞浸润深度和密度呈正相关(均P<0.05);病理性变化与滋养浸润深度及密度呈负相关(均P<0.05)。其生理性变化与子痫前期病情程度呈负相关(P<0.05);病理性变化与子痫前期病情程度呈正相关(P<0.05)。胎盘床滋养细胞浸润子宫浅肌层的深度和密度与子痫前期的病情程度呈负相关(均P<0.05)。正常妊娠胎盘床子宫浅肌层有62.50%的螺旋动脉管壁中可见滋养层细胞浸润,而子痫前期重度组产妇仅见27.50%(P<0.01)。胎盘床底蜕膜及子宫浅肌层微血管密度在子痫前期重度组明显低于子痫前期轻度组和正常对照组(P<0.01)。结论:子痫前期产妇胎盘床存在滋养细胞浅浸润。子痫前期产妇胎盘床滋养细胞浸润改变及胎盘床螺旋动脉的病理形态学变化主要发生在子宫浅肌层中,且与其病情的严重程度相关。子痫前期产妇胎盘床微血管密度自底蜕膜开始减少,提示子痫前期胎盘床微血管发育受阻。
perficial myometrial segment. Group C was the most superficial in the 3 groups （ P 〈 0.01 ）. The density of trophoblasts which invaded the placenta bed in the lower half of the basal decidual segment and the myometrial segment showed us Group C was the lowest （ P 〈 0.01 ）. There was statistical difference among the 3 groups （ P 〈 0.01 ）. The average lumen area of the spiral arteries in the decidual segment and the superficial myometrial segment of the placenta bed was the smallest in Group C among the 3 groups （ P 〈 0.01 ） and there was statistical difference among the 3 groups （ P 〈 0.01 ）. The spiral arteries were the thickest in Group C with statistical difference among the 3 groups （ P 〈 0.01 ）. The physiological and pathological change of the spiral arteries was mainly in the superficial myometrial segment. The incidence rate of physiological changes in the lowest in Group C with statistical difference among the 3 groups （ P 〈 0.01 ） pathological changes There was significan spiral arteries was the The incidence rate of was the highest in Group C （ P 〈 0.01 ） and the normal group was the highest. t difference among the 3 groups （ P 〈 0.01 ）. There was positive correlation between the physiological change of the spiral arteries and the invaing degree of the trophoblasts （ P 〈 0.05 ） , there was negative correlation between the pathological change of the spiral arteries and the invasion depth as well as the invasion density of the correlation between the physiological change and the trophoblasts （ P 〈 0.05 ）. There was negative pathogenetic condition of pre-eclampsia （ P 〈 0.05 ）while there was positive correlation between the pathological change and the pathogenetic condition degree of pre-eclampsia（ P 〈 0.05 ）. There was negative correlation between the invasion depth as well as density in uterus＇ superficial myometrial segment by trophoblast and the pathogenetic condition degree of pre-eclampsia（ P 〈 0.05 ）. There was invasion trophoblast in 62.50% lumen wall of spiral arteries in uterus superficial myometrial segment of the placental bed in normal pregnancy while 27.5 % was seen in severe pre-eclampsia. Microvascular density in the decidual segment and the superficial myometrial segment of the placenta bed in Group C was the lowest among the 3 groups with statistical difference （ P 〈 0.01 ）. Conclusion The invasion depth of the trophoblasts in pre-eclampsia was more superficial than normal pregnancy. The changes of the invasion of the trophoblasts and the pathological changes of the spiral arteries in the placenta bed mainly existed in the superficial myometrial segment which was closely related to the severity of the illness. That microvascular density in the placental bed of pre-eclampsia started to decrease from the basal decidual segment shows that the microvessel development in the placenta bed is impaired in pre-eclampsia.
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2008年第2期121-129,共9页
Journal of Central South University ：Medical Science
关键词
子痫前期
胎盘床
螺旋动脉
微血管密度
滋养细胞
pre-eclampsia
placenta bed
spiral arteries
microvessel density
trophoblast
