乙型肝炎病毒感染孕妇胎盘绒毛病理形态研究

Morphologic Change of Villus and Analysis of Fetal Distress in Pregnancy with Hepatitis B Virus Infection

通过分析妊娠合并乙型肝炎病毒 (HBV)感染孕妇的胎盘绒毛及血管的病理变化 ,探讨其与胎儿预后的关系。 1 )对 2 0例妊娠期HBV表面抗原 (HBsAg)、HBVe抗原 (HBeAg)、HBV核心抗体 (HBcAb)和HBVDNA均阳性、肝功能正常的孕妇及其新生儿 (研究组 ) ,1 8例无肝炎病毒感染、肝功能正常的孕妇及新生儿 (对照组 ) ,取胎盘进行病理检查 ,并利用图像分析仪对胎盘绒毛横截面总面积和总周长 ,单个绒毛的横截面面积、周长和等圆直径 ,单个绒毛内血管数目及血管占绒毛的面积比值进行形态定量分析。 2 )计算 2组胎儿宫内窘迫的发生率。发现 :1 )研究组胎盘绒毛横截面总面积与对照组相比 ,无显著差异 ,绒毛总周长明显小于对照组 (P <0 .0 5 )。 2 )研究组胎盘单个绒毛横截面面积、周长和等圆直径均明显大于对照组 (P <0 .0 5 )。 3 )研究组胎盘单个绒毛内血管数目明显多于对照组 (P <0 .0 5 ) ,血管占绒毛的面积比值明显小于对照组 (P <0 .0 5 )。 4)研究组胎儿宫内窘迫发生率为 5 5 .0 % ,对照组为1 1 .1 %。结果提示 :妊娠合并HBV感染 ,可引起胎盘绒毛膜血管病 。

The aim was to investigate the prognosis of fetal distress in pregnant women with hepatitis B virus(HBV) infection through analyzing the morphologic change of villus and blood vessel. ① Twenty pregnant women and their newborns were selected. The HBV surface antigen(HBsAg), e antigen(HBeAg), core antibody(HBcAb) and deoxyribonucleic acid(HBV DNA) were positive and the hepatic function normal. Eighteen pregnant women without HBV infection, normal hepatic function and their newborns were collected as control. Morphologic change of villus and blood vessel were observed.The total transverse areas and circumference of villus; the transverse area, circumference, diameter of single villus; the number of vessel in single villus and the area odds of vessel and villus were analyzed through image analysis machine. ② The incidence ratio of fetal distress in uterus was calculated. The results were: ① Comparing the investigate and the control, the total transverse areas was of insignificant difference. The total circumference was smaller than the control(P<0.05). ②The transverse area, circumference and diameter of single villus of the investigate was larger than the control(P<0.05). ③ The number of vessel in single villus of the investigate was more than the control. The area ratio of vessel to villus was smaller than the control(P<0.05). ④ The incidence ratio of fetal distress in the investigate was 55.0%, the control was 11.1%. It suggests that the chorangiosis of placenta is caused in pregnant women by hepatitis B virus(HBV) infection, which is the main reason of fetal distress in uterus.