妊娠肝内胆汁淤积症患者胎盘合体滋养细胞超微结构的观察与脐静脉血总胆酸水平的测定

Stereological study on syncytial cell of human placenta and determinations of total bile acid in cord blood of intrahepatic cholestasis of pregnancy

目的探讨妊娠肝内胆汁淤积症(ICP)患者是否存在胎盘合体滋养细胞超微结构损伤及胎儿胆酸水平的变化。方法选取ICP患者10例(ICP组)和正常孕妇10例(正常组),采用细胞形态学计量方法观察两组孕妇胎盘合体滋养细胞体视学参数变化;采用循环酶法检测两组孕妇分娩胎儿的脐静脉血总胆酸水平。结果(1)ICP组胎盘合体滋养细胞微绒毛的数目及数密度分别为(21±12)个/视野及(1.9±1.3)μm-3,明显少于正常组的(35±11)个/视野及(4.1±3.2)μm-3,两组比较,差异有统计学意义(P<0.05);ICP组胎盘合体滋养细胞微绒毛平均体积及表面积密度分别为(0.1200±0.0050)μm3、(2.500±0.600)μm2/μm3,明显大于正常组的(0.0500±0.0010)μm3及(1.300±0.400)μm2/μm3,两组比较,差异有统计学意义(P<0.05)。(2)ICP组胎盘合体滋养细胞线粒体的平均体积、表面积密度及体积密度分别为(0.0200±0.0020)μm3、(0.600±0.010)μm2/μm3及(0.0800±0.0090)μm3/μm3,明显大于正常组的(0.0100±0.0050)μm3、(0.500±0.030)μm2/μm3及(0.0500±0.0020)μm3/μm3,两组比较,差异有统计学意义(P<0.05)。(3)ICP组胎盘合体滋养细胞内质网的平均体积、表面积密度及体积密度分别为(0.0200±0.0010)μm3、(0.900±0.010)μm2/μm3及(0.0900±0.0050)μm3/μm3,明显大于正常组的(0.0100±0.0030)μm3、(0.500±0.030)μm2/μm3及(0.0500±0.0010)μm3/μm3,两组比较,差异有统计学意义(P<0.05)。(4)ICP组胎儿脐静脉血总胆酸水平为(8.6±3.2)μmol/L,正常组为(4.6±1.5)μmol/L,两组比较,差异有统计学意义(P<0.05)。结论ICP患者高水平的胆酸可能损伤胎盘合体滋养细胞的细胞器,影响胎盘对胆酸的运输功能。

Objective To investigate the relation of changes of fetal bile acid and morphologic ultrastructure of human placental syncytial cells in intrahepatic cholestasis of pregnancy (ICP). Methods(Total bile acid of cord venous blood was measured by cycle enzyme method between intrahepatic cholestasis of pregnancy and control groups after birth. The ultrastructure of human placental syncytial cell was analyzed by morphologic study in two groups. Results (1) The total bile acid of cord venous blood in ICP group was significantly higher than in control group[(8.6±3.2) μmol/L vs (4.6±1.5)μmol/L ](P<0.05). (2) The amount and number density of syncytial microvilli ultrastructure reduced significantly in ICP group[respectively (21±12 )e/Es,(1.9±1.3) μm^(-3)], compared with control group[respectively (35±11) e/Es, (4.1±3.2) μm^(-3)] (P<0.05).The average volume and surface area density of placental syncytial cell in ICP group [respectively (0.1200±0.0050) μm^3, (2.500±0.600) μm^2/μm^3]were statistically increased compared with that in control group[respectively (0.0500±0.0010) μm^3, (1.300±0.400) μm^2/μm^3](P<0.05). But no significant difference in the volume density of placental syncytial microvilli was observed between two groups (P>0.05). The average volume, surface area density and volume density of mitochondrion in ICP group [respectively (0.0200±0.0020) μm^3,(0.600±0.010) μm^2/μm^3,(0.0800±0.0090)μm^3/μm^3] were significantly enlarged than in control group [respectively (0.0100±0.0050)μm^3, (0.500±0.030) μm^2/μm^3,(0.0500±0.0020) μm^3/μm^3](P<0.05).The average volume, surface area density and volume density of endoplasmic reticulum in ICP group[respectively (0.0200±0.0010) μm^3, (0.900±0.010) μm^2/μm^3,(0.0900±0.0050) μm^3/μm^3] were significantly larger than in control group [respectively (0.0100±0.0030)μm^3, (0.500±0.030) μm^2/μm^3,(0.0500±0.0010) μm^3/μm^3](P<0.05). No significant difference in number density of mitochondrion and endoplasmic reticulum between two groups was found (P>0.05). Conclusion In ICP, high levels of bile acids may impair cellular organelle, resulting in abnormality of physiological function of syncytial cells, and affecting the synthesis and transportation functions of placenta.