重度子痫前期胎盘的免疫组化改变与围产儿预后的关系

Study on immunohistochemistry of placentas complicated with preeclampsia and effects upon perinatal prognosis

目的:研究重度子痫前期胎盘的免疫组织化学改变,探讨白细胞抗原CD146、CD31在胎盘组织中的表达及其与围产儿预后的关系。方法:20例重度子痫前期患者为研究组,孕周接近的无合并症的流产、早产的胎盘、孕早期流产的绒毛共20例为对照组。应用间接免疫组化法结合计算机辅助图像分析技术,分析胎盘组织白细胞抗原CD146、CD31的表达及对围产儿预后的影响。结果:对照组20例胎盘组织中间滋养层都有CD146的表达,但是没有CD31的表达。研究组20例标本中2例展示微弱的CD146着色,18例中间滋养层CD146染色为阴性,CD31在研究组标本的中间滋养层细胞上也没有表达,染色阴性,差异具有显著性。研究组围产儿死亡、HIE、新生儿窒息、SGA发生率均明显增高,脐动脉血流异常、胎心监护异常和妊娠图异常发生率明显增高,差异具有极显著性。结论:与正常妊娠比较,重度子痫前期胎盘CD146的异常表达,可能反应体内CD146的功能,为重度子痫前期的病因学提供重要线索,认为异常滋养层浸润(滋养层浸润过少过浅)是子痫前期发病的潜在因素;同时造成围产儿预后不良。

Objective： To investigate the expression of CD146 and CD31 in placentas complicated with preeclampsia and the relation to perinatal prognosis. Methods： 20 placentas complicated with preeclampsia and another 20 normal cases with premature labor were biopsied. Indirect immunocytochemistry and image semiquantity analysis technology were used to detect the expression of CD146 and CD31 in these placentas, whose relationship with the perinatal prognosis was analyzed with statistical methods. Results： In normal pregnancy CD146 CD31 staining was positive. However, in preeclampsia CD146 was almost absent in intermediate trophoblasts. The perinatal morbidity and mortality, abnormal blood flow in preeclampsia increased than those in normal pregnancy. Conclusion： The expressions of CD146 by intermediate trophoblasts in preeclampsia, not only provide important clues to understand the etiology of preeclampsia, but also provide profound understand of in vivo function of CD146 in implantation. Therefore abnormal tro.phoblast invasion is thought to be the underlying cause of preeclampsia. They result in abnormal perinatal prognosis.