妊娠期糖尿病胎盘微绒毛形态计量学改变与围产儿并发症关系的探讨

Study on the correlation between morphometric change of GDM placental microvillous and the pregnant outcome

目的:探讨妊娠期糖尿病胎盘绒毛变化与围产儿并发症的关系。方法:选择足月妊娠期糖尿病38例的胎盘为观察组,选择正常足月妊娠30例的胎盘为对照组,分娩时在胎盘母面取材,制成快速脱水、表面喷金镀膜标本,在扫描电镜下用VIDAS型图像分析仪对胎盘微绒毛进行组织形态计量学测定。称取胎盘重量、计算胎盘系数(胎盘重量与新生儿出生体重比值),记录新生儿Apgar评分、体重、脐血胆红素及新生儿出生后30min内血糖值。结果:糖尿病孕妇的胎盘合体滋养层细胞微绒毛面积、周长、长轴、短轴小于对照组,差异均有统计学意义(P<0.05);异形指数大于对照组,差异有统计学意义(P<0.05)。扫描电镜下观察组胎盘组织超微结构病理变化明显,表现为胎盘绒毛成熟不良、水肿,合体滋养层表面微绒毛排列紊乱,直径大小不一,局部缺损,呈葡萄状。观察组胎盘重量明显高于对照组,两组差异显著(P<0.05)。胎盘系数两组间差异非常显著(P<0,01);两组新生儿窒息、出生30min内血糖值、血胆红素均有显著差异(P<0.01)。结论:妊娠期糖尿病胎盘病理变化进一步加重了胎儿缺氧,增加了新生儿窒息率,导致新生儿发生更多的并发症。

Objective： To explore the correlation between the pathological changes of the placental structure with GDM and the pregnant outcome. Methods：Thirty eight pregnant women with GDM were studied as the observed group, and 30 normal cases in the same pregnant stage as the control group. All the samples were gotten from the maternal surface of the placentas after the labor immediately. All the specimens were dehydrated, ionplated with gold and measured for morphometric parameters with VIDAS image analysis system by scanning electron microscope（SEM）. Weighed the placentas, counted the placental index（ the ratio of the placenta weight to the fetal weight） ,and recorded the fatal Apgar counting, fatal weight, blood TBIL, IBIL and the blood glucose level in the 30 minutes period after the labors. Results：The obvious pathologic changes were observed under the scanning electron microscopy in the morphological ultrastructures of the observed group placentas. Placentas from diabetic pregnant women showed immaturity and edema of the villi, and the microvilli of syncytiotrophoblast were irregularly in line and were distinctly differentiated in diameter, with local damages and grape-like in shape. There was statistically difference in total microvilli amount, values of area, perimeter, major axis,minor axis, between the placental microvillous of the observed group GDM and the control group （P 〈 0. 05 ） and difference in value of abnormity exponent between the placental microvillous of observed group and control group （P 〈 0.05）. The placentas of the observed group were heavier than that of the control group（P 〈 0.05）. Obvious differences（P 〈 0.01 ） were observed between the placenta index of two groups;and the same obvious（P 〈 0.01 ） in the newborn apnea, the blood glucose level in the 30 minutes after the labor and blood TBIL, IBIL. Conclusion：The pathological changes in the placentas with GDM will contribute to the fetal hypoxia and the newborn apnea,and lead to more newborn complications.