重度子痫前期胎盘滋养叶细胞凋亡与胎儿脐血流阻力指数关系的临床观察

The relationship of between apoptosis of placental trophoblast cells and umbilical artery resistant index in severe eclampsism patients

目的探讨凋亡相关蛋白Fas、Bcl-2在胎盘滋养叶细胞中的表达和意义以及滋养叶细胞凋亡与胎儿脐血流阻力指数(RI)的关系。方法用免疫组织化学法检测重度子痫前期患者共54例(实验组),同时选择同期正常晚孕女性20例作为对照组,检测入选者胎盘组织中Fas、Bcl-2蛋白的表达及滋养叶细胞凋亡,并于产前超声检测胎儿脐血流RI。结果细胞凋亡相关蛋白Bcl-2、Fas在2组胎盘织中均有表达。其中Bcl-2蛋白的表达在实验组低于对照组(P<0.05);Fas蛋白的表达在实验组明显高于对照组(P<0.05)。在2组均可观察到细胞凋亡现象,在滋养层细胞(合体细胞滋养层及细胞滋养层)、间质细胞、血管内皮细胞胞浆及细胞核内均有表达,合体细胞尤多见。实验组细胞凋亡较对照组明显增多(P<0.05)。重度子痫前期时,Bcl-2与Fas蛋白的表达呈负性相关(P<0.05);Bcl-2蛋白表达与胎盘细胞凋亡呈负性相关(P<0.05),而Fas蛋白的表达与胎盘细胞凋亡呈正性相关(P<0.05)。细胞凋亡指数(AI)与胎儿脐血流RI呈正相关(P<0.05)。结论重度子痫前期的发病原因与胎盘滋养叶细胞凋亡、Bcl-2和Fas基因异常表达以及脐血流RI相关。

Objective To investigate the significance of the expression of Fas and Bcl-2 gene in placental trophoblast cells, and the relationship between apoptosis of placental trophoblast cells and umbilical artery resistant index. Methods The expression of Fas and Bcl-2 was detected by immunohistochemical staining in 54 patients with severe preeclampsia （experiment group） and 20 normal pregnancy women （control group）. Apoptosis of placental trophoblast cells was observed by using TUNEL method and confocal laser scanning microscope as well as fluorescence-FITC labeling. Umbilical artery resistant indexes were measured by Doppler sonography in prenatal examination . Results The expression of Fas and Bcl-2 was found in severe preeclampsia. The positive expression of Bcl-2 was found in cytoplasm of syncytiotrophoblasts of placenta, while the cytotrophoblasts had weak expression of Bcl-2 in beth groups. The expression of Bcl-2 in experiment group was significantly lower than that in control group （ P 〈 0.05）. Fas was found in the cytoplasm of syncytiotrophoblasts and cytotrophoblasts. Fas in experement group was significantly higher than that of control group（ P 〈 0.05）. The correlative analysis between Fas and Bcl-2 protein in experimental group showed that there was a negative correlation between Fas and Bcl-2 in trial group （ P 〈 0.05）. The apoptosis index （AI） in experiment group was significantly higher than that of control group （ P 〈 0. 05 ）. The correlation analysis between apoptosis and Fas as well Bcl-2 in severe preeclampsia showed that Bcl-2 was correlated negatively with apoptosis （ P 〈 0.01）, and Fas was positively with apoptosis （ P 〈 0.05）. Umbilical artery resistant index was correlated positively with the index of cell apoptosis（ P 〈 0. 05）. Conclusion Placental trophoblast cells apoptosis, Bcl-2 and Fas abnormity expression and umbilical artery resistant index are closely related with the pathogenesis of severe preeclampsia.