解脲支原体感染时早孕蜕膜组织的病理变化

The pathological changes of deciduas infected by ureaplasma urealyticum in early pregnant women

目的:探讨解脲支原体感染对早孕蜕膜组织的影响。方法:采用培养法检测40例自然流产患者(实验组)及40例要求人工流产的健康妇女(对照组)宫颈分泌物的UU感染率,并将手术刮取的蜕膜组织立即送病理检查。随机选取实验组8例患者的蜕膜组织在电镜下进行细胞超微结构观察。结果:①实验组宫颈分泌物UU阳性率为52.5%(21/40),对照组为20%(8/40),两组间差异有统计学意义(P<0.01)。②实验组蜕膜组织病理诊断宫内感染率为47.5%(19/40),对照组为7.5%(3/40),两组间差异有统计学意义(P<0.01)。③实验组宫颈分泌物UU阳性者宫内感染率为76.2%(16/21);宫颈分泌物UU阴性者为15.8%(3/19),两组间差异有统计学意义(P<0.05)。④病理检查发现,蜕膜UU感染者,可见蜕膜水肿,细胞之间出现裂隙,间质弥散性淋巴细胞浸润。⑤电镜下可见,在合体滋养层细胞周围、胶原纤维之间以及绒毛膜细胞滋养层细胞膜上均可见大量UU颗粒,滋养层细胞浆呈空泡样变性,细胞内线粒体肿胀、内质网囊性扩张,染色质周边聚集,细胞肿胀坏死。结论:定植在女性下生殖道的UU可引起逆行感染,损伤早孕蜕膜组织,影响其正常功能而导致自然流产。

Objective： To explore the effect of ureaplasma urealyticum （UU） infection on deciduas in early pregnant women. Methods： The infection rates of cervical secretion from 40 women of spontaneous abortion （ experimental group） and 40 healthy women （ control group） demanding pregnancy termination were detected by cultivating method, and the pathological examination of the deciduas was carried out immediately. The deciduas tissues of 8 patients from experimental group were observed under electron microscope. Results： （1）The positive rates of UU infection in experimental group and control group were 52. 5% and 20%, respectively, there was significant difference between two groups （P 〈 0. 01 ） . （2）The intrauterine infection rates of decidnas tissues in experimental group and control group were 47.5% and 7.5% , respectively, there was significant difference between two groups （ P 〈 0. 01 ） . （3）The intrauterine infection rates of cervical secretion in experimental group and control group were 76. 2% and 15. 8%, respectively, there was significant difference between two groups （P 〈 0. 05 ） . （4）Pathological examination found that deciduas tissues infected by UU became edema, there were fissures among ceils in stroma, infiltrative lymphocytes distribute dispersed. （5）Electron microscope found that there had large numbers of UU granule around syncytiotrophoblast cells, among collagen fiber and on the cell membrane of chorion cytotrophoblast. Trophoblast cytoplasm presented vacuole - like denaturation. Intracellular mitochondrias became swell, endoplasmic reticulum saccular dilatation, chromatin congregated in periphery, cellular swelling and necrosis. Conclusion ： UU locating in genital tract of women can cause intrauterine infection, damage deciduas tissue, finally lead to spontaneous abortion.