抗心磷脂抗体阳性产妇胎盘的病理观察

Immuno Pathomorphological Study of Placenta with Anticardiophospholipid Antibody Positive

目的探讨抗心磷脂抗体（ａｎｔｉｃａｒｄｉｏｌｉｐｉｎａｎｔｉｂｏｄｙ，ＡＣＡ）阳性产妇与不良妊娠的关系。方法选ＡＣＡ阳性产妇胎盘１６例（不良妊娠及正常妊娠结果各８例）为研究组。ＡＣＡ阴性产妇胎盘８例为对照组。用免疫荧光法标记。结果免疫荧光显示研究组胎盘的滋养细胞胞浆和绒毛血管壁出现免疫复合物沉积。ＩｇＡ表现为线条状，ＩｇＧ、ＩｇＭ、Ｃ３和Ｃ４表现为线条状，颗粒状和块状。对照组免疫球蛋白均呈阴性反应，Ｃ４呈小灶性阳性反应。同期分娩的ＩＵＧＲ病例中，ＡＣＡ阳性发生率为１９．３０％（２２／１１４）；ＡＣＡ阳性产妇中ＩＵＧＲ发生率为１５．２８％（２２／１４４）。ＩＵＧＲ合并重度妊高征３例，早产２例。５例新生儿血清ＡＣＡＩｇＧ阳性。结论ＡＣＡ阳性产妇的不良妊娠后果与自身免疫系统功能异常有关。胎盘部位的免疫性损伤可影响胎盘功能。

Objective To investigate the relationship between the anticardiophospholipid antibody (ACA) positive cases and the poor pregnancy outcomes by observing the immuno pathomorphology of the placenta. Methods 16 cases of ACA positive placenta (8 normal and 8 poor pregnancy outcomes) were collected as the studied group, and 8 cases of ACA negative placentas served as the controlled group, and immunofluorescence technique (IFT) was used. Results In the studied group, the deposits of immuno complex were found in the cytoplasm of trophoblast and on the walls of villous blood vessels. IgA manifested as filiform, and IgG, IgM, C 3 and C 4 appeared as filiform, granular and tubercular as well. In contrast, all the immuno globulins displayed negative reaction in the controlled group, and C 4 demonstrated some small focal positive reaction. The frequency of ACA positive in IUGR cases were 19.30% (22/144), and of the IUGR in all the ACA positive pregnant women was 15.28%(22/144). There were 3 cases of IUGR complicated by severe pregnancy induced hypertension, 2 cases of prematurity and 5 newborns with serum ACA IgG positive. Conclusion The poor pregnancy outcome in ACA positive women is related to the dysfunction of autoimmuno system, and ACA positive may be one of the causes of IUGR. The immuno injury occurred in the placenta may affect the normal function of placenta. Maternal antibody may be transmitted to the fetus, and its significance needs further study.