妊高征患者脐血管病变的临床研究

Clinical Study on Pathologic Changes of Umbilical Cord Vessels in Pregnancy Induced Hypertension

目的探讨妊高征时脐血管的病理学特征与疾病严重程度的关系。方法利用光镜观察４５例妊高征患者（妊高征组）和３０例正常晚孕妇女（对照组）的脐带形态学特征；并随机选取２０例妊高征患者的近胎盘端、胎儿端及近中端脐带进行光镜观察。结果妊高征组不同部位脐带病理学特征基本一致；按脐带血管病变的有无及轻重程度将妊高征组分为无病变（６例）、轻度病变（１３例）及重度病变（２６例）３类；与轻度妊高征比较，中度和重度妊高征脐血管病变逐渐加重（Ｐ＜０．０５，Ｐ＜０．０１）；对照组未见明显脐血管病变。妊高征脐血管病变与尿蛋白和平均动脉压及新生儿结局有密切关系。结论脐血管病变能反映妊高征的基本病理改变，与疾病的严重程度呈平行关系；脐带形态学病变具有均一性。

Objective To evaluate the relationship between the pathologic features of umbilical cord vessels and the severity of disease in pregnancy induced hypertension (PIH). Methods The umbilical cord vessels of forty five women with PIH and thirty normal term pregnant women (control group) were observed under light microscopy; the three parts of cord i.e near placenta, near fetus and middle section of twenty women with PIH selected randomly were observed as well. Results There were no different pathologic changes in the 3 parts of umbilical cord in PIH; Forty five women with PIH were categorized into three groups according to the degree of lesions: no lesion ( n =6),mild ( n =13) and severe ( n =26). The pathologic changes of umbilical vessels in moderate and severe PIH were more severe than those in mild PIH ( P<0.05, P<0.01 ). However, there were no apparent pathologic changes in the control. The pathologic changes of umbilical vessels in PIH had significant relationship with mean arterial pressure (MAP), neonatal outcome and urinary protein. Conclusions The pathologic changes of umbilical vessels can reflect the characteristic lesion of PIH and are parallel with the severity of disease; and there is a homogeneity in pathomorphology of umbilical cord.