早产胎盘病理改变与早产儿并发症的分析

The relationship between preterm placental pathology and the outcome of preterm neonates

目的分析早产儿胎盘病理改变特点,探讨胎盘病理与早产及早产儿结局的关系。方法选择2008年5月至2010年5月我院产科分娩的单胎早产儿及其胎盘为早产组,同期分娩的单胎足月儿及其胎盘为足月组,检测所有新生儿胎盘组织病理学改变,早产儿脐血C反应蛋白(CRP)、相关细胞因子白细胞介素-8(IL-8)、肿瘤坏死因子(TNF),以及神经元特异性烯醇酶(NSE),记录早产儿并发症情况。结果与足月儿胎盘(42例)比较,早产儿胎盘(109例)形状不规则发生率高(17.4%比9.5%),但差异无统计学意义(P=0.226),胎盘子面血管分支计数少[(4.4±0.7)支比(5.4±0.7)支],差异有统计学意义(P<0.05)。胎盘组织病理学显示早产儿胎盘感染性病变发生率高(77.1%比40.5%,P<0.05)。早产并胎盘感染性病变时,脐血细胞因子IL-8、TNF及NSE增高,颅内出血发生率高于非感染组(P均<0.05)。结论早产胎盘形状不规则多见,血管数目少,感染性病变发生率高;早产胎盘感染性病变发生率高及脐血感染相关因子水平增高均提示感染可能是早产的原因之一,且与早产儿高患病率相关。

Objective To analyze the main pathological features of the preterm placenta, and to study the relationship between the placenta pathology and the outcome of preterm neonates. Methods A total of 109 singleton-pregnancy delivered preterm neonates were studied, comparing with 42 full term neonates. The placental pathology of each neonate were examined, the C-reactive protein and related cytokines （IL-8 , TNF, NSE） in the cord blood of preterm neonates were tested , and the complications of the preterm infants were recorded. Results The occurrence of irregular- shaped placenta in the preterm neonates was higher than the term neonates （ 17. 4% vs. 9. 5%, P =0. 226） ; The number of placental feto-surface blood vessel branches in the preterm neonates was significantly lower than the term neonates [ （4. 4 ±0. 7） vs. （5.4 ±0. 7）, P 〈 0. 05 ]. The occurrence of infection of placental pathology in the preterm infants was significantly higher than the term neonates （77. 1% vs. 40. 5%, P 〈0. 05）. Comparing with placenta without infection, IL-8, TNF and NSE in cord blood were significantly increased in the infected placenta of preterm neonates, P 〈 0. 05 ; The incidence of cerebral hemorrhage in preterm neonates with infection was higher than non-infected group, P 〈 0. 05. Conclusions In preterm neonates the irregular shape of placenta was common, and the placenta tended to have fewer angiogenesis and higher infection risk. The infection of placenta and the cytokines in cord blood indicated that infection was one of the reasons causing preterm birth and associated with the higher prevalence of eomorbidities among preterm neonates.