妊娠肝内胆汁淤积症患者血硒及胎盘硒水平变化与胎盘组织学改变的关系

Changes of Selenium Concentration in Blood and Placenta in Intrahepatic Cholestasis of Pregnancy

目的 探讨妊娠妇女血硒及胎盘硒水平与妊娠肝内胆汁淤积症 (ICP)患者胎盘组织形态学改变的关系。方法 采用催化极谱法及 5 ,5 ' 二硫代双 (二硝基苯甲酸 )直接法 ,检测ICP患者 30例 (ICP组 )及正常妊娠妇女 30例 (对照组 )血硒和胎盘硒水平 ,以及全血谷胱甘肽过氧化物酶 (GSH Px)活性的变化 ;并对ICP患者及正常妊娠妇女各 10例胎盘组织进行病理学观察。结果 (1)ICP组血硒水平为 (0 .0 389± 0 .0 0 90 )mg/L ,胎盘硒水平为 (0 .3770± 0 .0 96 4)mg/Kg ,GSH Px活性为 (5 9.31±11.42 )活力单位 ;对照组血硒水平为 (0 .0 477± 0 .0 0 94)mg/L ,胎盘硒水平为 (0 .45 5 4± 0 .0 6 2 6 )mg/kg,GSH Px活性为 (6 8.48± 10 .47)活力单位 ;两组比较 ,差异均有极显著性 (P <0 .0 0 2 )。 (2 )血硒水平与GSH Px活性在ICP组 (r=0 .0 5 498)和对照组 (r=0 .0 6 2 34 )均呈正相关 (P <0 .0 0 1) ;ICP组血硒与胎盘硒水平呈正相关 (r=0 .6 473,P <0 .0 0 1) ,对照组血硒与胎盘硒水平无明显相关。 (3)ICP组胎盘组织病理观察可见绒毛水肿 ,纤维素坏死 ,合体细胞结节增多 ,血管合体膜增厚 ,绒毛间隙狭窄 ;对照组未见明显上述病理改变。结论 硒是GSH Px的活性成分 ,ICP患者胎盘硒水平降低 ,可导致胎盘GSH Px活性下?

Objective To explore the effect of deficiency of blood selenium and placental selenium on the damage of histomorphology of the placentas in ICP. Methods We measured the selenium concentration by a catalytic polorographic method in blood and placenta and glutathione peroxidase (GSH Px) activity by a 5,5’ dithionbis (2 nitrobenzoic acid) direct method in blood in 30 women with ICP (ICP group) and 30 normal pregnant women (control group). Furthermore, the features of the placentas (10 from control group and 10 from ICP group) pathologic changes were observed microscopically. Results (1) The selenium concentrations in blood (0.038 9±0.009 0)mg/L and placenta (0.377 0±0.096 4) mg/kg and the activity of GSH Px (59.31±11.42)U in ICP group were found to be significantly lower than those in blood (0.047 7±0.009 4) mg/L and placenta (0.455 4±0.062 6) mg/kg and the activity of GSH Px (68.48±10.47)U in control group, respectively ( P <0.002). (2) The activity of GSH Px had a significant positive correlation with selenium concentration in blood in ICP group ( r =0.054 98, P <0.001) and in control group ( r =0.062 34, P <0.001). There was a positive correlation between blood and placental selenium concentrations in ICP group ( r =0.647 3, P <0.001). On the other hand, there was not correlation in women with normal pregnancies. (3) Placentas obtained from women with ICP had swelling and fibrinoid necrosis of villi, increasing number of syncytial sprouts, thickening of vasculo syncytial membrane (VSM) and decreasing size of the intervillous space under light microscopy. Placentas from control group did not show the pathologic changes as mentioned above. Conclusions As selenium constitutes the active part of GSH Px, these results suggest that the placental selenium deficiency may lead to reduced placental GSH-Px activity and the antioxidative defence may have been defective which may be associated with the damage of histomorphology of the placentas in ICP.