双胎选择性生长受限危险因素分析及胎盘血管内皮生长因子的表达

Analysis on risk factors and the expression of placental vascular endothelial growth factor in selective intrauterine growth restriction

目的 研究双胎选择性宫内生长受限（selective intrauterine growth restriction,sIUGR）胎盘血管内皮生长因子（VEGF）的表达并探讨影响妊娠结局的危险因素.方法 2010年6月至2013年6月深圳市人民医院产科分娩双胎妊娠590例,单绒毛膜双羊膜囊（monochorionic diamnotic,MCDA）双胎sIUGR 42例作为病例组,双绒毛膜双胎sIUGR 47例作为对照A组,同期分娩的无sIUGR单绒毛膜双羊膜囊双胎42例作为对照B组.分娩后收集胎盘并分别称重、检测胎盘份额、脐带插入情况.记录新生儿出生体重及围产儿结局.运用免疫组织化学法分别检测病例组和对照组胎盘组织中VEGF的表达,半定量测其表达强度.体重轻者称小胎,体重重者称大胎.结果 病例组、对照A组及对照B组围产儿死亡率分别为17.8％ （15/84）、6.4％（6/94）、1.2％（1/84）,脐带异常插入率分别为48.8％、10.6％、14.3％.病例组大、小胎胎盘重量为（521±149）g vs.（258±53）g.VEGF在病例组、对照A组大婴胎盘组织中的表达强度高于小婴（P＜0.01）.结论 单绒毛膜双羊膜囊双胎sIUGR围产儿死亡率明显升高.双胎sIUGR危险因素主要有胎盘份额分配不均衡、脐带帆状插入、胎盘血管内皮生长因子表达下降等.

Objective To evaluate the expression of placental vascular endothelial growth factor of twin pregnancies with selective intrauterine growth restriction （sIUGR） and its high risk factors.Methods There were 590 cases of twins delivered in Shenzhen People＇ s Hospital,including 42 cases of monochorionic diamnionic （MCDA） twins with sIUGR （case group） and 47 cases of dichorionic （DC） twins with sIUGR （control group A）.Other 42 cases of MCDA twins without IUGR（control group B） were randomly selected.Placental weight and cord insertion were recorded at deliveries.The expression of vascular endothelial growth factor （VEGF） in human placenta was evaluated by immunohistochemistry.Results The incidence of perinatal death in the case group was higher than that in the control group （17.8％ vs 6.4％ vs 1.2％,P ＜ 0.01）.The rate of velamentous cord insertion were 48.8％,10.6％ and 14.3％ in the case,control A and B groups,respectively （P ＜ 0.01）.The mean placental weight of the big and small twins were （521 ± 149）g vs （258 ± 53）g in the case group.As for the sIUGR cases,the expression of VEGF in the placental tissue at the big babies＇ share were much higher than those of the small ones＇.Conclusion The perinatal mortality was higher in MCDA sIUGR twins than those in DC twins or uncomplicated MC twins.The risk factors of MCDA sIUGR include unequal placental sharing,velamentous cord insertions and low expression of placenta VEGF.