妊娠肝内胆汁淤积症胎盘雌激素受体及血管舒缩因子的变化

The changes and significance of the estrogen receptors on placenta and the levels of serum free estriol,blood vessel endothelium factor in intrahepatic cholestasis of pregnancy.

目的 :探讨妊娠肝内胆汁淤积症 (ICP)患者血清中一氧化氮 (NO)、内皮素(ET)、游离雌三醇 (E3 )水平的变化和胎盘雌激素受体 (ER)表达强度在ICP病理生理改变中的作用。方法 :以ICP组 30例为研究组 ,手术前 30min取外周静脉血测定NO、ET及游离E3 的含量 ,以年龄相近同期手术的 30例正常孕妇作为对照组 ,产后从研究组和对照组中随机抽取 2 0例的胎盘中央组织块用免疫组化法检测ER的表达强度。结果 :ICP组的血清ET水平明显高于对照组 (P <0 .0 5 ) ,NO水平与对照组差异无显著性 (P >0 .0 5 )。ICP组血清游离E3 水平显著高于对照组 (P <0 .0 1) ,胎盘ER阳性表达百分比显著高于对照组 (P <0 .0 5 ) ,血清中E3 水平与胎盘组织中ER水平间呈正相关 (r′s=0 .5 98,P <0 .0 1)。结论 :雌激素水平升高及胎盘中ER表达增强和ET水平的升高可能与ICP的发生、发展有关。

Objectives:To study the changes and roles of nitric oxide (NO),endothelin (ET),free estriol (E 3) and expression intensity of estrogen receptors (ER) on placenta in the pathogenesis of patients with intrahepatic cholestasis of pregnancy (ICP).Methods:Thirty women with ICP and thirty normal pregnant women were enrolled in the study.The levels of NO,ET and free E 3 were measured in sera of peripheral blood which drawn within half an hour before cesarean section.Randomly selected 20 cases of ICP group and control group respectively and measured the expression intensity of ER on placenta tissue used immunohistochemical method.Results: The levels of ET in ICP group were higher than those of in control group (P<0.05),but the levels of NO were not significantly different between them (P>0.05).The levels of free E 3 were significantly increased in ICP group (P<0.01) and the positive rate of ER on placenta tissue was increased significantly in ICP group (P<0.05).There were positive correlation between serum free E 3 and expression of ER on placenta (r′ s=0.598,P<0.01). Conclusion:High level of E 3 and the intensive expression of ER on placenta and the increase of ET synthesis may play important roles in the etiology of ICP.