特发性胎儿生长受限胎盘组织学与体视学分析

The Histological Characteristics and Stereologic Study of Idiopathic Fetal Growth Restriction

目的:评估特发性胎儿生长受限(IFGR)胎盘大体、组织学及终末绒毛体视学特征。方法:对2013年1月至2014年12月在上海交通大学医学院附属国际和平妇幼保健院足月分娩的IFGR40例(IFGR组)及正常妊娠30例(对照组)行回顾性研究,比较二组胎盘组织学及体视学参数差异。结果:与对照组比较,IFGR组大体检查胎盘最长径×最短径减小(分别为17.21 cm×19.00 cm、14.25 cm×16.10 cm)、胎盘质量明显降低(分别为595.68±22.70 g、422.00±18.42 g)(P<0.001),胎盘质量及径线与胎儿体质量间均存在线性相关(r=0.574,r=0.603,P<0.001);但两组胎盘系数无明显差异(P>0.05)。组织学评估发现IFGR组胎盘中绒毛周围大量纤维蛋白沉积、慢性绒毛膜羊膜炎、绒毛发育迟缓、合体结节增多的发生率显著增高(P<0.05)。体视学测量发现IFGR组胎盘终末绒毛在每个镜下参考面积中的总个数明显多于正常对照组,终末绒毛平均面积及血管形成系数明显减低,差异均有统计学意义(P<0.05)。结论:IFGR时胎盘形态学和体视学特征均有改变,IFGR胎盘存在绒毛发育和胎儿-胎盘血管生成异常。

Objective：To evaluate histological changes of the idiopathic fetal growth restriction（IFGR） placen- ta, and to assess the stereological parameters of terminal villi. Methods：Retrospective study was conducted on 40 placentas from IFGR patients（ IFGR group） and 30 placentas from normal pregnancy women（control group） collected from January 2013 to December 2014 in the International Peace Maternity ＆ Child Health Hospital affilia- ted to Shanghai Jiao Tong University. The histological examination on placentas and quantitative stereological as- sessment on terminal villi were performed and compared between the two groups. Results：The mean placental diameter and mean placental weight were all lower in FGR group （14.25 cm × 16. 10 cm,and 422.00 ± 18. 42 g, respectively） than those in control group （ 17.21 cm × 19.00 cm, 595.68 ± 22.70 g, respectively） （ both P 〈 0. 001 ）. Both weight and diameter of placenta were significantly correlated with fetal weight（ r=0. 574, r=0. 603, P 〈0. 001 ）. However,there was no significant difference on placentalfactor between the two groups（ P 〉 0.05）. In addition we found that the presence of massive perivillous fibrin deposition,incidence of chronic chorioamnion- itis,delayed villous maturation, increased syncytial knots were significantly more common in IFGR group than those in control group（P〈0.05）. On stereological examination,both mean areas of terminal villi and capillariza- tion index were reduced while numbers of terminal villi per unit area increased （ P 〈 0.05）. Conclusions：The re- sults from histology and stereology demonstrat that there are villous maldevelopment and abnormal fetoplacental angiogenesis in placenta from IFGR patients.