子宫螺旋动脉重铸障碍在复发性流产中的研究进展

Progress of Study on Dysfunction of the Uterine Spiral Arteries Reconstruction of Recurrent Spontaneous Abortion

复发性流产是一种常见的病理妊娠,其病因和发病机制至今尚未完全阐明。足够的子宫胎盘血供对于正常妊娠是至关重要的,这有赖于广泛的子宫螺旋动脉生理性重铸所形成高流量、低阻力的母胎血液循环系统。子宫螺旋动脉血流反映母胎之间的血液循环,是子宫与妊娠母体的终末分支,能提供充足的胎盘血流和养分,满足胚胎的生长发育。滋养细胞的侵袭及其介导的子宫螺旋动脉细胞的凋亡是重铸过程的两个关键环节,若重铸障碍则胎盘灌注量不足,继而胚胎缺血、缺氧,导致一系列病理妊娠。早期研究表明复发性流产患者蜕膜组织中滋养细胞侵袭减少,螺旋动脉重铸障碍,因此对复发性流产这一特征性病理改变产生的研究成为阐明病因的关键。

Recurrent spontaneous abortion is a common complications of pregnancy, which etiology and pathogenesis has not been fully elucidated. Sufficient uteroplacental blood flow is crucial for normal pregnancy, which depends on the maternalfetal blood circulation system of high flow/low resistance resulted from physiologic transformation of the spiral arteries widespread throughout the placenta. Uterine spiral artery blood flow provides plenty of placental blood flow and nutrient to meet the development of embryos. The invasion extravillous trophoblast and apoptosis of uterine spiral artery cells are two key processes in the remodeling of the uterine spiral arteries. Failure of physiologic transformation of the spiral arteries will limit maternal blood flow into the placenta and the embryo therefore develops in a low blood flow/oxygen environment, which may lead to a series of pathological pregnancies. Early research has shown that decidual tissue of patients with recurrent spontaneous abortion were lack of trophoblast invasion, and performance the failure of physiologic transformation of the spiral arteries.