妊高征合并胎儿宫内发育迟缓者胎盘病理改变与血管细胞粘附分子-1表达水平的关系

Relationship between pathological changes and the expression of vascular cell adhesion molecule-1in the placenta of patients with pregnancy-induced hyperten sion complicated by intrauterine growth retardation

目的探讨妊高征(PIH)合并胎儿宫内发育迟缓(IUGR)时胎盘病理改变与胎盘组织中血管细胞粘附分子-1(VCAM-1)表达水平变化的关系.方法选取本院2001年l～9月分娩的妊高征合并IUGR患者(实验组)胎盘30例、单纯IUGR(IUGR组)28例、单纯PIH(PIH组)25例、正常妊娠(正常妊娠组)30例,常规HE染色及PAS染色,观察胎盘形态学变化.利用免疫组化方法对胎盘组织切片染色,观察子宫蜕膜层中螺旋动脉、绒毛组织滋养细胞及绒毛中毛细血管的VCAM-l表达.结果实验组中22例(73.33%)胎盘有明显病理改变,有病理改变的胎盘蜕膜组织内血管内皮细胞及胎盘绒毛毛细血管内皮VCAM-1的表达显著高于无病理改变者(P＜0.001);而绒毛上皮组织滋养层细胞vCAM-1的表达则显著低于无病理改变者(P=0.019).结论妊高征合并IUGR时胎盘发生了明显的病理改变,这种病理改变与胎盘中VCAM-1的异常表达密切相关.

Objective To study t he relationship of the pathological changes with the expression of vascular cell adhesion molecule-1(VCAM-1) in the placenta of patients with pregnancy-induced hypertension (PIH) that is complicated by intrauter-ine growth retardation (IUG R). Methods Tissue specimens of the placenta were respectively collected from 30 patients with PIH complicated by IUGR, 28 patients with IUGR, 25 patients with PIH and 30 normal women after delivery. After HE and PAS staining, the tissue sections were observed microscopically to detect morphological changes in the pl acenta. Immunohis-tochemical examination was employed to detect the expression o f the VCAM-1 in the decidual vascular endothelium, syncy-tiotrophoblast and vill ous capillary vessel of the placenta in these tissue specimens. Results Signific ant pathological changes were observed in 22 placentas of the patients with PIH complicated by IUGR, with the incidence of 73.33%. The pathological changes ex emplified by stromal fibrosis, fibrinoid necrosis and leucocyte infiltration of the villi, increase in villous syncytial nodules, decrease in villous vascular tissues, hyperplasia of cytotrophoblasts and basal lamina thickening were more prevalent in the placentas of patients with PIH complicated by IUGR than in nor mal women (P<0.05). The expression of VCAM-1 in the decidual vascular endotheli um and placental villous capillary vessels was observed to be significantly high er in the placentas with pathological changes than in those without (P<0.05), w hich was the opposite to the changes in the expression in the syn-cytiotrophobla st (P<0.05). Conclusion Significant pathological changes can be present in the p lacenta of patients with PIH complicated by IUGR, and may be intimately related to abnormal expressions of VCAM-1 in the placenta.