低分子肝素治疗胎儿宫内生长受限效果及对胎盘电镜结构与FPR2表达的影响

Low molecular weight heparin in the treatment of fetal intrauterine growth restriction and its influence on the structure of placenta electron microscope and FPR2 expression

目的探讨低分子肝素治疗胎儿宫内生长受限(FGR)的效果以及对胎盘电镜结构与甲酸基肽受体2(FPR2)表达的影响。方法回顾性分析2017年11月至2019年1月在妇产科进行治疗的98例FGR患者的临床资料,根据治疗方法分为研究组(n=50)、常规组(n=32)和对照组(n=16),3组均给予加强营养支持、注意补充微量元素、左侧卧位卧床休息,在此基础上,研究组给予低分子肝素治疗,常规组给予常规治疗,对照组无特殊治疗。比较3组临床治疗效果,采用免疫组织化学SP法检测并比较各组胎盘组织中FPR2表达水平,同时采用透射电镜观察胎盘超微结构。结果FGR的临床治疗总有效率研究组(90.00%)高于对照组(56.25%)(P<0.017)。透射电镜观察显示,研究组胎盘中的合体滋养细胞表面含有大量的整齐微绒毛,呈指状,其中胞质内具有丰富的粗面内质网和线粒体,核染色质致密且分布均匀,绒毛间质内胶原纤维较少,毛细血管较扩张。FGR胎盘的滋养细胞、绒毛间质细胞以及内皮细胞中的FPR2蛋白表达水平与着色强度呈研究组>常规组>对照组(P<0.01)。结论低分子肝素治疗FGR的临床效果明显,且能够有效改善胎盘组织的超微结构,提高胎盘中FPR2蛋白的表达水平。

Objective To investigate the effect of low molecular weight heparin(LMWH)in the treatment of fetal intrauterine growth restriction(FGR)and its influence on the structure of placenta electron microscope and the expression of formate peptide receptor 2(FPR2).Methods The clinical data of 98 patients with FGR who were treated in obstetrics and gynecology from November 2017 to January 2019 were analyzed retrospectively.The patients were divided into research group(n=50),routine group(n=32)and control group(n=16)according to the treatment method.The research group was given LMWH treatment,the conventional group was given conventional treatment,and the control group was given no special treatment.The clinical treatment effects of the three groups were compared,and the immunohistochemical SP method was used to detect the expression levels of FPR2 in the placental tissue of each group,and the ultrastructure of the placenta was observed by transmission electron microscopy.Results The total effective rate of clinical treatment of FGR in research group(90.00%)was higher than that in control group(56.25%)(P<0.017).Transmission electron microscopy showed that the surface of syncytiotrophoblasts in the placenta of research group contained a large number of neat microvilli,which were finger-like.The cytoplasm was rich in rough endoplasmic reticulum and mitochondria.The nuclear chromatin was dense and evenly distributed.There were fewer collagen fibers and dilated capillaries.The expression level and staining intensity of FPR2 protein in trophoblast cells,villous interstitial cells and endothelial cells of FGR placenta were as follows:research group>conventional group>control group(P<0.01).Conclusion The clinical effect of LMWH on FGR is obvious,and at the same time,it can effectively improve the ultrastructure of placental tissue and increase the expression level of FPR2 protein in placenta.