妊娠期糖尿病胎盘组织TLR4的表达与妊娠结局的关系

Relationship between TLR4 expression and pregnancy outcome in gestational diabetes placenta tissue

目的:探讨Toll样受体4(Toll-like receptor 4,TLR4)在妊娠期糖尿病(gestational diabetes mellitus,GDM)胎盘组织中的表达及其与胎盘组织形态学异常和妊娠结局的关系。方法:选择南通大学附属如皋医院2018年6月至2019年6月收治的34例妊娠期糖尿病患者(GDM组),选取同期40例正常孕妇为对照组,采用HE染色法检测胎盘病理形态学,反转录聚合酶链反应(RT-PCR)技术和免疫组织化学检测TLR4在胎盘中的表达情况,并比较两组差别与妊娠结局关系。采用Pearson单因素相关分析研究胎盘病理形态的改变与胎盘组织TLR4表达相关性。结果:GDM组出现胎儿生长受限、胎儿宫内窘迫比率均明显高于对照组。GDM组患者绒毛成熟不良、干绒毛小动脉增厚和胎盘绒毛间质毛细血管充盈的发生比例与对照组比较差异有统计学意义(均P<0.05)。GDM组胎盘TLR4 mRNA表达水平明显增加,差异有统计学意义(P<0.05)。GDM组胎盘母体面及胎儿面TLR4蛋白的表达率均显著高于对照组,差异有统计学意义(P<0.05)。胎盘组织TLR4的表达与胎盘绒毛成熟不良、干绒毛小动脉增厚及毛细血管充盈呈正相关(均P<0.05)。结论:GDM患者胎盘组织中TLR4高表达,且可能与胎盘组织病理形态学的异常相关,对妊娠结局产生不良影响。

Objective:To investigate the expression of Toll-like receptor 4(TLR4)in placental tissues of pregnant women with gestational diabetes mellitus(GDM)and its relationship with placental histomorphological abnormalities and pregnancy outcomes.Methods:A total of 34 patients with gestational diabetes mellitus admitted to Rugao Hospital Affiliated to Nantong University were selected as a GDM group.A total of 40 normal pregnant women were selected as a control group during the same period.Hematoxylin eosin(HE)staining was used to detect the placental pathomorphology,and reverse transcription polymerase chain reaction(RT-PCR)and immunohistochemistry was used to detect the expression of TLR4 in the placenta,and the relationship between the differences of each group and pregnancy outcomes was compared.Pearson single factor correlation analysis was used to analyze the correlation between TLR4 protein expression in placental tissues and placental pathological changes(P<0.05).Results:The incidences of fetal growth restriction and fetal distress in the GDM group were significantly higher than those in the control group.The incidences of poor villus maturation,arteriolar thickening of dry villi and capillary filling of placental villi in the GDM group were significantly higher than those in the control group.The level of mRNA expression in placenta TLR4 protein in the GDM group increased significantly,with a statistically significant difference(P<0.05)and the expression rate of TLR4 protein on maternal and fetal surfaces of the placenta in the GDM group was significantly higher than that in the control group(P<0.05).The expression of TLR4 protein was positively correlated with poor placental villus maturation,arteriolar thickening of dry villi,and capillary filling(P<0.05).Conclusion:The high expression of TLR4 protein in the placenta of GDM patients may related to the abnormality of placental histopathology and have adverse effects on pregnancy outcome.