妊娠高血压胎盘病理检查及VEGF、GATA-3异常表达的变化及其临床意义

Pathological examination of placenta and abnormal expression of VEGF and GATA-3 in gestational hypertension and its clinical significance

目的探讨妊娠高血压妇女胎盘组织的病理学改变特征、组织中血管内皮生长因子(VEGF)、GATA蛋白3(GATA-3)表达异常及其临床意义。方法回顾性选取在淮北市妇幼保健院接受产前检查且分娩的妊娠高血压孕妇100例(病例组)、选取同期正常妊娠分娩的孕妇100例作为对照组。病例组根据病情分为:妊娠期高血压22例,子痫前期轻度14例,子痫前期重度64例。对比各组胎盘病理学特征、胎盘组织中的VEGF、GATA-3蛋白的表达情况,并采用受试者工作曲线(ROC)分析VEGF、GATA-3蛋白表达与不良分娩结局的关系。结果病例组的胎盘绒毛间隙纤维素沉积、胎盘绒毛间质纤维化、细胞滋养细胞增生、绒毛血管减少检出率为37.00%、47.00%、62.00%、28.00%,显著高于对照组(9.00%、4.00%、14.00%、3.00%),差异均有统计学意义(P<0.05)。病例组的胎盘组织的VEGF、GATA-3蛋白阳性表达率为34.00%、21.00%,均低于对照组(65.00%、57.00%),差异均有统计学意义(P<0.05)。子痫前期重度(68.75%、84.38%、68.75%、57.81%)、子痫前期轻度(50.00%、71.43%、64.29%、35.71%)患者的胎盘绒毛间隙纤维素沉积、胎盘绒毛间质纤维化、绒毛血管减少检出率显著高于妊娠期高血压组(18.18%、22.73%、59.09%、13.64%),差异均有统计学意义(P<0.05)。子痫前期重度(10.94%、4.69%)、子痫前期轻度(21.43%、7.14%)患者的胎盘组织的VEGF、GATA-3蛋白阳性表达率均低于妊娠高血压组(50.00%、31.81%),差异均有统计学意义(P<0.05)。不良分娩结局组胎盘组织中的VEGF、GATA-3阳性表达率为14.29%、4.76%,显著低于良好组(39.24%、25.32%),差异均有统计学意义(P<0.05);VEGF、GATA-3蛋白预测妊娠高血压孕妇不良分娩结局的ROC曲线下面积值分别为0.732、0.850。结论妊娠高血压妇女胎盘组织病理学改变特征明显,VEGF、GATA-3阳性表达率显著降低,并且与患者病情程度、不良分娩结局有关。

Objective To investigate the pathological changes of placental tissue in women with pregnancy-induced hypertension,abnormal expression of vascular endothelial growth factor(VEGF)and GATA protein 3(GATA-3)in tissue and their clinical significance.Methods In this study,a case-control study was adopted.On the basis of compliance with clinical trial safety and medical ethics,100 pregnant women with gestational hypertension(case group)who received prenatal examination and gave birth in Huaibei Maternal and Child Health Hospital,and 100 pregnant women who gave birth during normal pregnancy during the same period were selected as the control group.The case group was divided into 22 cases of gestational hypertension,14 cases of mild preeclampsia and 64 cases of severe preeclampsia according to the condition.The pathological characteristics of the placenta,the expression of VEGF and GATA-3 protein in placental tissue were compared between the two groups,and the receiver operating curve(ROC)was used to analyze the relationship between the expression of VEGF and GATA-3 protein and adverse delivery outcomes.relation.Results The detection rates of cellulose deposition in placental villous space,placental villous interstitial fibrosis,cytotrophoblast proliferation,and decreased villous blood vessels in the case group were 37.00%,47.00%,62.00%,28.00%,which were significantly higher than those in the control group(9.00%,4.00%,14.00%,3.00%),and the differences were statistically significant(P<0.05).The positive expression rates of VEGF and GATA-3 proteins in the tissues were 34.00%,21.00%,which were lower than those in the control group(65.00%,57.00%),and the differences were statistically significant(P<0.05).The detection rates of cellulose deposition in placental villous space,interstitial fibrosis and reduced villi vessels in patients with severe preeclampsia group(68.75%,84.38%,68.75%,57.81%)and mild preeclampsia group(50.00%,71.43%,64.29%,35.71%)were significantly higher than those in patients with gestational hypertension(18.18%,22.73%,59.09%,13.64%),and the differences were statistically significant(P<0.05).The positive expression rates of VEGF and GATA-3 protein in the placental tissue of the patients with severe preeclampsia group(10.94%,4.69%)and mild preeclampsia group(21.43%,7.14%)were lower than those of gestational hypertension(50.00%,31.81%),the differences were statistically significant(P<0.05).The positive expression rates of VEGF and GATA-3 in the placenta tissue of the poor delivery outcome group were 14.29%,4.76%,which were significantly lower than those of the good group(39.24%,25.32%),the differences were statistically significant(P<0.05).VEGF and GATA-3 proteins predicted gestational hypertension the AUC values of the area under the ROC curve for adverse delivery outcomes of pregnant women were 0.732 and 0.850,respectively.Conclusion The histopathological changes of placenta in women with gestational hypertension were obvious,and the positive expression rates of VEGF and GATA-3 were significantly reduced,which were related to the severity of the patient’s disease and poor delivery outcomes.