妊娠合并主动脉夹层/主动脉瘤14例临床特征与胎盘病理学分析

Clinical characteristics and placental pathology analysis of 14 cases of pregnancy with aortic dissection/aortic aneurysm

目的探讨妊娠合并主动脉夹层/主动脉瘤患者的胎盘病理形态改变及与临床特征的关系。方法选取首都医科大学附属北京安贞医院2012年1月至2021年10月14例妊娠合并主动脉夹层/主动脉瘤患者的胎盘标本及2021年1至12月10例正常妊娠妇女的胎盘标本,采用常规HE染色及免疫组织化学染色,光镜下观察组织形态学改变,并结合临床资料进行分析。结果14例妊娠合并主动脉夹层/主动脉瘤送检胎盘的患者年龄22~38岁,中位年龄28岁,孕周22~39周,中位孕周34周;妊娠中期2例,妊娠晚期12例;均为单胎妊娠;Stanford A型主动脉夹层7例,Stanford B型主动脉夹层6例,主动脉根部瘤1例;孕妇先行剖宫产术后行主动脉夹层手术4例,先行主动脉夹层手术后行剖宫产术3例,同时行剖宫产术和主动脉夹层手术7例;新生儿中足月产2例,早产儿12例;新生儿存活12例,死亡2例。胎儿/胎盘重量比(FPR)<第10百分位数5例,FPR>第90百分位数1例。妊娠合并主动脉夹层组绒毛成熟加速及远端绒毛发育不良比例高于正常组,两组差异有统计学意义(P<0.05);而绒毛梗死及蜕膜血管病变与正常组差别不明显,两组差异无统计学意义(P>0.05);主动脉夹层类型与胎盘发生远端绒毛发育不良及绒毛成熟加速无相关性(P>0.05);妊娠合并主动脉夹层组胎盘与正常对照组相比绒毛间质血管数显著减少,差异有统计学意义(P<0.01)。结论妊娠合并主动脉夹层患者的胎盘有一定病理学改变,且主要表现为绒毛成熟加速及远端绒毛发育不良,是绒毛缺血缺氧的表现,也是母体血管灌注不良胎盘病理表现的一部分。

Objective To investigate the pathological changes of placenta in pregnant women with aortic dissection/aneurysm and their relationship with clinical features.Methods The placental samples of 14 pregnant women with aortic dissection/aneurysm diagnosed from January 2012 to October 2021 and 10 normal placental samples of pregnant women from January 2021 to December 2021 at Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing,China were selected.Routine H&E staining and immunohistochemistry were used to analyze the histological features under light microscope.The clinical data were also analyzed.Results The age of 14 pregnant patients with aortic dissection/aneurysm for placental examination ranged from 22 to 38 years(median,28 years).The gestational ages ranged from 22 to 39 weeks(median,34 weeks).The pregnancy of second trimester was noted in 2 cases,and the third trimester in 12 cases.All cases were singleton pregnancy.Seven cases were Stanford type A aortic dissection,6 cases were Stanford type B aortic dissection,and one case was aortic root aneurysm.Four of the pregnant women underwent aortic dissection surgery after caesarean section,three underwent caesarean section after aortic dissection surgery,and seven underwent both caesarean section and aortic dissection procedures.Among the newborns,2 cases were full-term birth,and 12 cases were premature birth.Twelve cases had alive newborns,and 2 cases stillbirths.Fetal/placental weight ratio(FPR)<10th percentile was in 5 cases and FPR>90th percentile in one case.Compared with the normal group,accelerated villus maturation and distal villus dysplasia were more frequently found in pregnancy with aortic dissection group(P<0.05).There was no significant difference in villi infarction and decidua vascular lesions between the two groups(P>0.05),nor was there correlation between the type of aortic dissection and distal villus dysplasia and accelerated villus maturation of placentas(P>0.05).The number of villous interstitial blood vessels in the placentas of pregnancy with aortic dissection group was significantly fewer than that in the normal control group(P<0.01).Conclusions There are considerable pathological changes in the placentas of pregnant women with aortic dissection/aneurysm.The main histological features are accelerated villus maturation and distal villus dysplasia,which are manifestations of villous ischemia and hypoxia,and also a part of the placental pathological manifestations of maternal vascular dysperfusion.