早发型胎儿生长受限合并胎儿血流异常胎盘病理特征及相关因素分析

Analysis of Placental Pathological Features and the Related Factors of Early-Onset Fetal Growth Restriction with Abnormal Fetal Blood Flow

目的:探讨早发型胎儿生长受限(FGR)合并胎儿血流异常的胎盘病理特征及相关因素。方法:选取2016年5月1日至2021年12月30日在北京大学第三医院住院分娩的单胎、早发型FGR汉族孕妇108例,根据是否合并胎儿血流异常分为血流异常组(n=42)和血流正常组(n=66)。比较两组的一般临床资料、胎盘大体形态、胎盘HE染色和透射电镜结果。采用多因素二分类Logistic回归,分析发生早发型FGR合并胎儿血流异常的影响因素。结果:①血流异常组合并妊娠期高血压疾病比例高于血流正常组(P<0.05),分娩孕周和新生儿出生体质量小于血流正常组(P<0.05);②血流异常组胎盘的长、宽、体积和质量均小于血流正常组(P<0.05);③HE染色显示,血流异常组合体滋养细胞结节增多、绒毛间隙纤维素沉积、绒毛钙化、绒毛内纤维素沉积、干绒毛间质增生、绒毛小动脉管壁增厚的比例高于血流正常组(P<0.05),绒毛血管扩张比例低于血流正常组(P<0.05);④透射电镜下血流异常组合体滋养细胞微绒毛体积密度(Vv),表面积密度(Sv)和数量密度(Nv)小于血流正常组(P<0.05),线粒体和内质网Vv和Sv均大于血流正常组(P<0.05);⑤多因素Logistic回归显示,合体滋养细胞结节增多、绒毛间隙纤维素沉积、绒毛钙化、绒毛小动脉管壁增厚、合体滋养细胞微绒毛Vv和Sv减小、合体滋养细胞线粒体和内质网Vv增大是发生早发型FGR合并胎儿血流异常的独立危险因素(OR>1,P<0.05),而分娩孕周增加、胎盘质量增加和绒毛血管扩张是其保护性因素(OR<1,P<0.05)。结论:早发型FGR发生胎儿血流异常患者的胎盘质量减轻、胎盘合体滋养细胞结节增多、绒毛间隙纤维素沉积、钙化、小动脉管壁增厚的比例增加,而绒毛血管扩张的比例下降;合体滋养细胞微绒毛Vv和Sv减小,线粒体和内质网Vv增大,这可能是早发型FGR发生胎儿血流异常的影响因素。

Objective:To explore the placental pathological features and related factors of early-onset fetal growth restriction(FGR)with abnormal fetal blood flow.Methods:108 single pregnant women of Han nationality with early-onset FGR who were hospitalized and delivered in the Peking University Third Hospital from May 1,2016 to December 30,2021 were selected.They were divided into the abnormal blood flow group(n=42)and the normal blood flow group(n=66)according to whether the combination of abnormal fetal blood flow.The general clinical data,gross morphology of placenta and the results of placental HE staining and transmission electron microscope(TEM)were compared.Multivariate binary Logistic regression was used to analyze the factors of affecting the occurrence of early-onset FGR combined with abnormal fetal blood flow.Results:①The proportion of pregnant women with hypertensive disorders of pregnancy in the abnormal blood flow group was higher than that in the normal blood flow group(P<0.05),and gestational age at the time of delivery and the birth weights in the abnormal blood flow group were lower than those in the normal blood flow group(P<0.05).②The length,width,volume and weight of placenta in the abnormal blood flow group were smaller than those in the normal blood flow group(P<0.05).③Hematoxylin-eosin(HE)staining showed that the proportion of the increase of syncytiotrophoblastic knots,perivillous fibrin deposition,villous calcification,villous stromal fibrin deposition,stem villi stromal hyperplasia and villous arteriole wall thickening in the abnormal blood flow group was higher than that in the normal blood flow group(P<0.05).The proportion of villous vascular ectasia in the abnormal blood flow group was lower than that in the normal blood flow group(P<0.05).④TEM scanning showed that the Vv,Sv and Nv of the syncytiotrophoblast microvilli in the abnormal blood flow group were lower than those in the normal blood flow group(P<0.05),while the Vv and Sv of the mitochondria and endoplasmic reticulum were higher than those in the normal blood flow group(P<0.05).⑤Multivariate Logistic regression showed that the increase of syncytiotrophoblastic knots,perivillous fibrin deposition,villous calcification,villous arteriole wall thickening,the decrease of the Vv and Sv of microvilli,and the increase of the Vv of the mitochondria and endoplasmic reticulum were independent risk factors for early-onset FGR complicated with abnormal fetal blood flow(OR>1,P<0.05).Gestational age at the time of delivery,placental weight and vascular ectasia were protective factors(OR<1,P<0.05).Conclusions:The decrease of the placental weight,the increase of syncytiotrophoblastic knots,perivillous fibrin deposition,calcification,arteriole wall thickening increase,while the rate of vascular ectasia decreases,the Vv and Sv of microvilli decrease,while the Vv of the mitochondria and endoplasmic reticulum increase,which may be the affecting factors of early-onset FGR with abnormal fetal blood flow.