中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2008年
2期
85-89
,共5页
妊娠并发症%胆汁淤积,肝内%脐带%一氧化氮合酶%内皮缩血管肽1%胎儿窘迫
妊娠併髮癥%膽汁淤積,肝內%臍帶%一氧化氮閤酶%內皮縮血管肽1%胎兒窘迫
임신병발증%담즙어적,간내%제대%일양화담합매%내피축혈관태1%태인군박
Pregnancy complications%Cholestasis,intrahepatic%Umbilical cord%Nitric-oxide synthase:Endothelin-1:Fetal distress
目的 探讨妊娠肝内胆汁淤积症(ICP)患者脐带血管病理改变、脐带血管活性物质表达的变化与胎儿窘迫发生的关系.方法 应用HE染色法制片,光镜下观察25例ICP伴有胎儿窘迫(ICP窘迫组)、25例ICP不伴胎儿窘迫(ICP对照组)以及27例正常妊娠妇女(正常妊娠组)新生儿脐带血管病理改变;应用免疫组化辣根过氧化物酶-生物素标记(SABC)法测定内皮型一氧化氮合酶(eNOS)、诱导型一氧化氮合酶(iNOS)及内皮素1(ET-1)蛋白在各组脐静脉内皮细胞中的表达量,以平均吸光度(A)值表示;应用循环酶法测定脐静脉血总胆酸水平并进行相关性分析.结果 (1)脐静脉血总胆酸水平:ICP窘迫组为(19.0±2.3)μmol/L,ICP对照组为(9.0±1.7)μmol/L,正常妊娠组为(4.4±1.5)μmol/L,各组分别比较,差异均有统计学意义(P＜0.05).(2)脐静脉病理改变:ICP患者脐静脉内皮细胞单层扁平结构丧失,细胞向管腔耸立,梭形排列,细胞排列不均甚至脱落.ICP窘迫组患者脐静脉内皮细胞出现此病理改变的发生率(92%,23/25)明显高于ICP对照组(68%,17/25),差异有统计学意义(P＜0.05).(3)脐静脉内皮细胞中eNOS蛋白表达量:ICP窘迫组为0.09±0.06,ICP对照组为0.21±0.08,正常妊娠组为0.47±0.07,各组分别比较,差异均有统计学意义(P＜0.05).脐静脉内皮细胞中iNOS蛋白表达量:ICP窘迫组为0.20±0.04,ICP对照组为0.21±0.05,正常妊娠组为0.26±0.04,两ICP组分别与正常妊娠组比较,差异均有统计学意义(P＜0.01,P＜0.05);而ICP窘迫组与ICP对照组间比较,差异无统计学意义(P＞0.05).(4)脐静脉内皮细胞中ET-1蛋白表达量:ICP窘迫组为0.49±0.08,ICP对照组为0.32±0.07,正常妊娠组为0.14±0.06,两ICP组分别与正常妊娠组比较,差异均有统计学意义(P＜0.01,P＜0.05).(5)脐静脉血总胆酸水平与其病理改变的关系:脐静脉血总胆酸水平升高是脐静脉病理改变的危险因素;且与脐血管内皮细胞eNOS、iNOS的蛋白表达量呈负相关关系(r1=-0.88、r2=-0.45,P＜0.01);与脐血管内皮细胞ET-1蛋白的表达量呈正相关关系(r3=0.79,P＜0.01).结论 ICP患者脐静脉血高胆酸状态可能损伤脐静脉内皮细胞,且与其eNOS、iNOS蛋白表达下调、ET-1蛋白表达上调有关,脐静脉的这些改变可能与ICP患者胎儿窘迫的发生有关.
目的 探討妊娠肝內膽汁淤積癥(ICP)患者臍帶血管病理改變、臍帶血管活性物質錶達的變化與胎兒窘迫髮生的關繫.方法 應用HE染色法製片,光鏡下觀察25例ICP伴有胎兒窘迫(ICP窘迫組)、25例ICP不伴胎兒窘迫(ICP對照組)以及27例正常妊娠婦女(正常妊娠組)新生兒臍帶血管病理改變;應用免疫組化辣根過氧化物酶-生物素標記(SABC)法測定內皮型一氧化氮閤酶(eNOS)、誘導型一氧化氮閤酶(iNOS)及內皮素1(ET-1)蛋白在各組臍靜脈內皮細胞中的錶達量,以平均吸光度(A)值錶示;應用循環酶法測定臍靜脈血總膽痠水平併進行相關性分析.結果 (1)臍靜脈血總膽痠水平:ICP窘迫組為(19.0±2.3)μmol/L,ICP對照組為(9.0±1.7)μmol/L,正常妊娠組為(4.4±1.5)μmol/L,各組分彆比較,差異均有統計學意義(P＜0.05).(2)臍靜脈病理改變:ICP患者臍靜脈內皮細胞單層扁平結構喪失,細胞嚮管腔聳立,梭形排列,細胞排列不均甚至脫落.ICP窘迫組患者臍靜脈內皮細胞齣現此病理改變的髮生率(92%,23/25)明顯高于ICP對照組(68%,17/25),差異有統計學意義(P＜0.05).(3)臍靜脈內皮細胞中eNOS蛋白錶達量:ICP窘迫組為0.09±0.06,ICP對照組為0.21±0.08,正常妊娠組為0.47±0.07,各組分彆比較,差異均有統計學意義(P＜0.05).臍靜脈內皮細胞中iNOS蛋白錶達量:ICP窘迫組為0.20±0.04,ICP對照組為0.21±0.05,正常妊娠組為0.26±0.04,兩ICP組分彆與正常妊娠組比較,差異均有統計學意義(P＜0.01,P＜0.05);而ICP窘迫組與ICP對照組間比較,差異無統計學意義(P＞0.05).(4)臍靜脈內皮細胞中ET-1蛋白錶達量:ICP窘迫組為0.49±0.08,ICP對照組為0.32±0.07,正常妊娠組為0.14±0.06,兩ICP組分彆與正常妊娠組比較,差異均有統計學意義(P＜0.01,P＜0.05).(5)臍靜脈血總膽痠水平與其病理改變的關繫:臍靜脈血總膽痠水平升高是臍靜脈病理改變的危險因素;且與臍血管內皮細胞eNOS、iNOS的蛋白錶達量呈負相關關繫(r1=-0.88、r2=-0.45,P＜0.01);與臍血管內皮細胞ET-1蛋白的錶達量呈正相關關繫(r3=0.79,P＜0.01).結論 ICP患者臍靜脈血高膽痠狀態可能損傷臍靜脈內皮細胞,且與其eNOS、iNOS蛋白錶達下調、ET-1蛋白錶達上調有關,臍靜脈的這些改變可能與ICP患者胎兒窘迫的髮生有關.
목적 탐토임신간내담즙어적증(ICP)환자제대혈관병리개변、제대혈관활성물질표체적변화여태인군박발생적관계.방법 응용HE염색법제편,광경하관찰25례ICP반유태인군박(ICP군박조)、25례ICP불반태인군박(ICP대조조)이급27례정상임신부녀(정상임신조)신생인제대혈관병리개변;응용면역조화랄근과양화물매-생물소표기(SABC)법측정내피형일양화담합매(eNOS)、유도형일양화담합매(iNOS)급내피소1(ET-1)단백재각조제정맥내피세포중적표체량,이평균흡광도(A)치표시;응용순배매법측정제정맥혈총담산수평병진행상관성분석.결과 (1)제정맥혈총담산수평:ICP군박조위(19.0±2.3)μmol/L,ICP대조조위(9.0±1.7)μmol/L,정상임신조위(4.4±1.5)μmol/L,각조분별비교,차이균유통계학의의(P＜0.05).(2)제정맥병리개변:ICP환자제정맥내피세포단층편평결구상실,세포향관강용립,사형배렬,세포배렬불균심지탈락.ICP군박조환자제정맥내피세포출현차병리개변적발생솔(92%,23/25)명현고우ICP대조조(68%,17/25),차이유통계학의의(P＜0.05).(3)제정맥내피세포중eNOS단백표체량:ICP군박조위0.09±0.06,ICP대조조위0.21±0.08,정상임신조위0.47±0.07,각조분별비교,차이균유통계학의의(P＜0.05).제정맥내피세포중iNOS단백표체량:ICP군박조위0.20±0.04,ICP대조조위0.21±0.05,정상임신조위0.26±0.04,량ICP조분별여정상임신조비교,차이균유통계학의의(P＜0.01,P＜0.05);이ICP군박조여ICP대조조간비교,차이무통계학의의(P＞0.05).(4)제정맥내피세포중ET-1단백표체량:ICP군박조위0.49±0.08,ICP대조조위0.32±0.07,정상임신조위0.14±0.06,량ICP조분별여정상임신조비교,차이균유통계학의의(P＜0.01,P＜0.05).(5)제정맥혈총담산수평여기병리개변적관계:제정맥혈총담산수평승고시제정맥병리개변적위험인소;차여제혈관내피세포eNOS、iNOS적단백표체량정부상관관계(r1=-0.88、r2=-0.45,P＜0.01);여제혈관내피세포ET-1단백적표체량정정상관관계(r3=0.79,P＜0.01).결론 ICP환자제정맥혈고담산상태가능손상제정맥내피세포,차여기eNOS、iNOS단백표체하조、ET-1단백표체상조유관,제정맥적저사개변가능여ICP환자태인군박적발생유관.
Objective To investigate the changes of umbilical cord and the vasoactive substance in umbilical vein in intrahepatic cholestasis of pregnancy.Methods By HE staining method we analyzed the pathologic change of umbilical cord of 25 women with intrahepatic cholestasis of pregnancy(ICP)and fetal distress(ICP fetal distress group),25 ICP women without fetal distress group(ICP control group)and 27 normal pregnancies(control group).The nitric oxide synthase(NOS)and endothelin-1(ET-1)were detected in human umbilical vein endothelial cells(HUVEC)by immunohistochemistry method.Umbilical vein total bile acid(TBA)and NOS and ET-1 were measured.Resuits (1)A remarkable high TBA level was found in umbilical vein in ICP,and it was higher in ICP fetal distress group(19.0±2.3)μmol/L than in ICP control group(9.0±1.7)μmol/L(P＜0.05);it was higher in ICP control group than the control group(4.4±1.5)μmol/L(P＜0.05).(2)A significant difference was found in the endotheliocytes of umbilical vein in ICP fetal distress group compared with ICP control group.The ratio of cells with pathological changes in ICP fetal distress group(92％,23/25)was higher than ICP control group(68％,17/25;P＜0.05).The occurrence of the pathological changes was associated with TBA.(3)The expression of eNOS in ICP fetal distress group 0.09±0.06 was lower than in ICP control group 0.21±0.08(P＜0.05),and it was lower in ICP control group than in control group 0.47±0.07(P＜0.05).In contrast.the expression of ET-1 in ICP fetal distress group 0.49±0.08 was higher than in ICP control group 0.32±0.07(P＜0.05),and it was higher in ICP control group than control group 0.14±0.06(P＜0.05).The expression of inducible nitric oxide synthase(iNOS)in ICP fetal distress group 0.20±0.04 and ICP control group 0.21±0.05 was lower than in control group 0.26±0.04(P＜0.05),but no significant difference was found in ICP fetal distress group and ICP control group(P＞0.05).(4)The expression of eNOS,iNOS and ET-1 was correlated with umbilical vein TBA in ICP(r1=-0.88,r2=-0.45,r3=0.79;P＜0.01),respectively.Conclusions High level of TBA in ICP is harmful to the umbilical vein endothelium,which is correlated with the raised expression of ET-1.and the decreased expression of eNOS,and iNOS in human umbilical cord endothelium cells.All these changes of umbilical vein may be associated with the occurrence of fetal distress in ICP.
