中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2013年
3期
171-176
,共6页
沈晶%杨淑莉%靖丽娟%陈帅%马晓艳%崔满华
瀋晶%楊淑莉%靖麗娟%陳帥%馬曉豔%崔滿華
침정%양숙리%정려연%진수%마효염%최만화
先兆子痫%玻连蛋白%胎盘%滋养层
先兆子癇%玻連蛋白%胎盤%滋養層
선조자간%파련단백%태반%자양층
Pre-eclampsia%Vitronectin%Placenta%Trophoblasts
目的 探讨胎盘基底板中玻连蛋白(VN)的表达及其与重度子痫前期发病的关系.方法 选择2010年3月-2011年12月吉林大学白求恩第二医院产科住院分娩的17例早发型重度子痫前期孕妇为早发型重度子痫前期组,16例晚发型重度子痫前期孕妇为晚发型重度子痫前期组；另选同期孕34周以前的15例健康孕妇为早期对照组(因胎儿心脏发育畸形等原因引产者),孕34周以后的15例健康孕妇为晚期对照组.采用免疫组化方法及逆转录(RT)-PCR技术分别检测胎盘基底板梗塞灶中心及其周围组织中VN蛋白及mRNA表达,并对各组孕妇的凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIb)水平进行检测并计算国际标准化比率(INR).对早发型重度子痫前期组和早期对照组孕妇检测结果异常的凝血指标与VN表达水平进行相关性分析.结果 (1)4组胎盘基底板中均可检测到VN蛋白的表达,尤其在胎盘梗塞灶中心坏死组织中呈高表达,而在远离梗塞区组织中呈弱表达.(2)早发型重度子痫前期组胎盘基底板中VN蛋白表达水平为0.152 ±0.019、晚发型重度子痫前期组为0.113±0.023、晚期对照组为0.095±0.014、早期对照组为0.055 ±0.010,各组分别比较,差异均有统计学意义(P＜0.01).VN蛋白在胎盘梗塞灶中心、梗塞灶边缘、近梗塞区组织及远离梗塞区组织中的表达水平依次逐渐降低,分别比较,差异均有统计学意义(P＜0.01).各组胎盘梗塞灶中心、梗塞灶边缘、近梗塞区组织及远离梗塞区组织分别纵向比较,差异均无统计学意义(P＞0.05).(3)各组胎盘梗塞灶中心、梗塞灶边缘、近梗塞区组织、远离梗塞区组织胎盘基底板中均可检测到VN mRNA表达,早发型重度子痫前期组及早期对照组的梗塞灶中心VN mRNA表达水平较远离梗塞区组织升高,差异有统计学意义(P＜0.05).(4)早发型重度子痫前期组PT为(9.45±0.63)s,明显短于早期对照组的(9.88±0.17)s,两组比较,差异有统计学意义(P＜0.05)；而各组APTT、FIb及INR水平分别比较,差异均无统计学意义(P＞0.05).(5)早发型重度子痫前期组胎盘VN表达水平与PT呈显著负相关(r=-0.612,P＜0.05)；而早期对照组胎盘VN表达水平与PT无相关性(r=0.489,P＞0.05).结论 VN在早发型重度子痫前期孕妇胎盘基底板中呈高表达,并引起凝血与纤溶系统平衡失调,最终导致重度子痫前期的发生.
目的 探討胎盤基底闆中玻連蛋白(VN)的錶達及其與重度子癇前期髮病的關繫.方法 選擇2010年3月-2011年12月吉林大學白求恩第二醫院產科住院分娩的17例早髮型重度子癇前期孕婦為早髮型重度子癇前期組,16例晚髮型重度子癇前期孕婦為晚髮型重度子癇前期組；另選同期孕34週以前的15例健康孕婦為早期對照組(因胎兒心髒髮育畸形等原因引產者),孕34週以後的15例健康孕婦為晚期對照組.採用免疫組化方法及逆轉錄(RT)-PCR技術分彆檢測胎盤基底闆梗塞竈中心及其週圍組織中VN蛋白及mRNA錶達,併對各組孕婦的凝血酶原時間(PT)、部分凝血活酶時間(APTT)、纖維蛋白原(FIb)水平進行檢測併計算國際標準化比率(INR).對早髮型重度子癇前期組和早期對照組孕婦檢測結果異常的凝血指標與VN錶達水平進行相關性分析.結果 (1)4組胎盤基底闆中均可檢測到VN蛋白的錶達,尤其在胎盤梗塞竈中心壞死組織中呈高錶達,而在遠離梗塞區組織中呈弱錶達.(2)早髮型重度子癇前期組胎盤基底闆中VN蛋白錶達水平為0.152 ±0.019、晚髮型重度子癇前期組為0.113±0.023、晚期對照組為0.095±0.014、早期對照組為0.055 ±0.010,各組分彆比較,差異均有統計學意義(P＜0.01).VN蛋白在胎盤梗塞竈中心、梗塞竈邊緣、近梗塞區組織及遠離梗塞區組織中的錶達水平依次逐漸降低,分彆比較,差異均有統計學意義(P＜0.01).各組胎盤梗塞竈中心、梗塞竈邊緣、近梗塞區組織及遠離梗塞區組織分彆縱嚮比較,差異均無統計學意義(P＞0.05).(3)各組胎盤梗塞竈中心、梗塞竈邊緣、近梗塞區組織、遠離梗塞區組織胎盤基底闆中均可檢測到VN mRNA錶達,早髮型重度子癇前期組及早期對照組的梗塞竈中心VN mRNA錶達水平較遠離梗塞區組織升高,差異有統計學意義(P＜0.05).(4)早髮型重度子癇前期組PT為(9.45±0.63)s,明顯短于早期對照組的(9.88±0.17)s,兩組比較,差異有統計學意義(P＜0.05)；而各組APTT、FIb及INR水平分彆比較,差異均無統計學意義(P＞0.05).(5)早髮型重度子癇前期組胎盤VN錶達水平與PT呈顯著負相關(r=-0.612,P＜0.05)；而早期對照組胎盤VN錶達水平與PT無相關性(r=0.489,P＞0.05).結論 VN在早髮型重度子癇前期孕婦胎盤基底闆中呈高錶達,併引起凝血與纖溶繫統平衡失調,最終導緻重度子癇前期的髮生.
목적 탐토태반기저판중파련단백(VN)적표체급기여중도자간전기발병적관계.방법 선택2010년3월-2011년12월길림대학백구은제이의원산과주원분면적17례조발형중도자간전기잉부위조발형중도자간전기조,16례만발형중도자간전기잉부위만발형중도자간전기조；령선동기잉34주이전적15례건강잉부위조기대조조(인태인심장발육기형등원인인산자),잉34주이후적15례건강잉부위만기대조조.채용면역조화방법급역전록(RT)-PCR기술분별검측태반기저판경새조중심급기주위조직중VN단백급mRNA표체,병대각조잉부적응혈매원시간(PT)、부분응혈활매시간(APTT)、섬유단백원(FIb)수평진행검측병계산국제표준화비솔(INR).대조발형중도자간전기조화조기대조조잉부검측결과이상적응혈지표여VN표체수평진행상관성분석.결과 (1)4조태반기저판중균가검측도VN단백적표체,우기재태반경새조중심배사조직중정고표체,이재원리경새구조직중정약표체.(2)조발형중도자간전기조태반기저판중VN단백표체수평위0.152 ±0.019、만발형중도자간전기조위0.113±0.023、만기대조조위0.095±0.014、조기대조조위0.055 ±0.010,각조분별비교,차이균유통계학의의(P＜0.01).VN단백재태반경새조중심、경새조변연、근경새구조직급원리경새구조직중적표체수평의차축점강저,분별비교,차이균유통계학의의(P＜0.01).각조태반경새조중심、경새조변연、근경새구조직급원리경새구조직분별종향비교,차이균무통계학의의(P＞0.05).(3)각조태반경새조중심、경새조변연、근경새구조직、원리경새구조직태반기저판중균가검측도VN mRNA표체,조발형중도자간전기조급조기대조조적경새조중심VN mRNA표체수평교원리경새구조직승고,차이유통계학의의(P＜0.05).(4)조발형중도자간전기조PT위(9.45±0.63)s,명현단우조기대조조적(9.88±0.17)s,량조비교,차이유통계학의의(P＜0.05)；이각조APTT、FIb급INR수평분별비교,차이균무통계학의의(P＞0.05).(5)조발형중도자간전기조태반VN표체수평여PT정현저부상관(r=-0.612,P＜0.05)；이조기대조조태반VN표체수평여PT무상관성(r=0.489,P＞0.05).결론 VN재조발형중도자간전기잉부태반기저판중정고표체,병인기응혈여섬용계통평형실조,최종도치중도자간전기적발생.
Objective To investigate the expression of vitronectin (VN) in placental basal plate and its relationship with the pathogenesis of severe preeclampsia.Methods From March 2010 to December 2011,17 patients with early-onset severe preeclampsia who delivered in the Second Hospital of Jilin University were recruited as the early-onset severe preeclampsia group; and 16 women were recruited as the late-onset severe preeclampsia group.Meanwhile,15 healthy pregnant women who delivered before 34 weeks were defined as the early control group (termination of pregnancy was carried out because of fetal heart malformations),and 15 healthy pregnant women delivered after 34 weeks were defined as the late control group.Imnunohistochemistry and semi-quantitative reverse transcription (RT)-PCR were used to investigate the expression of VN protein and mRNA in the placental infarct center and its surrounding tissue of placental basal plate.The levels of serum prothrombin time (PT),part thromboplastin time (APTT) and fibrinogen (FIb) were detected and the international normalized ratio (INR) was calculated.The correlation of abnormal coagulation markers and VN expression levels in the early-onset severe preeclampsia group and the early control group was studied.Results (l) VN protein was detected in all placental basal plate of the four groups.It was highly expressed in the necrotic tissue of placental infarct center and weakly expressed in the tissue far from the infarcted area.(2) The mean levels of VN protein expression in placental basal plate of the early-onset severe preeclampsia group,the late-onset severe preeclampsia group,the late control group and the early control group were 0.152 ± 0.019,0.113 ± 0.023,0.095 ± 0.014 and 0.055 ± 0.010,respectively.And the differences between the groups were statistically significant (P ＜ 0.01).The VN protein expression in placental infarct center,infarct edge,peri-infarct tissue and tissue far from the infarcted area gradually reduced,and the differences were statistically significant (P ＜ 0.01).Compared with the same areas of each group,the differences were not statistically significant (P ＞ 0.05).(3) VN mRNA were detectable in infarct center,infarct edge,per-infarct tissue and tissue far from the infarcted area of placental basal plate.In the early-onset severe preeclampsia group and the early control group,it was statistically higher in infarct center than in tissue far from the infarcted area (P ＜ 0.05).(4) PT of the early-onset severe preeclampsia group was (9.45 ± 0.63) s,significantly shorter than that of the early control group [(9.88 ± 0.17) s,P ＜ 0.05].While there was no statistically significant difference in APTT,FIB and INR among the four groups (P ＞ 0.05).(5) In the early-onset severe preeclampsia group,VN expression level and PT were significantly negative correlated (r =-0.612,P ＜0.05) ; while in the early control group there was no correlation (r =0.489,P ＞ 0.05).Conclusion VN was highly expressed in placental basal plate of the early-onset severe preeclampsia group,which caused the imbalance of coagulation and fibrinolysis system and the pathogenesis of severe preeclampsia.
