胎盘早剥相关因素及其诊断和结局分析

目的分析胎盘早剥的发病原因,以及不同分级胎盘早剥患者的临床表现、诊断和结局。方法收集房山区中医医院2001年1月至2014年3月92例胎盘早剥患者的临床资料并进行统计分析。结果在12082例产妇中共有92例胎盘早剥患者,胎盘早剥发生率为0．8％。妊娠期高血压疾病、胎膜早破、外伤因素是主要的发病诱因,分别占38．0％、20．7％、12．0％。临床表现主要为阴道出血、不规则腹痛、血性羊水。3级患者的板状腹、胎心异常、胎心率消失及休克发生率比较差异均有统计学意义（x2值分别为19．20、9．77、6．83、8．42,均P〈0．05）。产前诊断为胎盘早剥者59例,产前诊断率为64．1％,Ⅰ度、Ⅱ度、Ⅲ度胎盘早剥患者的产前诊断率分别为36．7％、64．0％、86．5％,差异有统计学意义（x2=17．88,P〈0．05）。剖宫产75例（81．5％）,阴道分娩17例（18．5％）,子宫次全切除1例;并发子宫胎盘卒中4例,弥散性血管内凝血1例,均为Ⅲ度胎盘早剥患者。围产儿死亡13例,死亡率为13．8％,死胎10例,新生儿窒息21例,转新生儿重症监护室（NICU）23例,新生儿死亡3例。Ⅲ度胎盘早剥出现死胎、新生儿窒息及转NICU的比例显著高于Ⅰ度和Ⅱ度患者,差异均有统计学意义（x2值分别为6．17、6．10、18．67,均P〈0．05）。结论积极预防胎盘早剥诱因,及时诊断胎盘早剥并积极治疗,有助于减少胎盘早剥的发生,改善母婴顸后。     

胎盘粘连植入组织和人胎盘滋养层细胞中VCAM-1的表达及其与侵入性胎盘疾病的相关性

目的探讨胎盘粘连植入组织和人胎盘滋养层细胞中血管细胞黏附分子-1(vascular cell adhesion molecule-1,VCAM-1)的表达及其与侵入性胎盘疾病的相关性。方法采用酶联免疫吸附试验检测2017年9月至2018年9月期间我院收治的20例产妇静脉血中可溶性VCAM-1(sVCAM-1)的表达水平,根据sVCAM-1的平均值将另外随机选取的200例产妇分为高表达组和低表达组,计算两组侵入性胎盘发生率。采用免疫组化染色、实时定量PCR和Western blot检测40例侵入性胎盘组织和40例正常胎盘组织中的VCAM-1、TNF-α、NF-κB p65和IκBα表达。应用20 ng/mL的TNF-α处理人胎盘滋养层HTR8/SVneo细胞系后检测细胞中VCAM-1、TNF-α、NF-κB p65和IκBα的表达。结果20例健康产妇静脉血中的VCAM-1平均水平为36.32±3.25 ng/mL。高表达组的侵入性胎盘发生率(6.98%)显著高于低表达组(0.64%)(χ^2=0.922,P=0.009)。实时定量RT-PCR和Western blot结果表明,与对照组相比,侵入性胎盘组VCAM-1的mRNA和蛋白表达水平显著升高。免疫染色显示VCAM-1蛋白主要在滋养细胞的细胞质和膜中表达,侵入性胎盘组的VCAM-1阳性率(72.50%)显著高于对照组(17.50%)(Z=-5.063,P<0.001)。与对照组相比,侵入性胎盘组的TNF-α和NF-κB p65表达水平显著升高,而IκBα表达水平显著降低(P<0.05)。与未用TNF-α处理(0 ng/mL)的HTR8/SVneo细胞相比,应用20 ng/mL浓度的TNF-α处理细胞1周后,细胞中的NF-κB p65和VCAM-1表达水平显著升高,而IκBα表达水平显著降低(P<0.05)。结论VCAM-1在侵入性胎盘产妇血液和胎盘组织中均为高表达模式。VCAM-1的活化至少部分依赖于TNF-α、NF-κB信号通路的激活,从而诱导其在滋养细胞中高表达并引起过度侵袭,导致侵入性胎盘的发生。     

An epidemiological study investigating the relationship between chorangioma and infantile hemangioma

Objectives

This study aimed to verify whether the infantile hemangioma (IH) incidence in children whose placentas showed a chorangioma is higher than in the general population, thus addressing the hypothesized relationship between chorangioma and IH.

Methods

All chorangioma diagnoses by the 1st Service of Pathology, University of Padova in 2004–2010, based on the analysis of placentas sent by the Department of Gynecological Sciences and Human Reproduction (University of Padova), were identified. Demographic, anamnestic and clinical data were collected from the mothers and newborns; mothers and pediatricians were interviewed by telephone within 1 year after birth to verify if any IH appeared. The incidence rates of IH and other adverse events (IUGR, preterm delivery, cesarean section, stillbirth) were compared with national and regional data, when available, or with estimates from the scientific literature.

Results

Thirty-eight chorangioma diagnoses were found. Of 33 infants born with a placenta affected by chorangioma, 18 infants had IH. The IH incidence recorded in our series (55%) was significantly higher than that recorded in national and regional surveys and in the scientific literature. Similar findings have been observed for the incidence of stillbirth, preterm birth and low birth weight incidence.

Conclusions

The IH incidence observed in our series appears to be significantly higher than that recorded among the general population, suggesting that an association between placental chorangioma and IH could exist which should be further verified in prospective studies.     

胎盘植入的超声诊断研究

胎盘植入属于临床产科并发症类型,而且属于严重并发症。胎盘植入可能因为产时或产后取出胎盘困难,而诱发子宫大出血,对产妇的生命安全造成严重威胁。近几年来,随着临床剖宫产术后再次妊娠的孕妇占比率逐渐增多,导致瘢痕子宫胎盘植入发生率也随之显著增加。若在产前可以明确诊断,则可以给予临床制定治疗方案提供透析可靠的参考辅助依据,从而在一定程度上减少子宫切除可能性及孕产妇死亡可能性。超声检查方法具备着直观性特点、可重复性特点等,在临床进行胎盘植入产前诊断过程中,可以取得比较理想应用效果。     

Microchimerism: Defining and redefining the prepregnancy context – A review

Bidirectional transplacental exchange characterizes human pregnancy. Cells exchanged between mother and fetus can durably persist as microchimerism and may have both short- and long-term consequences for the recipient. The amount, type, and persistence of microchimerism are influenced by obstetric characteristics, pregnancy complications, exposures to infection, and other factors. A reproductive-aged woman enters pregnancy harboring previously acquired microchimeric “grafts,” which may influence her preconception health and her subsequent pregnancy outcomes. Many questions remain to be answered about microchimerism with broad-ranging implications. This review will summarize key aspects of this field of research and propose important questions to be addressed moving forward.     

Vitamin D decreases expression of NLRP1 and NLRP3 inflammasomes in placental explants from women with preeclampsia cultured with hydrogen peroxide

This study aimed to evaluate the immunomodulatory effect of vitamin D (VD) on the NLRP1 and NLRP3 inflammasomes in placental explants from preeclamptic (PE) and normotensive (NT) pregnant women. Placental explants from eight PE and eight NT pregnant women were cultured with or without hydrogen peroxide (H₂O₂)_, VD or H₂O₂ + VD. Gene and protein expression of NLRP1, NLRP3, HMGB1, caspase-1, IL-1β, TNF-α and IL-18 were determined by qPCR and Western blotting/ELISA. Compared to NT pregnant women, the endogenous gene expression of NLRP1, NLRP3, HMGB1, IL-1β, TNF-α and IL-18 was significantly higher in explants from PE and became decreased after VD treatment. Similarly, VD decreased the protein expression of NLRP1, NLRP3, caspase-1, HMGB1, IL-1β, TNF-α and IL-18 in PE. Placental explants from NT cultured with H₂O₂ showed increased gene and protein expression of NLRP1, NLRP3, caspase-1, IL-1β, TNF-α and HMGB1, while H₂O₂ was also able to increase TNF-α and caspase-1 gene expression in PE. Treatment with H₂O₂ + VD decreased gene/protein expression of NLRP1, NLRP3, caspase-1, HMGB1, IL-1β, TNF-α and IL-18 in PE and NT explants with H₂O₂. NLRP1 and NLRP3 are upregulated in the PE. VD may play an immunomodulatory role in the placental inflammation and downregulates oxidative stress induced in vitro by H₂O_2.     

胎盘早剥早期诊断和处理

目的探讨胎盘早剥的病因,相关因素,总结早期诊断,处理的方法,降低围生儿死亡,改善母婴结局。方法对我院近5年来发生的胎盘早剥病例68例进行回顾性分析。结果胎盘早剥的发生率为0.42%,胎盘早剥多发生于外来人口,且一般无产前检查,孕期往往合并妊娠期高血压疾病且未经正规治疗,以腹痛、阴道流血为主要临床表现,并发DIC及凝血功能障碍7例,子宫切除5例,围生儿死亡18例。结论加强孕期保健,规范外来孕妇产前检查,及早发现和治疗妊娠期高血压疾病,可降低胎盘早剥的发生。重视胎盘早剥的诱因、临床症状及体征,可早期诊断胎盘早剥。一旦发现胎盘早剥,尽快终止妊娠,可改善母婴结局。     

胎膜早破并发胎盘早剥的早期诊治探讨

目的探讨妊娠晚期胎膜早破并发胎盘早剥的发生率及早期诊治要点。方法回顾分析2002年1月-2005年12月该院产科分娩的胎膜早破病例，其中并发胎盘早剥者9例，与非胎膜早破发生胎盘早剥者进行比较，分析早期诊治与母婴结局的关系。结果4年内分娩总数3998例，胎膜早破并发胎盘早剥者占全部胎盘早剥的45％，胎膜早破为胎盘早剥的第1住诱因。胎膜早破并发胎盘早剥的发生率为2．97％，而非胎膜旱破组为0．30％，两组比较，差异有非常显著性（P〈0．001），胎心异常，少量血性羊水为常见临床表现。结论胎膜早破是胎盘早剥的重要诱因，重视胎膜早破后每1个异常临床表现，有助于早期诊治，以降低母婴并发症发生。