滋养细胞凋亡的二阶段与子痫前期二阶段发病机制关系的探讨

子痫前期是产科的严重并发症，不仅影响孕产妇健康，而且影响后代远期预后，发病原因至今不清。该病是胎盘源性疾病，其发生发展可分为两个阶段：第1阶段为病理生理变化形成过程，以滋养细胞浸润异常，螺旋动脉重铸不良，胎盘血流灌注减少为特点；第2阶段为器官受损阶段，导致各种临床征象发生。滋养细胞凋亡在子痫前期发病中起重要作用，细胞凋亡失衡可导致其侵袭能力异常。在子痫前期发病的不同阶段，滋养细胞凋亡的机制也不同。总结相关文献发现，第1阶段为蜕膜自然杀伤细胞及诱导绒毛外滋养细胞凋亡引起螺旋动脉重铸不足的阶段，第2阶段为螺旋动脉重铸不足引起胎盘缺血缺氧导致合体滋养细胞凋亡的阶段。其相关的机制有待进一步研究。

The Relationship between Two Phase Apoptosis of Trophoblast and Two Phase Pathogenesis of Preeclampsia

Preeclampsia is a serve obstetric complication, which not only affects maternal health, but also influences the long-term prognosis of their offspring. The etiology and pathogenesis have not been fully understood. Preeclampsia is a placenta source disease, its development can be divided into two stages. The first stage for the forming process of pathophysiological changes which is characterized with abnormal extravillous trophoblast invasion, impaired spiral artery remodeling and reduced placental perfusion. The second stage for organ damage which cause a variety of clinical manifestations. Apoptosis of villous trophoblast plays an important role on the pathogenesis of preeclampsia, apoptosis imbalance can lead to the abnormal invasion ability. At different stage of the disease, apoptosis mechanism of the villous trophoblast is also different. Summarizes the literature found that first stage maily for the decidual killer cells induce excessive extravillous trophoblast apoptosis which causes impaired spiral artery remodeling, the second stage of the abnormal structure of spiral arteries which causes ischemia and hypoxia of placenta resulted in excessive syncytiotrophoblast apoptosis. But the related mechanism needs further research.