未并发IUGR妊娠高血压综合征胎盘的体视学研究

探讨妊娠高血压综合征(妊高征)胎盘的病理形态改变特点及其与妊高征发病机制的关系.利用体视学图像分析系统对轻度妊高征9例(A组),中度妊高征9例(B组),重度妊高征9例(C组),正常同期妊娠9例(D组)的胎盘终末绒毛、绒毛毛细血管进行显微镜下形态学定量分析.发现中度和重度妊高征组纤维素样坏死绒毛体积百分含量显著高于对照组及轻度妊高征组(p＜0.05);轻度妊高征组血管合体膜的厚度显著小于中度妊高征组、重度妊高征组和对照组(P＜0.05);胎盘绒毛和绒毛毛细血管表面密度各级间差异无统计学意义(p＜0.05);各组间的绒毛毛细血管表面积体积比有显著性差异(p＜0.05).上述结果表明,中度和重度妊高征胎盘绒毛纤维素样坏死增加;轻度妊高征血管合体膜变薄;轻度妊高征胎盘血液灌注量增加,绒毛毛细血管管径增大;中度和重度妊高征胎盘灌注量减少,绒毛毛细血管管壁皱缩,管径变小,由此可见,改善胎盘血流灌注是治疗妊高征的关键.

A STEREOLOGICAL STUDY ON HUMAN PLACENTA IN PREGNANCY-INDUCED HYPERTENSION NOT COMPLICATED BYIUGR

The morphologic change of human placentas in pregnancy-induced hypertension syndrome (PIHS) and its relationship to the pathogenesis of PIHS were studied. The patients were divided into four groups: group A (9 cases of mild PIHS); group B (9 cases of moderate PIHS); group C (9 cases of severe PIHS); group D (9 cases of normal pregnancy from 28-42 weeks). The morphologic quantitative analysis was made for their terminal villi and villous capillaries under microscope by using stereologic image analysis system. It was found that the volume proportions of placental villi, placental infarct villi in moderate and severe PIHS were significantly higher than those in mild PIHS and control group (p<0.05); the vasoculo-syncytial membrane (VSM) in mild PIHS was significantly thinner than that in moderate and severe PIHS as well as control group (p<0.05); no significant difference was found among the four groups in the surface density of placental villi and villous capillaries (p>0.05);significant difference was found among the four groups in the ratio of surface to volume in placental villi and villous capillaries (p<0.05). The results showed that the volume proportions of placental villi in moderate and severe PIHS were higher, VSM in mild PIHS was thinner than that in control group, perfusion was increased in placenta of mild PIHS, the diameter of villous capillaries in mild PIHS became bigger. However, perfusion was reduced in placenta of moderate and severe PIHS, the diameter of villous capillaries in moderate and severe PIHS became smaller. It is concluded that it is the key to improve the blood perfusion of placentas in the treatment of PIHS.