早发型重度子痫前期胎盘超微结构的临床研究

目的通过透视电镜定量分析早发型重度子痫前期（EOSP）患者胎盘超微结构的变化特点,探讨EOSP胎盘超微结构定量改变与围产儿不良结局的关系。方法选择2012年1月—2014年1月在该院产科住院分娩的EOSP患者24例为EOSP组,早产孕妇30例作为对照组,采用计量的方法测定两组胎盘超微结构的参数,血管合体膜（vasculo-syncytial membrane,VSM）的厚度、微绒毛的数量、合体滋养细胞（syncytiotrophoblasts,ST）基膜至毛细血管内皮细胞基底膜（BM）的厚度、ST内脂质空泡的数量、线粒体（Mitochondria,Mito）和内质网（endoplasmic reticulum,ER）的形态结构的变化,记录新生儿出生时Apgar评分、出生体重,分析各参数变化与围产儿不良结局的关系。结果 1EOSP组胎盘VSM和BM厚度明显增加（P〈0.01）,微绒毛数量减少（P〈0.01）,差异有统计学意义,脂质空泡的数量增加;2EOSP组线粒体和内质网肿胀或者结构消失;3宫内生长受限（FGR）发病率增加,差异有统计学意义（P〈0.01）,新生儿窒息增加,差异有统计学意义（P〈0.05）。结论 EOSP状态下,胎盘的超微结构受到损伤,可能影响胎盘的转运和合成功能,导致围产儿不良妊娠结局。

Clinical Study of Early-onset Severe Preeclampsia Placenta Ultrastructure

Objective To analyze the characteristics and changes of the ultrastructure of human placenta in early-onset severe preeclampsia （EOSP） quantitatively by transmission electron microscopy, and explore the relationship between the quantitative changes of placental ultrastructure in EOSP and adverse perinatal outcome. Methods 24 cases with EOSP were selected as the EOSP group, and 30 pregnant women with premature birth were selected as the control group. A quantitative method was used to measure the two groups＂ parameters of placental ultrastructure, the thickness of vasculo-syncytial membrane （VSM）, the number of microvilli, the thickness from the basement layer of syncytiotrophoblast （ST） to the basement membrane（BM） of capillary endothe- lial cell, the number of lipid vacuoles in ST, the changes in morphological structure of mitochondria （Mito） and endoplasmic reticu- lum（ER）. The neonatal Apgar score and birth weight of the two groups were recorded, and the relationship between variation of various parameters and adverse perinatal outcome was analyzed. Results （~）In EOSP group, the placental VSM and BM significant- ly thickened（P〈0.01）, the number of microvilli decreased （P〈0.01） and lipid vacuoles increased. （~）The mitochondria and endoplas- mic reticulum in EOSP group were swollen or the structure disappeared. （~）In EOSP group, the incidence of fetal growth retarda- tion（FGR） was higher, the difference was statistically significant（P〈0.01）; the incidence of neonatal asphyxia was higher, the differ- ence was statistically significant（P〈0.05）. Conclusion When EOSP happens, the placental ultrastructure is damaged, which may af- fect the placental synthesization and transportation function and lead to the adverse perinatal outcome.