妊娠肝内胆汁淤积症患者高水平胆汁酸对血管内皮细胞生长因子的作用

目的　探讨妊娠肝内胆汁淤积症 (ICP)患者高水平胆汁酸对血管内皮细胞生长因子(VEGF)的作用及其与胎儿窘迫的关系。方法　采用酶联免疫吸附试验 (ELISA)法测定 3 3例ICP产妇(ICP组 )和 3 0例正常晚期妊娠妇女 (对照组 )血清中VEGF水平 ;采用免疫组织化学方法测定两组产妇的胎盘血管密度 ;采用放射免疫法测定两组产妇的血清胆汁酸水平。结果　 (1)ICP组产妇的VEGF水平为 (2 0 72± 17)ng/L ,胆汁酸水平为 (47 9± 14 2 )ng/L ,血管密度为 (68± 5 )个 /高倍镜下 ;对照组产妇VEGF水平为 (2 2 5 6± 3 0 )ng/L ,胆汁酸水平为 (1 6± 0 7)ng/L ,血管密度为 (74± 7)个 /高倍镜下。 (2 )ICP组产妇血清中VEGF水平与胆汁酸水平呈负相关 ,与胎盘血管密度呈正相关。对照组产妇血清中VEGF水平与胆汁酸水平无相关性 ,与胎盘血管密度呈正相关。结论　ICP产妇血清中高水平的胆汁酸对血管内皮细胞具有细胞毒性作用 ,导致内皮细胞分泌VEGF减少 ,造成ICP患者胎盘毛细血管减少 ,母儿间物质交换困难。这可能是ICP患者易发生胎儿窘迫及胎死宫内的原因之一。

Relationship of vascular endothelial growth factor with bile acid in intrahepatic cholestasis of pregnancy

OBJECTIVE: To investigate the relationship of vascular endothelial growth factor (VEGF) with bile acid in intrahepatic cholestasis of pregnancy patients (ICP). METHODS: Thirty three ICP patients and 30 normal pregnant women in late pregnancy were studied, maternal serum VEGF concentrations were examined by enzyme linked immunoadsorbent assay (ELISA). Capillaries density in placenta are detected by s-ABC immunohistochemistry, radio-immunity method is used to assay the maternal serum glycocholic acid. RESULTS: Serum VEGF in ICP (2 072 +/- 17) ng/L has negative correlation with glycocholic acid (47.9 +/- 14.2) ng/L, however, positive correlation with capillaries density in placenta (68 +/- 5)/HP; The serum VEGF in normal pregnant woman (2 256 +/- 30) ng/L does not have relationship to glycocholic acid (1.6 +/- 0.7) ng/L but it has positive correlation with capillaries density in placenta (74 +/- 7)/HP. CONCLUSION: Cytotoxicity of high concentration bile acids impairs vascular endothelial cells resulting in lower excretion of VEGF in vascular endothelial cells of ICP, which lead to placental blood capillaries dysplasia and lower permeability, it may be one of reasons of fetal distress and fetal death in uteri in ICP.