重度子痫前期患者外周血胎儿有核红细胞与胎盘病理改变及患者妊娠结局的关系

目的探讨重度子痫前期患者外周血胎儿有核红细胞(FNRBC)与胎盘病理改变及患者妊娠结局的关系。方法选取2018年1月至2019年5月在北京市海淀区妇幼保健院住院分娩的重度子痫前期患者72例作为子痫前期组,以及同期在该院正常分娩的健康产妇60例作为对照组。对两组产妇胎盘进行病理学检查,并检测分娩前外周血FNRBC水平,分析重度子痫前期患者胎盘病理检查梗死灶范围与FNRBC及产妇妊娠结局的关系。结果子痫前期组产妇分娩孕周、新生儿出生体质量、胎盘重量明显低于对照组,差异有统计学意义(P<0.05);子痫前期组产妇收缩压、舒张压显著高于对照组,差异有统计学意义(P<0.05)。子痫前期组患者胎盘梗死灶范围占比与对照组比较,差异有统计学意义(P<0.05)。子痫前期组外周血FNRBC水平显著高于对照组,差异有统计学意义(P<0.05)。早发型重度子痫前期患者外周血FNRBC水平明显高于晚发型重度子痫前期患者,差异有统计学意义(P<0.05)。不同胎盘梗死灶范围重症子痫前期患者FNRBC水平比较,差异有统计学意义(P<0.05),随胎盘梗死灶范围增大FNRBC水平显著升高(P<0.05)。FNRBC阳性患者不良妊娠发生率明显高于FNRBC阴性患者,差异有统计学意义(P<0.05)。结论重度子痫前期患者出现胎盘病理性改变及大面积梗死,且以早发型重度子痫前期患者改变更为明显,患者胎盘梗死范围与外周血FNRBC水平及患者妊娠结局密切相关,提示外周血FNRBC可能作为患者胎盘病理变化及妊娠结局的潜在预测指标。

The relationship between peripheral blood fetal nucleated red blood cells and placental pathological changes and pregnancy outcome in patients with severe preeclampsia

Objective To investigate the relationship between the peripheral blood fetal nucleated red blood cells(FNRBC)and placental pathological changes and pregnancy outcome in patients with severe preeclampsia.Methods A total of 72 patients with severe preeclampsia who delivered in Beijing Haidian maternal and child health hospital from January 2018 to May 2019 were selected as preeclampsia group,and 60 healthy parturients who delivered normally in the hospital during the same period were selected as control group.The placentas of the two groups were examined pathologically,and the FNRBC level in the peripheral blood before delivery was examined.The relationship between the infarct area of placentas in severe preeclampsia and the pregnancy outcome was analyzed.Results The gestational age,birth weight and placenta weight of the preeclampsia group were significantly lower than those of the control group,thd difference was statistical significance(P<0.05).The systolic and diastolic blood pressures in the preeclampsia group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).Compared with the control group,the proportion of the area of placental infarction in preeclampsia group was statistically significant(P<0.05).The level of FNRBC in peripheral blood of preeclampsia group was significantly higher than that of control group,and the difference was statistically significant(P<0.05).The level of FNRBC in peripheral blood of early-onset severe preeclampsia patients was significantly higher than that of late-onset severe preeclampsia patients,and the difference was statistically significant(P<0.05).FNRBC levels in severe preeclampsia patients with different ranges of placental infarct showed statistically significant differences(P<0.05),and FNRBC levels were significantly increased with the increase of the range of placental infarct(P<0.05).The incidence of adverse pregnancy in FNRBC positive patients was significantly higher than that in FNRBC negative patients,and the difference was statistically significant(P<0.05).Conclusion The placental pathological changes and large area infarctions in patients with severe preeclampsia are more obvious in patients with early-onset severe preeclampsia.The extent of placental infarctions is closely related to the level of FNRBC in peripheral blood and pregnancy outcome,suggesting that FNRBC in peripheral blood may be a potential predictor of placental pathological changes and pregnancy outcome.