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目的探讨妊娠中期妊娠相关蛋白A(PAPP-A)在预测妊娠期高血压疾病中的作用及其与胎盘病理改变的关系。方法 2008年1月至2009年12月在中山大学附属中山市人民医院对妊娠12~16周产科门诊建册并规律产检的正常单胎孕妇2025例进行研究,首次就诊时抽取肘静脉血,应用酶联免疫法检测其血清中的PAPP-A,并追踪这些孕妇的妊娠发展及分娩情况。对于发生妊娠期高血压疾病、早发型子痫前期和晚发型子痫前期者产时收集其胎盘组织,用HE染色后观察胎盘绒毛滋养细胞、合体滋养细胞结节增生情况及绒毛间质纤维化和绒毛血管病变情况。并随机抽取正常孕妇胎盘组织进行病理检查对比。结果纳入研究的孕妇2025例,剔除不符合要求病例后,共1862例孕妇中,妊娠期高血压疾病88例,需34周前终止妊娠的早发型子痫前期34例,34周后终止妊娠的晚发型子痫前期53例,正常孕妇1687例。早发型子痫前期组外周血PAPP-A水平比对照组低,P<0.05;妊娠期高血压疾病组、晚发型子痫前期组血清PAPP-A与对照组比较差异无统计学意义(P>0.05)。妊娠期高血压疾病组、早发型子痫前期组及晚发型子痫前期组胎盘病理改变率与对照组比较,总病理改变率3组与对照组比较均高于对照组,P<0.05,但发生病理变化类型不同。结论妊娠期高血压疾病孕妇胎盘发生了明显病理改变,孕12~16周时PAPP-A的减低与早发型子痫前期的发生及其胎盘病理变化相关,在早发型子痫前期的预测中具有一定价值。
Objective To investigate the role of PAPP-A in the prediction of hypertensive disorder complicating pregnancy and its relationship with placental pathology. Methods From January 2008 to December 2009, 2025 normal singleton pregnancies were enrolled in Zhongshan People’s Hospital Affiliated to Sun Yat-sen University from December 2008 to December 2006. The elbow venous blood samples were drawn from the first visit and applied Serum PAPP-A was detected by enzyme-linked immunosorbent assay and the pregnancy development and delivery status of these pregnant women were tracked. In the case of hypertensive disorder complicating pregnancy, the placenta tissues of preeclampsia and late-onset preeclampsia were collected during labor and the placental villi trophoblast cells were observed by HE staining. The proliferation of syncytiotrophoblast nodules and villus interstitial fibrosis And villus lesions. The placental tissues of normal pregnant women were randomly selected for pathological examination. RESULTS: A total of 2025 pregnant women were enrolled in this study. Among 1862 pregnant women, 88 cases of hypertensive disorder complicating pregnancy, 34 cases of preeclampsia requiring termination of pregnancy 34 weeks ago, and 34 weeks after termination of pregnancy 53 cases of late onset preeclampsia, 1687 normal pregnant women. The level of PAPP-A in peripheral blood of early-onset preeclampsia group was lower than that of the control group (P <0.05). There was no significant difference of PAPP-A in pregnancy-induced hypertension group and late-onset preeclampsia group and control group (P> 0.05). Compared with the control group, the pathological changes of placenta in gestational hypertension group, early-onset preeclampsia group and late-onset preeclampsia group were higher than those in the control group (P <0.05) Pathological changes occur in different types. Conclusions The placenta of pregnant women with hypertensive disorders of pregnancy has significant pathological changes. The decrease of PAPP-A at 12-16 weeks of gestation is related to the occurrence of preeclampsia and the pathological changes of placenta. It has the predictive value in the prediction of early onset preeclampsia A certain value.