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目的检测α-平滑肌肌动蛋白(α-SMA)在重度子痫前期(SPE)患者胎盘基底板梗塞灶和绒毛聚集区的表达,探讨其在SPE发病机制中的作用。方法采用免疫组织化学、RT-PCR和蛋白印迹法,检测2011年1月至2012年3月吉林大学第二医院产科40例SPE患者(早发型和晚发型SPE各20例)及38例健康妊娠者(对照组)胎盘基底板中α-SMA的分布及其mRNA和蛋白表达水平。结果早发型SPE胎盘多灶梗塞发生率显著高于早期对照组(P=0.000)和晚发型SPE(P=0.000);早发型SPE胎盘多灶绒毛聚集发生率显著高于早期对照组(P=0.000);晚发型SPE胎盘多灶绒毛聚集发生率显著高于晚期对照组(P=0.003)。α-SMA主要表达于基底板绒毛内的血管平滑肌细胞和绒毛间质的成纤维母细胞的胞浆和胞膜;其表达量在正常部位、晚期、过渡期、早期梗塞灶或绒毛聚集区依次增加(P<0.01),并与相应部位表达α-SMA的细胞数量呈正相关;在小绒毛、中绒毛和大绒毛中也同样依次增加(P<0.01)。结论α-SMA在重度子痫前期胎盘基底板梗塞灶和绒毛聚集灶中表达增加。胎盘基底板中多灶梗塞和多灶绒毛聚集可通过直接阻塞血管及通过其内表达α-SMA的细胞收缩作用加重阻断局部血流及对子宫牵张,可能参与SPE的发病过程。
Objective To investigate the expression of α-smooth muscle actin (α-SMA) in focal infarction and villus of placenta basalis in patients with severe preeclampsia (SPE) and its role in the pathogenesis of SPE. Methods 40 cases of SPE patients (20 cases of early-onset and late-onset SPE) and 38 cases of healthy pregnancy from January 2011 to March 2012 in Department of Obstetrics and Gynecology of the Second Hospital of Jilin University were detected by immunohistochemistry, RT-PCR and Western blotting. (Control group) distribution of α-SMA in placenta basal plate and its mRNA and protein expression levels. Results The incidence of multifocal infarction in early-onset SPE placenta was significantly higher than that of the early control group (P = 0.000) and late-onset SPE (P = 0.000). The incidence of polycystic villi in early-onset SPE was significantly higher than that in the early control group (P = 0.000). The incidence of multifocal villi in late-onset SPE placenta was significantly higher than that in the late control group (P = 0.003). α-SMA is mainly expressed in the cytoplasm and membrane of vascular smooth muscle cells and villous interstitial fibroblasts in the basal plate villus; the expression of α-SMA in the normal part, late stage, transitional phase, early infarction or villus aggregation zone (P <0.01), which was positively correlated with the number of cells expressing α-SMA in the corresponding sites, and also increased in small villi, middle villi and large villi (P <0.01). Conclusion The expression of α-SMA in infarction and villus of placenta basalis in severe preeclampsia increased. Multi-focal infarction and multifocal villus aggregation in the basilar plate of the placenta may block the local blood flow and uterine distraction, which may be involved in the pathogenesis of SPE through the direct blockage of blood vessels and the cell contraction by expressing α-SMA in it.