妊娠肝内胆汁淤积症患者胎盘小叶绒毛血管系统的体视学研究  

Decreased Volume of Placental Lobular Villi Vessels in Patients with Intrahepatic Cholestasis of Pregnancy

作　　者：何毛毛[1] 刘正飞[2] 王晓东[3] 

机构地区：[1]广州医学院第一附属医院妇产科,广州510120 [2]四川省宜宾市第一人民医院妇产科,宜宾644000 [3]四川大学华西第二医院妇产科,成都610041

出　　处：《四川大学学报（医学版）》2011年第6期797-801,共5页Journal of Sichuan University(Medical Sciences)

基　　金：四川省科技支撑计划项目(编号:2009SZ0016)资助

摘　　要：目的观察妊娠肝内胆汁淤积症(ICP)胎盘小叶绒毛血管系统的体视学变化。方法随机选择于37～40周择期剖宫产终止妊娠的ICP与正常妊娠各10例,采用体视学方法测定胎盘小叶绒毛血管的容积及横切面积。结果 ICP组患者胎盘小叶绒毛血管容积〔(203.63±41.29)mL〕较正常组〔(287.81±69.81)mL〕下降约29%、血管横切面积〔(485087.6±104707.63)μm2 vs.(617119.5±158422.65)μm2〕下降约21%,其中含平滑肌绒毛血管容积〔(55.98±21.08)mL vs.(131.98±84.68)mL〕、横切面积〔(127576.2±54897.44)μm2 vs.(271809.6±162354.35)μm2〕下降明显(P<0.05),无平滑肌绒毛血管容积〔(155.91±30.52)mL vs.(161.48±75.80)mL〕、横切面积〔(341849.3±57043.88)μm2 vs.(342639.6±145717.51)μm2〕无明显下降(P>0.05);绒毛血管数量〔(365.20±96.73)vs.(313.40±137.51)〕无明显变化(P>0.05)。ICP组胎盘小叶绒毛血管容积(r=0.302)及含平滑肌绒毛血管容积(r=0.115)虽与发病孕周有正相关趋势,但P>0.05,胎盘小叶绒毛血管容积有随母血总胆酸(TBA)水平升高而下降的趋势(r=-0.413),但P>0.05。结论 ICP胎盘小叶绒毛血管容积下降约29%,主要由含平滑肌绒毛血管容量下降所致;ICP胎盘小叶绒毛血管容积与ICP发病孕周可能呈正相关、与母血TBA水平可能呈负相关关系尚不能确定。Objective To investigate the stereological changes of placental lobular villi vessels in patients with intrahepatic cholestasis of pregnancy（ICP）.Methods Stereological analysis on vessels volume and cross-areas of placental samples taken from 10 normal and 10 ICP patients at 37-40 week pregnancy were performed.Results Compared with normal pregnancy,the ICP patients had 29% reduction in the volume of placental lobular villi vessels（（287.81±69.81） mL vs.（203.63±41.29） mL）;21% reduction in the cross-areas（（617119.5±158422.65） μm2 vs.（485087.6±104707.63） μm2）;but no change in the numbers（（313.40±137.51） vs.（365.20±96.73）） of lobular villi vessels（P0.05）.Similarly,significant decreases in the volume（（131.98±84.68） mL vs.（55.98±21.08） mL） and cross-areas（（271809.6±162354.35） μm2 vs.（127576.2±54897.44） μm2） of placental lobular villi vessels with smooth muscles in the ICP patients were also found（P0.05）.But the volume（（161.48±75.80） mL vs.（155.91±30.52） mL） and cross-areas（（342639.6±145717.51） μm2 vs.（341849.3±57043.88） μm2） of placental lobular villi vessels without smooth muscle in the ICP patients remained unchanged（P0.05）.The placental lobular villi vascular volume was negatively correlated（r=-0.413） with the maternal plasma level of total bile acid（TBA）（P0.05）,and positively correlated（r=0.302） with the onset week of ICP（P0.05）.But the correlations were not statistically significant.Conclusion Patients with ICP have 29% reduction in placental lobular villi vascular volume,which is mainly a result of reduction of lobular villi vessels with smooth muscles.The placental lobular villi vascular volume is possibly negatively correled with maternal plasma level of TBA,and positively correled with the onset week of ICP.

关 键 词：胆汁淤积症 肝内 妊娠 体视学 胎盘 血管 

分 类 号：R714.2[医药卫生—妇产科学]