妊娠中期子宫动脉切迹与子痫前期发病风险及血清内皮损伤、胎盘灌注不足的相关性研究  

Correlation between mid-pregnancy uterine artery notch with preeclampsia related risk,serum endothelial injury and placental hypoperfusion

作　　者：郭雪晶[1] 倪鑫[2] 黄鹰[3] 古航[1] 

机构地区：[1]第二军医大学附属长海医院妇产科,上海200433 [2]第二军医大学生理教研室,上海200433 [3]上海市浦东新区妇幼保健院妇产科,上海201206

出　　处：《海南医学院学报》2016年第20期2455-2458,共4页Journal of Hainan Medical University

基　　金：国家自然科学基金资助项目(31271250)~~

摘　　要：目的：研究妊娠中期子宫动脉切迹与子痫前期发病风险及血清内皮损伤、胎盘灌注不足的相关性。方法：选择在上海市浦东新区妇幼保健院进行产前检查的单胎初产孕妇2 800例进行前瞻性研究,根据妊娠22-24周时子宫动脉切迹的情况分为切迹组和非切迹组,于孕24-30周、31-36周、37-41周时采集血清并测定血清中内皮损伤指标VEGF、PLGF、sFlt-1、sEng,行超声检查并测定子宫螺旋动脉的阻力指数（RI）、搏动指数（PI）,分娩后测定胎盘组织中凋亡分子的含量。结果：切迹组孕妇的子痫前期发生率显著高于非切迹组（P〈0.05）;孕24-30周、31-36周、37-41周时,切迹组孕妇血清中VEGF、PLGF的含量显著低于非切迹组（P〈0.05）,sFlt-1、sEng的含量显著高于非切迹组,子宫螺旋动脉的PI和RI均显著高于非切迹组（P〈0.05）;分娩后,切迹组胎盘组织中p57kip2、Bax、Caspase-3、Fas、FasL的含量显著高于非切迹组（P〈0.05）。结论：妊娠中期（妊娠22-24周）子宫动脉切迹的孕妇发生子痫前期的风险较高并且会造成母体内皮损伤、螺旋动脉重铸障碍、胎盘血流灌注不足。Objective：To study the correlation of mid-pregnancy uterine artery notch with preeclampsia related risk,serum endothelial injury and placental hypoperfusion.Methods：A total of 2 800 singleton primiparas who received antenatal examination in Maternal and Child Health Hospital of Pudong New Area Shanghai between April were selected and divided into notch group and non-notch group according to the uterine artery notch at 22-24 weeks of gestation,serum was collected at 24-30 weeks,31-36 weeks and 37-41 weeks of gestation respectively to determine endothelial injury indexes VEGF,PLGF,sFlt-1and sEng in serum,ultrasonography was conducted to determine uterine spiral arterial resistance index（RI）and pulsatility index（PI）,and the levels of apoptosis molecules in placenta tissue were determined after delivery.Results：Preeclampsia incidence of notch group was significantly higher than that of non-notch group;at 24-30 weeks,31-36 weeks and 37-41 weeks ofgestation,serum VEGF and PLGF levels of notch group were significantly lower than those of non-notch group,sFlt-1and sEng levels were significantly higher than those of non-notch group,and uterine spiral artery PI and RI were significantly higher than those of non-notch group;after delivery,p57kip2,Bax,Caspase-3,Fas and FasL levels in placenta tissue of notch group were significantly higher than those of non-notch group.Conclusion：The risk of preeclampsia is high in pregnant women with mid-pregnancy（22-24 weeks of gestation）uterine artery notch and it may cause maternal endothelial injury,spiral artery remodeling dysfunction and placental hypoperfusion.

关 键 词：子痫前期 子宫动脉切迹 内皮损伤 凋亡 

分 类 号：R714.25[医药卫生—妇产科学]