利凡诺引产对胎盘形态的影响:病理诊断误区分析  

Effect of rivanol-induced abortion on placental histology:pitfalls in pathological interpretations

作　　者：俞婷 钟芳芳 张丽虹 周先荣 陶祥 Yu Ting;Zhong Fangfang;Zhang Lihong;Zhou Xianrong;Tao Xiang(Department of Pathology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院病理科,上海200011

出　　处：《中华病理学杂志》2020年第8期782-787,共6页Chinese Journal of Pathology

摘　　要：目的探讨与利凡诺相关的胎盘继发病理改变,及其与原发胎盘病变的鉴别诊断。方法收集复旦大学附属妇产科医院病理科2017年1月至2019年10月收治的利凡诺引产病例85例,对照组为同时期孕周相匹配的自然流产或早产病例81例。病理诊断采用国际胎盘工作组2016年制定的Amsterdam共识所推荐的胎盘诊断术语,比较分析各类病变发生率的差异。结果利凡诺组孕妇年龄(30.5±4.1)岁(22~41岁),对照组(30.9±4.3)岁(22~44岁),两组胎龄分别为(23.2±3.5)周(17~35周),(23.3±2.8)周(17~33周)。利凡诺组的绒毛膜羊膜炎出现比率为91.8%,明显高于对照组(63.0%,P<0.05)。其中急性绒毛膜羊膜炎中母源性炎性反应期别分布与对照组相比差异有统计学意义,1期(绒毛膜板下炎)的比率分别为61.0%和28.6%(P<0.05),且炎性细胞更密集。急性蜕膜炎也更多见于利凡诺组(27.1%比13.6%,P<0.05)。而胎儿炎症反应(绒毛膜板血管炎和脐血管炎)、母体血管灌注异常(绒毛间隙狭窄/粘连、纤维素沉积、蜕膜动脉病、胎盘梗死、胎盘后血肿)以及胎儿血管灌注异常(绒毛间质出血、无血管绒毛)发生率的差异均无统计学意义。结论利凡诺引起的化学性绒毛膜羊膜炎表现为低期别及高级别的母源性炎症反应。利凡诺使用与胎儿的炎症反应、母体灌注异常、胎儿灌注异常的发生无明显相关性,故出现相应的形态学提示可能由原有的胎盘病变导致。Objective Placental pathology reflects the health condition of both mother and fetus during pregnancy,providing information about pathogenesis especially in adverse pregnancies,and may provide guidance on subsequent pregnancies.Description on the placental changes after long-term use of rivanol is lacking,and this evaluated the placental changes,with emphasis on the differential diagnosis from other primary placental lesions.Methods A total of 85 placentas from rivanol induced abortion submitted to the Department of Pathology,Obstetrics and Gynecology Hospital of Fudan University from Januaury 2017 to October 2019 were reviewed;and 81 gestational-age-matched cases of spontaneous abortion or preterm delivery during the same period were also included as the control group.Diagnoses were based on the consensus statement of 2016 Amsterdam Placental Workshop Group.Statistical differences were analyzed by individual diagnostic terms.Results The maternal age in rivanol group was(30.5±4.1)(range 22-41)years,compared with(30.9±4.3)(range 22-44)years in the control group.Gestational age was(23.2±3.5)(range 17-35)weeks and(23.3±2.8)(range 17-33)weeks in the rivanol and control groups.The incidence of chorioamnionitis in rivanol group was 91.8%,significantly higher than the control(63.0%,P<0.05);and there were more stage 1(subchorionic)maternal response in rivanol than in the control(61.0%vs.28.6%,P<0.05)groups.In addition,acute deciduitis was also more common in rivanol group(27.1%vs.13.6%,P<0.05).No significant difference was observed in fetal inflammatory responses(vasculitis of vessels in chorion plate and umbilical cord);maternal malperfusion(narrowing of intervillous space,increased intervillous fibrin deposition,decidual arteriopathy,villous infarction and retroplacental hematoma);and fetal malperfusion(villous stromal hemorrhage and avascular villi).Conclusions The chemical chorioamnionitis caused by rivanol is characterized by maternal inflammatory response of low stage and high grade.The use of rivanol has no ob

关 键 词：绒毛膜羊膜炎 引产 利凡诺 胎盘病理 Amsterdam胎盘诊断小组共识 

分 类 号：R719.3[医药卫生—妇产科学]