先天性心脏病胎儿胎盘病理改变与缺氧的相关性分析  

Placental pathology in fetuses with congenital heart disease and its association with hypoxia

作　　者：何巧 王渊 崔玲 王啸[1] 张慧娟[1,2] HE Qiao;WANG Yuan;CUI Ling;WANG Xiao;ZHANG Huijuan(Department of Pathology,International Peace Maternity and Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200030,China;Shanghai Key Laboratory of Embryo Original Diseases,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院病理科,上海200030 [2]上海市胚胎源性疾病重点实验室,上海200030

出　　处：《临床与实验病理学杂志》2024年第11期1193-1198,共6页Chinese Journal of Clinical and Experimental Pathology

基　　金：国家自然科学基金(81971404)。

摘　　要：目的探讨先天性心脏病(congenital heart disease,CHD)胎儿胎盘病理形态学改变,CHD胎盘与缺氧和线粒体相关功能蛋白异常的关系。方法收集52例CHD行引产手术的胎儿相关临床资料和胎盘组织,将CHD组和单纯唇腭裂不伴其他畸形引产儿(对照组)的胎盘切片行常规HE染色。采用免疫组化EnVision法检测胎盘滋养细胞中缺氧相关因子HIF-1α和线粒体相关因子COXⅠ、COXⅣ的表达,分析其临床特点与胎盘病理改变。结果约84.6%(44/52)的CHD组胎盘形态学异常,其中干绒毛包涵体占38.5%(20/52)、干绒毛间叶发育不良占23.1%(12/52)、干绒毛钙化占19.2%(10/52)、绒毛膜羊膜炎占32.7%(17/52)。与对照组相比,CHD组在干绒毛包涵体、绒毛膜羊膜炎发生频率中差异有统计学意义(P<0.05)。CHD组4个亚组之间,干绒毛间叶发育不良发生频率在复杂心脏畸形组中表达更高(P<0.05)。与对照组相比,CHD组HIF-1α蛋白表达明显增高(P<0.05),线粒体相关因子COXⅠ、COXⅣ蛋白降低(P<0.05),差异有统计学意义。结论伴CHD的胎儿胎盘病理形态学常见改变包括胎盘干绒毛包涵体、干绒毛间叶发育不良、干绒毛钙化和绒毛膜羊膜炎等。胎盘缺氧影响滋养细胞线粒体功能和ATP能量供应,可能在胎儿心脏-胎盘共生阶段对胎儿心脏发育产生一定影响。Purpose To explore the placental pathological changes in fetuses with congenital heart disease(CHD)and the presence of hypoxia and mitochondrial-related protein abnormalities in CHD placenta.Methods Clinical data and placental tissues from 52 fetuses undergoing induction of labor for CHD were collected.Placental sections from the CHD group and control group(fetuses with isolated cleft lip and palate without other malformations)were stained with routine HE staining for morphological observation under a microscope.Immunohistochemistry with EnVision method was used to detect the expression of hypoxia-related factor HIF-1αand mitochondrial-related factors COXⅠand COXⅣin placental trophoblastic cells.Its clinical characteristics and placental pathological changes were also analyzed.Results Approximately 84.6%(44/52)of the CHD group were accompanied by morphological changes,including stem villous inclusion bodies(38.5%,20/52),stem villous mesenchymal dysplasia(23.1%,12/52),and stem villous calcification(19.2%,10/52),chorioamnionitis(32.7%,17/52).Compared to the control group,the CHD group had a statistically significant difference in the occurrence of villous inclusion bodies and chorioamnionitis(P<0.05).Among the four CHD subgroups,the incidence of villous dysplasia was higher in the complex cardiac malformation subgroup(P<0.05).Compared to the control group,the CHD group showed significantly increased expression of HIF-1αprotein(P<0.05)and decreased expression of mitochondrial-related factors COXⅠand COXⅣ(P<0.05),with statistically significant differences.Conclusion There are some changes in placenta pathology in fetuses with CHD,including villous inclusion bodies,villous dysplasia,villous calcification,and chorioamnionitis.Placental hypoxia affects trophoblast mitochondrial function and ATP energy supply,which may have certain effects on fetal cardiac development during the fetal-heart-placenta symbiotic stage.

关 键 词：先天性心脏病 胎盘病理学 缺氧相关因子 线粒体相关因子 

分 类 号：R714.56[医药卫生—妇产科学]