Characteristic of vascular casting of human placental with preeclampsia and improvement of its blood-priming function with treatment of trigeminy drugs

doi:10.3877/cma.j.issn.1673-5250.2015.05.008

Objective

To investigate clinic significance of vascular casting of three-dimensional structure in human normal pregnancy and preeclampsia (PE) placental, and effect of improvement of its blood-priming function with treatment by trigeminy drugs as aspirin, nifedipine and salbutamol.

Methods

From August 2006 to August 2013, a total of 158 cases of pregnant women with PE were chosen as study subjects. According to their treatment strategies during delivery, they were divided into MgSO₄ group (n=54, antispasmodic treatment by MgSO₄), nifedipine group (n=48, treatment by nifedipine) and trigeminy drugs group (n=56, treatment by trigeminy drugs as aspirin, nifedipine and salbutamol). During the same period and in the same hospital, a total of 86 cases of normal and full-term pregnant women were included into normal group. Modified method of cast of placenta vascular was performed to cast placental vascular in 4 groups and their characteristics were analyzed. Intra erythrocyte Ca²⁺ (IECa²⁺ ) levels among 4 groups were measured and incidence of neonatal mild, severe asphyxia, fetal intrauterine growth restriction (FGR), and stillbirth among mild, severe PE pregnant women were analyzed by statistical methods. There were no significat differences among 4 groups in age, gestational age at delivery etc. (P>0.05).

Results

①The three dimensional structure in human placentas with normal and PE pregnancy were revealed. The volume of placental vascular bed in sever PE was statistically less than that in normal group [(102.8±46.1) mL vs (152.5±55.3) mL], and there was significance difference (t=2.707, P<0.01). ②IECa²⁺ levels in normal group were (1 101.7±89.2) FC before deliver stage, and (1 173.5±86.2) FC during deliver stage, and the difference was statistically different (t=2.843, P<0.01). However the IECa²⁺ levels of ones with sever PE in MgSO₄ group, nifedipine group and trigeminy drugs group showed statistically higher than those in normal group before, during and after deliver stage, respectively (t=2.118, 2.134, 2.003; 2.140, 2.079, 2.083; 2.721, 2.109, 2.152; P<0.05). ③The incidences of mild and sever asphyxia, FGR and stillbirth of neonatals of sever PE in trigeminy drugs group were all statistically lower than those in MgSO₄ group, and the differences were statistically different (χ²=64.10, 67.21, 65.31, 69.10; P<0.05), and slightly lower than those in nifedipine group, while the differences were not statistically different (P=0.636, 0.563, 0.336, 0.417).

Conclusions

The human placental vascular casts constructed in this study provide a valuable tool for understanding the structures of uteroplacental vasculatures. They can be used as models for visualizing placental structures and investigating placental functions in diseases such as PE. The level of IECa²⁺ can reflect the degree of asphyxia. Treatment by trigeminy drugs as aspirin, nifedipine and salbutamol has an important effect for improving outcomes of newborns by increasing the placenta blood-giving function.

Key words: Pre-eclampsia, Placenta, Vascular casting, Pregnancy outcome, Perfusion, blood, Asphyxia, Infant newborn

表1 MgSO₄组、硝苯地平组及三联组轻、重度PE患者分娩轻、重度窒息与FGR新生儿及死胎所占比例比较[例数(%)]

组别		例数	轻度窒息	重度窒息	FGR	死胎
MgSO₄组		54
	轻度PE	39	12(22.2)	1(1.9)	0 (0.0)	0(0.0)
	重度PE	15	5 (9.3)	5(9.3)	7(13.0)	2(3.7)
硝苯地平组		48
	轻度PE	28	4 (8.3)	1(2.1)	0 (0.0)	0(0.0)
	重度PE	20	5(10.4)	2(4.2)	6(12.5)	1(2.1)
三联组		56
	轻度PE	28	3 (5.4)	1(1.8)	0 (0.0)	0(0.0)
	重度PE	28	2 (3.6)	1(1.8)	4 (7.1)	0(0.0)

表1 MgSO₄组、硝苯地平组及三联组轻、重度PE患者分娩轻、重度窒息与FGR新生儿及死胎所占比例比较[例数(%)]

组别		例数	轻度窒息	重度窒息	FGR	死胎
MgSO₄组		54
	轻度PE	39	12(22.2)	1(1.9)	0 (0.0)	0(0.0)
	重度PE	15	5 (9.3)	5(9.3)	7(13.0)	2(3.7)
硝苯地平组		48
	轻度PE	28	4 (8.3)	1(2.1)	0 (0.0)	0(0.0)
	重度PE	20	5(10.4)	2(4.2)	6(12.5)	1(2.1)
三联组		56
	轻度PE	28	3 (5.4)	1(1.8)	0 (0.0)	0(0.0)
	重度PE	28	2 (3.6)	1(1.8)	4 (7.1)	0(0.0)

图1 正常妊娠和PE胎盘血管铸型(红色为V系血管，蓝色或白色为A系血管)[图1A：正常妊娠胎盘脐A、V系血管灌注铸型材料后标本(已固定，尚未腐蚀)特点。图1B：正常组胎盘血管A、V系血管走形、分支标本特点。图1C、1D：轻度PE胎盘血管铸型标本特点。图1E、1F：重度PE胎盘血管铸型标本特点]

表2 MgSO₄组、硝苯地平组、三联组轻度、重度PE患者及正常组孕妇产前、产时及产后第5天IECa^2＋水平比较(FC，±s)

组别		例数	产前	产时	产后第5天
MgSO₄组		54
	轻度PE	39	1 123.5±90.4	1 233.5±87.9^a	1 088.3±87.2
	重度PE	15	1 276.1±105.7^a	1 347.9±93.8^{a b c}	1 156.4±89.3^{a b}
硝苯地平组		48
	轻度PE	28	1 136.5±78.9	1 213.5±75.2^a	1 022.3±89.9^b
	重度PE	20	1 253.5±105.6^a	1 287.2±73.2^{a c}	1 137.7±80.9^{a b}
三联组		56
	轻度PE	28	1 126.3±75.7	1 232.4±77.7^a	1 112.9±85.3
	重度PE	28	1 246.1±95.7^a	1 268.9±90.1^{a c}	1 142.1±89.1^{a b}
正常组		86	1 101.7±89.2	1 173.5±86.2	1 073.7±80.5

表2 MgSO₄组、硝苯地平组、三联组轻度、重度PE患者及正常组孕妇产前、产时及产后第5天IECa^2＋水平比较(FC，±s)

组别		例数	产前	产时	产后第5天
MgSO₄组		54
	轻度PE	39	1 123.5±90.4	1 233.5±87.9^a	1 088.3±87.2
	重度PE	15	1 276.1±105.7^a	1 347.9±93.8^{a b c}	1 156.4±89.3^{a b}
硝苯地平组		48
	轻度PE	28	1 136.5±78.9	1 213.5±75.2^a	1 022.3±89.9^b
	重度PE	20	1 253.5±105.6^a	1 287.2±73.2^{a c}	1 137.7±80.9^{a b}
三联组		56
	轻度PE	28	1 126.3±75.7	1 232.4±77.7^a	1 112.9±85.3
	重度PE	28	1 246.1±95.7^a	1 268.9±90.1^{a c}	1 142.1±89.1^{a b}
正常组		86	1 101.7±89.2	1 173.5±86.2	1 073.7±80.5

表3 MgSO₄组、硝苯地平组及三联组重度PE患者分娩新生儿的轻、重度窒息，FGR和死胎的发生率比较[例数(%)]

组别	例数	轻度窒息	重度窒息	FGR	死胎
MgSO₄组	15	5(33.3)	5(33.3)	7(46.7)	2(13.3)
硝苯地平组	20	3(15.0)	2(10.0)	6(30.0)	1 (5.0)^a
三联组	28	2 (7.1)^a	1 (3.6)^a	4(14.2)^a	0 (0.0)^a

表3 MgSO₄组、硝苯地平组及三联组重度PE患者分娩新生儿的轻、重度窒息，FGR和死胎的发生率比较[例数(%)]

组别	例数	轻度窒息	重度窒息	FGR	死胎
MgSO₄组	15	5(33.3)	5(33.3)	7(46.7)	2(13.3)
硝苯地平组	20	3(15.0)	2(10.0)	6(30.0)	1 (5.0)^a
三联组	28	2 (7.1)^a	1 (3.6)^a	4(14.2)^a	0 (0.0)^a

[1]	Sibai BM. Hypertension. //Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: normal and problem pregnancies. 6th ed[M]. Philadelphia, Pa: Saunders Elsevier, 2012：35-45.
[2]	Pennington KA, Schlitt JM, Jackson DL, et al. Preeclampsia: multiple approaches for a multifactorial disease[J]. Dis Model Mech, 2012, 5(1):9-18.
[3]	尹格平，李云飞，朱彤宇，等. 正常妊娠和妊娠子痫前期患者外周血红细胞内钙含量测定及临床价值[J]. 中华围产医学杂志，2002, 5(1):18-20.
[4]	尹格平，李静，陈铭，等. 正常妊娠和妊娠子痫前期患者胎盘血管铸形[J]．中国体视学及图象分析杂志，2002, 2(7):107-110.
[5]	中国高血压防治指南修订委员会．中国高血压防治指南.3版[M]．北京：人民卫生出版社，2010: 54-59.
[6]	Salafia CM, Mininor VK, Pezzullo CP, et al. Intrauterine growth restriction in infants of less than thirty-two weeks' gestation: associated placental pathologic features[J]. Am J Obstet Gynecol, 1995, 173(9):1049-1053.
[7]	Khong TY, Pearce JM, Robertson WB. Acute atherosis in preeclampsia: maternal determinants and fetal outcome in the presence of the lesion[J]. Am J Obstet Gynecol, 1987, 157(2):360-363.
[8]	Starostina TA, Belokrinitskii DV, Kudriashova NM, et al. Circulating immunecomplexes and immunoglobulins A, M, and G in the mother fetus system in normal pregnancy and gestosis[J]. Akusk Ginekol Minekol Mosk, 1992, 1(1):19-22.
[9]	姚文兵．生物化学.7版[M]．北京：人民卫生出版社，2011：186-193.
[10]	Cunningham GC, Leveno KJ, Bloom SL，et al. 威廉姆斯产科学. 24th ed[M]. 北京：北京大学医学出版社，2015：21-33.
[11]	姚秀芝. 尼卡地平对重度子痫前期血压的控制[J]. 中国实用神经疾病杂志，2011, 14(4):78-79.
[12]	徐婷婷，邓春艳，周凡，等．低剂量阿司匹林对子痫前期高危人群预防效果的系统评价研究[J/CD]．中华妇幼临床医学杂志：电子版，2014，(5):585-593.
[13]	谢川，刘兴会．小剂量阿司匹林预防孕妇先兆子痫的指南解读[J/CD]．中华妇幼临床医学杂志：电子版，2015，(2):164-166.
[14]	Sibai BM.Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count[J]. Obstet Gynecol, 2004, 103(5 Pt 1):981-991.
[15]	李雪兰．重度子痫前期解痉及降压药物合理应用[J]. 中国实用妇科与产科杂志，2011, 27(12):908-910.

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