摘要
目的探讨补体活化对抗磷脂抗体(APLA)介导的妊娠合并系统性红斑狼疮(SLE)胎儿不良结局的影响。方法回顾性选择2016年5月至2018年5月安徽医科大学第一附属医院收治的28例妊娠合并SLE患者产后胎盘作为研究组,另选同期来我院住院分娩的28例正常妊娠孕妇产后胎盘作为对照组。比较2组孕妇妊娠结局,同时采用苏木精-伊红染色对2组孕妇胎盘进行常规病理检查,采用免疫组织化学方法检测2组孕妇胎盘组织中C1q、C4d表达。结果2组胎儿宫内窘迫发生率、新生儿窒息发生率、胎儿畸形发生率比较(10.71%vs.3.57%、7.14%vs.0、3.57%vs.0),差异无统计学意义(P>0.05);研究组胎盘重量、新生儿出生体重、正常分娩率分别为(350.10±125.68)g、(2.08±0.77)kg、10.71%,明显低于对照组[(500.01±156.66)g、(3.39±0.57)kg、96.43%],差异有统计学意义(P<0.05);研究组自然流产或死胎发生率为28.57%,明显高于对照组3.57%,差异有统计学意义(P<0.05)。对照组胎盘组织未见绒毛梗死及炎性细胞浸润,有不同程度灶性钙化和退变;研究组胎盘组织可见不同程度的绒毛梗死及炎细胞浸润,且有不同程度灶性钙化和退变。研究组C4d阳性率100%和阳性积分(3.46±0.87)分,均显著高于对照组0、0分,差异有统计学意义(P<0.05);研究组C1q阳性率和阳性积分与对照组比较[100%vs.100%;(2.68±0.78)分vs.(2.76±0.88)分],差异无统计学意义(P>0.05)。结论在补体活化影响APLA介导的妊娠合并SLE患者妊娠过程中,C4d可作为预测妊娠不良结局的生物标志物,为改善妊娠结局及提高产科质量制定更好的预防和治疗策略。
Objective To investigate the effect of complement activation on antiphospholipid antibody(APLA)associated maternal-fetus outcome of pregnancy complicated with systemic lupus erythematosus(SLE).Methods Twenty-eight cases of pregnant women complicated with SLE(study group)and 20 cases of normal pregnant women(control group)from May 2016 to May 2018 in the First Affiliated Hospital of Anhui Medical University were selected retrospectively.The placenta stained by hematoxylin eosin(HE)and maternal-fetus outcome of two groups were compared.Meanwhile,the C1 q and C4 d of the pregnant women were examined by placenta pathology and immunohistoehemistry(IHC).Results There was no statisticauy significant difference in the incidence rate of intrauterine distress,neonatal asphyxia,and fetal malformation between the two groups(10.71%vs.3.57%,7.14%vs.0,3.57%vs.0,P>0.05).The placenta weight,neonatal birth weight,and normal delivery rate were(350.10±125.68)g,(2.08±0.77)kg,10.71%,which were significantly lower in the study group than in the control group[(500.01±156.66)g,(3.39±0.57)kg,96.43%],the differences were statistically significant(P<0.05).The incidence of spontaneous abortion or stillbirth in the study group 28.57%was significantly higher than that of the control group 3.57%,the difference was statistically significant(P<0.05);Both groups had different degrees of focal calcification and degeneration,while the invasive infarcts and inflammatory cell infiltration in the placenta only occurred in the study group.The positive rate and positive score of C4 d in the study group were 100%,(3.46±0.87)scores,which were significantly higher than those in the control group(0,0 scores),the difference was statistically significant(P<0.05).while no statistic difference was found in the positive rate and positive score of C1 q[100%vs.100%;(2.68±0.78)scores vs.(2.76±0.88)scores,P>0.05].Conclusion C4 d can be used as a biomarker for predicting adverse pregnancy outcomes in the context of complement activation affecting APLA-mediated
作者
段灿灿
杨媛媛
孙美果
尹宗智
李晓兰
DUAN Can-can;YANG Yuan-yuan;SUN Mei-guo(Department of Obstetrics and Gynecology,First Affiliated Hospital of Anhui Medical University,Hefei Anhui 232001,China)
出处
《临床和实验医学杂志》
2020年第21期2309-2313,共5页
Journal of Clinical and Experimental Medicine
基金
安徽省高等学校省级质量工程项目(编号:2017jyxm1084)。
关键词
妊娠
系统性红斑狼疮
补体活化
抗磷脂抗体
妊娠结局
Pregnancy
Systemic lupus erythe-matosus
Complement activation
APLA
Maternal-fetus outcome
