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目的 了解胎儿生长受限 (fetal growth restriction,FGR)者胎盘病理改变与胎盘组织中基质金属蛋白酶 9(MMP- 9)表达水平变化的关系。 方法 选取我院 2 0 0 1年 1～ 9月分娩的 FGR患者及正常妊娠妇女胎盘各 30例 ,常规 HE染色及 PAS染色 ,观察胎盘形态学变化。另取 FGR及正常胎盘各 5例 ,5 0 0 H型透射电镜观察。利用免疫组化的方法对胎盘组织切片染色 ,观察 FGR胎盘绒毛组织滋养细胞 MMP- 9表达情况。 结果 FGR组中 2 2例胎盘有明显病理改变 ,发生率为73.33% ,FGR组绒毛间质纤维化及纤维蛋白样坏死绒毛 (6 3.3% )、绒毛血管减少 (70 .0 % )、合体结节增生 (4 3.3% )、细胞滋养细胞增生 (5 0 .0 % )均明显高于对照组 (分别为 6 .7%、10 .0 %、3.3%和13.3% ) (P<0 .0 1) ;电镜发现蜕膜螺旋动脉内皮损伤 ,管腔狭窄 ,部分动脉末端闭塞。有病理改变的胎盘绒毛滋养细胞 MMP- 9的表达 (18.2 % )明显低于无病理改变胎盘 (75 .0 % ) ,差异有非常显著性(P<0 .0 1)。 结论 FGR时胎盘发生了明显的病理改变 ,这种病理改变与胎盘中 MMP- 9的异常表达密切相关。
Objective To investigate the relationship between placental pathological changes and the expression of matrix metalloproteinase 9 (MMP-9) in placenta from fetal growth restriction (FGR). Methods Placenta of 30 FGR patients and normal pregnant women who were delivered from January to September in 2001 in our hospital were selected. The histopathological changes of placenta were observed by HE staining and PAS staining. Another FGR and normal placenta in 5 cases, 500 H-type transmission electron microscopy. Placenta tissue sections were stained with immunohistochemistry to observe the expression of MMP-9 in the placental villi of FGR. Results There were obvious pathological changes in placenta of 22 cases in FGR group, the incidence was 73.33%. FGR group had villus mesenchymal fibrosis and fibrinous necrosis villus (6.33%), villous vessels reduced (70.0%), (4.33%) and cyto-trophoblast proliferation (50.0%) were significantly higher than those in the control group (6.7%, 10.0%, 3.3% and 13.3% respectively) (P < 1); electron microscopy revealed decidual spiral artery endothelial injury, stenosis, partial arterial occlusion. The pathological changes of placental villi trophoblast cells MMP-9 expression (18.2%) was significantly lower than the non-pathological changes of the placenta (75.0%), the difference was significant (P <0.01). Conclusion The placenta has obvious pathological changes during FGR. The pathological changes are closely related to the abnormal expression of MMP-9 in placenta.