Late sporadic miscarriage is associated with abnormalities in spiral artery transformation and trophoblast invasion
Late sporadic miscarriage is associated with abnormalities in spiral artery transformation and trophoblast invasion
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DOI：
10.1002/path.1927
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发表时间：
2006-03-01
影响因子：
7.3
通讯作者：
Robson, SC
中科院分区：
文献类型：
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作者：
Ball, E;Bulmer, JN;Robson, SC
滋养层细胞侵入子宫蜕膜和子宫肌层，以及螺旋动脉转化，对于正常妊娠的发展是必不可少的;这一过程在先兆子痫、胎儿生长受限和早产中受损。晚期流产与滋养层浸润减少和螺旋动脉转化有关的假设，在大量的晚期胚胎流产的胎盘床活检标本中进行了验证，这些标本中含有蜕膜和子宫肌层（>= 13周妊娠; n = 26; n = 96螺旋动脉）和妊娠期匹配的超声测定的正常妊娠（n = 74; n = 236螺旋动脉）。使用抗生物素蛋白-生物素过氧化物酶技术对细胞角蛋白、结蛋白和血管性血友病因子进行免疫染色，分别检测滋养层、子宫肌层、血管平滑肌和内皮。采用逻辑回归模型评估和分析滋养细胞浸润和螺旋动脉转化的个体特征。与正常妊娠相比，晚期流产患者子宫肌层螺旋动脉血管内（4% vs. 31%，p = 0.001）和壁内滋养层（76% vs. 88%，p = 0.05）减少，纤维素样改变范围较小（4% vs. 18%，p = 0.01）。相反，蜕膜螺旋动脉中的血管内滋养层细胞增加（40% vs. 66%，p = 0.04）。这些发现表明，与先兆子痫一样，晚期散发性流产可能与滋养层浸润减少和子宫肌层螺旋动脉转化不足有关。版权所有（c）2006大不列颠和爱尔兰病理学会。由John Wiley & Sons有限公司出版
Trophoblast invasion of uterine decidua and myometrium, and spiral artery transformation, are essential for the development of normal pregnancy; this process is impaired in pre-eclampsia, fetal growth restriction, and pre-term labour. The hypothesis that late miscarriage is associated with reduced trophoblast invasion and spiral artery transformation was tested in a large series of placental bed biopsies containing decidua and myometrium from late, karyotyped, embryonic miscarriage (>= 13 weeks' gestation; n = 26; n = 96 spiral arteries) and gestationally matched ultrasound-dated normal pregnancies (n = 74; n = 236 spiral arteries). Cryostat sections were immunostained using an avidin-biotin peroxidase technique for cytokeratin, desmin, and von Willebrand factor to detect trophoblast, myometrium, and vascular smooth muscle and endothelium, respectively. Trophoblast invasion and individual features of spiral artery transformation were assessed and analysed using a logistic regression model. Compared with normal pregnancy, myometrial spiral arteries in late miscarriage showed reduced endovascular (4% vs. 31%, p = 0.001) and intramural trophoblast (76% vs. 88%, p = 0.05), and less extensive fibrinoid change (4% vs. 18%, p = 0.01). In contrast, endovascular trophoblast in decidual spiral arteries was increased (40% vs. 66%, p = 0.04). These findings suggest that, in common with pre-eclampsia, late sporadic miscarriage may be associated with reduced trophoblast invasion and inadequate transformation of myometrial spiral arteries. Copyright (c) 2006 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.