Dynamic modeling of uteroplacental blood flow in IUGR indicates vortices and elevated pressure in the intervillous space - a pilot study.
Dynamic modeling of uteroplacental blood flow in IUGR indicates vortices and elevated pressure in the intervillous space - a pilot study.
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IUGR 子宫胎盘血流的动态模型表明绒毛间隙存在涡流和升高的压力 - 一项初步研究。
DOI：
10.1038/srep40771
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发表时间：
2017-01-19
影响因子：
4.6
通讯作者：
Wall WA
中科院分区：
文献类型：
--
作者：
Roth CJ;Haeussner E;Ruebelmann T;Koch FV;Schmitz C;Frank HG;Wall WA
缺血性胎盘病是一个将宫内发育迟缓（IUGR）和先兆子痫（PE）与子宫螺旋动脉重塑不足联系起来的概念。子宫螺旋动脉重塑不足的流变学后果被假设为介导产科疾病的后期表现。然而，在绒毛间隙（IVS）的微观流变学不能在临床上检查和人类IVS的流变学动物模型不存在。因此，实施了计算机模拟方法以提供体内不可访问的数据。螺旋动脉的形态和IVS的流入区域进行了三维重建，为模拟提供了形态学阶段。先进的高端超级计算资源用于提供高空间分辨率的血流模拟。我们的模拟显示湍流血流（高速射流和漩涡）与IVS中的血压升高和绒毛表面处的壁剪切应力增加相结合，仅与螺旋动脉重塑不足相结合。子宫静脉的事后组织学分析显示IUGR胎盘中滋养层脱落增加的证据。我们的数据支持IVS的流变学改变是缺血性胎盘疾病与胎盘结构完整性和功能改变相关的机制。
Ischemic placental disease is a concept that links intrauterine growth retardation (IUGR) and preeclampsia (PE) back to insufficient remodeling of uterine spiral arteries. The rheological consequences of insufficient remodeling of uterine spiral arteries were hypothesized to mediate the considerably later manifestation of obstetric disease. However, the micro-rheology in the intervillous space (IVS) cannot be examined clinically and rheological animal models of the human IVS do not exist. Thus, an in silico approach was implemented to provide in vivo inaccessible data. The morphology of a spiral artery and the inflow region of the IVS were three-dimensionally reconstructed to provide a morphological stage for the simulations. Advanced high-end supercomputing resources were used to provide blood flow simulations at high spatial resolution. Our simulations revealed turbulent blood flow (high-velocity jets and vortices) combined with elevated blood pressure in the IVS and increased wall shear stress at the villous surface in conjunction with insufficient spiral artery remodeling only. Post-hoc histological analysis of uterine veins showed evidence of increased trophoblast shedding in an IUGR placenta. Our data support that rheological alteration in the IVS is a relevant mechanism linking ischemic placental disease to altered structural integrity and function of the placenta.