Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance.
Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance.
复制标题
急性绒毛膜炎和炎症炎：定义，病理特征和临床意义。
DOI：
10.1016/j.ajog.2015.08.040
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发表时间：
2015-10
影响因子：
9.8
通讯作者：
Kim YM
中科院分区：
文献类型：
--
作者：
Kim CJ;Romero R;Chaemsaithong P;Chaiyasit N;Yoon BH;Kim YM
胎盘的急性炎性病变包括中性粒细胞在器官不同部位的弥漫性浸润。这些病变包括急性绒毛膜炎、精索炎和绒毛膜血管炎，代表宿主（母体或胎儿）对羊膜腔内趋化性梯度的反应。虽然急性绒毛膜炎是母体宿主反应的证据，但精索炎和绒毛膜血管炎代表胎儿炎症反应。羊膜内感染通常被认为是急性组织学绒毛膜炎和精索炎的原因;然而，最近的证据表明，“无菌”羊膜内炎症，发生在没有可证实的微生物，但可以诱导的“危险信号”，往往与这些病变。在羊膜内感染的情况下，趋化因子（如白细胞介素-8和粒细胞趋化蛋白）建立了一个梯度，有利于中性粒细胞从母体或胎儿循环分别迁移到绒毛膜羊膜或脐带中。在细胞应激或细胞死亡过程中释放的危险信号也可以诱导中性粒细胞趋化因子的释放。绒毛膜炎的患病率是出生时胎龄的函数，并且在足月分娩的胎盘中存在3-5%，但在妊娠21-24周之间分娩的胎盘中存在94%。在自然分娩、早产、临床绒毛膜炎（早产或足月）或胎膜破裂的患者中发生率较高。真菌炎和绒毛膜血管炎是胎儿炎症反应综合征的标志，这种疾病的特征是胎儿血浆白细胞介素-6浓度升高，与早产即将发生、新生儿发病率较高（调整胎龄后）和胎儿多器官受累有关。该综合征是成人全身炎症反应综合征的对应物;然而，在胎儿中，它是短期和长期并发症（即新生儿败血症、支气管肺发育不良、脑室周围白质软化和脑瘫）的风险因素。本文就胎盘病理学中最常见的病变的定义、发病机制、分级分期及临床意义作一综述。提供了病变的插图和疾病机制的图表。
Acute inflammatory lesions of the placenta consist of diffuse infiltration of neutrophils at different sites in the organ. These lesions include acute chorioamnionitis, funisitis, and chorionic vasculitis, and represent a host response (maternal or fetal) to a chemotactic gradient in the amniotic cavity. While acute chorioamnionitis is evidence of a maternal host response, funisitis and chorionic vasculitis represent fetal inflammatory responses. Intra-amniotic infection has been generally considered to be the cause of acute histologic chorioamnionitis and funisitis; however, recent evidence indicates that “sterile” intra-amniotic inflammation, which occurs in the absence of demonstrable microorganisms but can be induced by “danger signals”, is frequently associated with these lesions. In the context of intra-amniotic infection, chemokines (such as interleukin-8 and granulocyte chemotactic protein) establish a gradient favoring the migration of neutrophils from maternal or fetal circulation into the chorioamniotic membranes or umbilical cord, respectively. Danger signals released during the course of cellular stress or cell death can also induce the release of neutrophil chemokines. The prevalence of chorioamnionitis is a function of gestational age at birth, and is present in 3-5% of placentas delivered at term, but in 94% of placentas delivered between 21-24 weeks of gestation. The frequency is higher in patients with spontaneous labor, preterm labor, clinical chorioamnionitis (preterm or term), or ruptured membranes. Funisitis and chorionic vasculitis are the hallmarks for the fetal inflammatory response syndrome, a condition characterized by an elevation in fetal plasma concentrations of interleukin-6, associated with the impending onset of preterm labor, a higher rate of neonatal morbidity (after adjustment for gestational age), and multi-organ fetal involvement. This syndrome is the counterpart of the systemic inflammatory response syndrome in adults; however, in fetuses, it is a risk factor for short- and long-term complications (i.e. neonatal sepsis, bronchopulmonary dysplasia, periventricular leukomalacia, and cerebral palsy). This article reviews the definition, pathogenesis, grading and staging, and clinical significance of the most common lesions in placental pathology. Illustrations of the lesions and diagrams of the mechanisms of disease are provided.