Villous trophoblast abnormalities in extremely preterm deliveries with elevated second trimester maternal serum hCG or inhibin-A
Villous trophoblast abnormalities in extremely preterm deliveries with elevated second trimester maternal serum hCG or inhibin-A
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DOI：
10.1016/j.placenta.2011.01.018
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发表时间：
2011-04-01
期刊：
影响因子：
3.8
通讯作者：
Keating, S.
中科院分区：
文献类型：
--
作者：
Fitzgerald, B.;Levytska, K.;Keating, S.
妊娠15-20周时测量的孕妇产前筛查标志物hCG和抑制素-A水平升高，增加了随后发生严重子痫前期和宫内生长受限(IUGR)的风险。由于这两个标记物都是由合体滋养层细胞产生的，我们检验了这样的假设，即这些升高是由于绒毛滋养层室的加速分化所致。我们对我们胎盘诊所12例胎盘总hCG和/或抑制素-A水平为中位数3.0倍的孕妇进行了回顾性研究，并将他们的胎盘病理结果与24例胎龄匹配的对照组进行了比较。形态计量学分析显示，与对照组相比，病例组Ki67阳性细胞滋养层细胞核体积比减少41%(学生t检验，p=0.028)。远端绒毛发育不良在病例组(10/12)明显高于对照组(4/24)；Fisher‘s精确检验，p=0.002。波状合胞结的形成在病例组(9/12)明显多于对照组(1/24)；Fisher‘s Exact检验，p<；0.0001。WLSK的形成与DVH有关，是由于衰老/凋亡的合体滋养层细胞核沿着合体核组织固有的线聚集所致。我们的数据支持这一假设，即妊娠中期孕妇血清总hCG和/或抑制素-A水平的升高可能是绒毛细胞滋养层细胞过早加速分化的结果。合体滋养细胞随后的病理发现可能使妊娠面临严重子痫前期和IUGR的风险。(C)爱思唯尔有限公司出版的2011年。
Elevated levels of the maternal prenatal screening markers hCG and inhibin-A, measured at 15-20 weeks gestation, increase the subsequent risk of severe pre-eclampsia and intra-uterine growth restriction (IUGR). Since both markers are produced by syncytiotrophoblast, we tested the hypothesis that these elevations were due to accelerated differentiation of the villous trophoblast compartment. We performed a retrospective study of 12 cases from our Placenta Clinic with total hCG and/or inhibin-A levels of >= 3.0 multiples of the median that subsequently delivered by 28 weeks gestation and compared their placental pathology findings with 24 gestational age-matched controls. Morphometric analysis demonstrated a 41% reduction in the volume ratio of Ki67 positive cytotrophoblast nuclei to total trophoblast in cases vs controls (Student's T-test; p = 0.028). Distal villous hypoplasia (DVH) was significantly more common in cases (10/12) than controls (4/24); Fisher's exact test, p = 0.002. Wave-like syncytial knot (WLSK) formation was significantly more common in cases (9/12) than controls (1/24); Fisher's exact test, p < 0.0001. WLSK formation was associated with DVH and resulted from accumulation of senescent/apoptotic syncytiotrophoblast nuclei along inherent lines of syncytial nuclear organization. Our data support the hypothesis that elevated second trimester maternal serum levels of total hCG and/or inhibin-A may result from premature accelerated differentiation of the villous cytotrophoblasts. The subsequent pathologic findings in the syncytiotrophoblast could render the pregnancy at risk of severe preeclampsia and IUGR. (C) 2011 Published by Elsevier Ltd.