| Objective:Pre-eclampsia is a hypertensive disorders in pregnancy, severe pre-eclampsia is a relative severe stage of the disease.All organs may be involved, high blood pressure, urine protein and edema are the main clinical manifestations.This mainly results to the maternal and child mortality and morbidity. According to the severity of the blood pressure and urine protein, it can be divided into mild and severe pre-eclampsia. However, in addition to the eclampsia, the severe pre-eclampsia has a serious threat to the mother and child. As early as in the1980s, American scholars had already proposed this concept of the early onset of severe pre-eclampsia (EOSP).Most scholars in China attribute the34weeks as a dividing line,the cases pathogenesis after34weeks belong to the late-onset severe preeclampsia(LOSP). In recent years, with the increasing emphasis on EOSP, we found that it progress of the rapidly and can easily lead to the progression of the disease even death of the maternal and fetal.While the etiology and pathogenesis is unclear, the placental ischemia and hypoxia and systemic endothelial cell injury are most approved. Placental tissue is often used as a starting point for research. Here we want to investigate the expression of CD105and VEGF in normal pregnancy and severe preeclampsia group placental tissue, and to analyse the neonatal and perinatal outcomes in EOSP and LOSP. We use echocardiography to know the changes of cardiac structure and function, which is helpful to assess changes in the microscopic pathology and cardiac system, and can provide further guidance for clinical work.Methods:Materials:Collecting placentas from99cases of pregnants with severe preeclampsia hospitalized from June2011to December2011in Tianjin Medical University Hospital,which have received the informed consent of all patients.After the delivery immediately cut an area of placenta about l.Ocm×1.0cm in the center of the placenta where the umbilical cord attached,and avoiding the infarction and calcification.We use saline rinsed sufficiently,and put into10%formalin to fix,then embedded with paraffin,and sectioned serially for immunohistochemistry.Experimental groups:Severe preeclampsia group:According to the diagnostic criteria of the7th edition of the "Obstetrics and Gynecology",60cases with severe preeclampsia were selected and be divided into two groups according to the gestational age of onset:(1)<34weeks early onset severe preeclampsia the group (EOSP group),30cases;(2)≥34weeks for late-onset severe preeclampsia (LOSP group),30cases.Control group:Collecting35cases delivery in hospital in the same period as a control group,who is in preterm and full-term delivery and without complications.Experimental methods:Conventionally dehydrate all specimens,then embed in paraffin and serially sectioned to4μm thick.After HE staining to determine the quality of slice,then do the immunohistochemical detection with S-P to at the same time and under the same condition,to know the expression of VEGF and CD105in preeclampsia and normal groups and analyse the correlation.At the same time we use Doppler echocardiography to measure the atrioventricular cavity size, myocardial thickness, left ventricular ejection fraction, E/A ratio and pericardial effusion,to assess the change of cardiac structure and function and the relation with the severity of disease.Results:(1)The positive rate of expression of VEGF is lower in preeclampsia group than the control group,and the difference is statistically significant (P<0.05);but between the EOSP and LOSP groups there is no significant difference(P>0.05).(2)The positive rate of expression of CD105is higher in preeclampsia group than the control group,and the difference is statistically significant (P<0.05);and the expression in the EOSP group is higher than LOSP groups,and there is significant difference(P<0.05).(3)The positive expression of VEGF and CD105in preeclampsia group is a significant negative correlation(r=-0.278,P=0.032).(4)Adverse neonatal outcomes in preeclampsia group was significantly higher than the control group:there are22cases of fetal growth restriction (FGR) in the preeclampsia group,while in control group no cases occurred. In EOSP group the average birth weight is1453g, mild asphyxia occurs in6cases, fetal growth restriction (FGR) in12cases; in LOSP group, the average birth weight of newborns is2447g, no neonatal asphyxia, the FGR occurred in10cases.(5)The ultrasound examination in preeclampsia group showed:Cardiac structural changes are mainly left atrial enlargement, changes in heart function are mainly diastolic dysfunction, handful patients complicated left ventricular systolic dysfunction,and more patients with a small amount of pericardial effusion.The atrioventricular cavity diameters and left ventricular systolic function were statistically different between EOSP and LOSP groups(P<0.05). Conclusion:High expression of CD105is in preeclampsia groups,while high expression of VEGF is in normal groups.CD105may reduce the expression of VEGF by some target genes,thus affecting the reconstruction of network of blood vessels, then leading to placental ischemia,which involved in the occurrence and development of preeclampsia, and the lack of blood supply to fetus results to a variety of adverse outcomes. |
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