| Objective:Severe preeclampsia(severe preeclampsia, s PE) is one of the common complications of pregnancy, due to severe preeclampsia is one of the important cause of maternal and perinatal death, scholars study its pathophysiological mechanism both at home and abroad. At present, the theory for severe preeclampsia pathophysiological mechanism is numerous, but the etiology and pathogenesis is still unclear, Many scholars believe that its etiology and pathogenesis are the following hypothetical factors: The placenta shallow implantation, Vascular endothelial damage factors, immune factors,genetic factor and so on. It is generally believed that the key link of the happened in severe preeclampsia are the deficiency of invasive ability of sertoli cell. In the process of sertoli cell invasion, Matrix metalloproteinases play an important role, especially the matrix metalloproteinases-9(martix metalloproteinases-9, MMP-9), it can degrade the extracellular matrix(extracellular matrix, ECM) with high efficiency, participate in the uterine spiral artery reconstruction and placenta formation. Umbilical artery is the only way to fetus from maternal nutrition, through the closely monitoring the indicators during pregnancy, we can intuitive to understand that due to the recasting of vascular disorders, whether the womb-placenta-fetal circulation appear the abnormal change or not, and the degree of lesions. Studies have shown that real-time monitoring of umbilical artery blood flow changes in ultrasound, can improve the end of the high-risk pregnant women, reduce the perinatal mortality. This study by testing the normal group, early-onset severe preeclampsia group, late-onset severe preeclampsia group of placent tissue expression of MMP-9, to explore its role in preeclampsia, at the same time combined ultrasound hemodynamic indexes, research the interrelation of perinatal outcomes and the relationship between each other. Accordingly to provide theoretical basis for prevention and early detection of the disease. Materials and Methods1. Study object:(1) Experimental group: Selecting 54 cases severe preeclampsia patients, which were collected in the third affiliated hospital of zhengzhou university hospital from April 2014 to December 2014, 24 patients with early onset severe preeclampsia(early onset severe preeclampsia group), 30 patients with late onset severe preeclampsia(late onset severe preeclampsia group).(2) Control group: Selecting 32 cases of normal pregnant women.2. Study methods:(1) Using color doppler ultrasonic to detect the prenatal fetal umbilical artery blood flow mechanics indexes of three groups: S/D value, the value of PI and the value of RI.(2) Using immunohistochemical method to detect the expression of MMP-9 in the placenta tissue localization of three groups of pregnant women.(3) Using Real-Time q PCR to detect the expression of MMP-9m RNA.(4) The perinatal outcomes of three groups of pregnant women were followed: Apagr score, the placenta weight, neonatal body weight, body length.3. Statistical methods: SPSS19.0 statistical software was used to ANOVA analysis all the data. Kruskal-Wallis analysis was used to compare the data which do not conform to the normal distribution. Correlation analysis use Pearson correlation analysis. Statistical signifcance was considered when P < 0.05. Results1. The comparison of the general cases of pregnant woman: compare three groups of pregnant women basic information(age, pregnancy time, production time), the differences had no statistical significance(P > 0.05).2. The comparison of three groups of fetal umbilical artery blood flow index: the S/D value of three groups are 3.79 ± 0.569, 3.29 ± 0.637, 2.12 ± 0.268, the PI value of three groups are 1.87 ± 0.397, 1.59 ± 0.345, 0.80 ± 0.132, the RI value of three groups are 1.06 ± 0.252, 1.07 ± 0.37, 0.55 ± 0.065. Respectively to compare three sets of fetal S/D value, PI value and RI value, the differences had no statistical significance(P < 0.05).3. The comparison of three groups of pregnant women in the placenta tissue of MMP-9 protein expression: Three groups of pregnant women in the placental tissue has different levels of the expression of MMP-9, mostly located in sertoli cell cytoplasm, In decidual cells, mesenchymal cells and vascular endothelial cells also have a little expression. In Early-onset and late-onset group, the expression of MMP-9 are 0.14 ± 0.012, 0.17 ± 0.011, were significantly lower than the expression of control group 0.35 ± 0.03. Separately compared, the differences had statistical significance(P < 0.05); The amount of the expression of MMP-9 early onset group compared with late onset group, is significantly reduced, the differences had statistical significance(P < 0.05).4. The comparison of the m RNA expression of MMP-9 in placenta tissue between three groups of pregnant women: The m RNA expression of MMP-9 levels in placenta tissue in early-onset and late-onset group were 0.583 ± 0.243, 0.611 ± 0.241, they are lower than the control group 0.999 ± 0.555, pairwise comparison, the differences had statistical significance(P < 0.05), but, when early-onset group compared with the late onset group, the differences had no statistical significance(P > 0.05).5. The relationship between the expression of MMP-9 m RNA and umbilical artery S/D value, the placenta weight, neonatal weight: Placental tissue m RNA expression of MMP-9 levels and umbilical artery blood flow index S/D value was significantly negative correlation(r =- 0.338,P < 0.01), placental tissue m RNA expression of MMP-9 levels and the placenta weight was positive correlation(r = 0.342,P < 0.01), Placental tissue m RNA expression of MMP-9 levels and the placenta weight was positive correlation(r = 0.310,P < 0.01). Conclusions:1. The earlier the onset of preeclampsia, the lower the level of the expression of MMP- 9 in planet will be.2. The variation of umbilical artery blood flow index can respond the expression of MMP-9 levels in planet.3. The expression of MMP-9 in planet was hightly related to the placental and the neonatal weight. |
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