Correlation Between Placental Growth Factor Levels,perinatal Outcomes And Placenta Pathology In Patients With Preeclampsia

Objective This study aimed to investigate the relationship between plasma placental growth factor(PLGF)levels and perinatal outcomes,placental important factors and placental pathology in patients with preeclampsia(PE).By studying placental pathological,placental PLGF,soluble tyrosine kinase receptor-1(s Flt-1)and P27 protein to reveal causes.This confirms that plasma PLGF in PE patients have clinical value for predicting perinatal outcomes.The management of PE patients based on plasma PLGF levels can help improve the perinatal outcomes,especially in reducing the occurrence of fetal growth restriction(FGR).Methods1.Single-pregnancy with PE who had undergone cesarean section termination of pregnancy were enrolled in the study.At the same time,single-pregnancy women with normal blood pressure were enrolled in the control group.According to the gestational ages of labor and plasma PLGF levels,they were divided into the preterm PE1 group(plasma PLGF levels ≥ 12pg/m L,n=51),the preterm PE2 group(plasma PLGF levels < 12pg/m L,n=72),the term PE1 group(plasma PLGF levels ≥12pg/m L,n=126),the term PE2 group(plasma PLGF levels < 12pg/m L,n=40),the preterm group(plasma PLGF levels ≥ 12pg/m L,n=34)and the term group(plasma PLGF levels ≥ 12pg/m L,n=112).Then the clinical biochemical indicators and perinatal outcomes of those women were compared in preterm or term groups,respectively.2.The placental tissues were randomly collected from the three preterm groups at a 3:1 ratio.Then placental hematoxylin-eosin and immunohistochemical staining of PLGF,s Flt-1 and P27 protein were performed.Image-pro plus 6.0 image processing system was used to calculate the average optical density(AOD)of PLGF,s Flt-1 and P27 proteins in the placenta.The pathological changes of placenta and the expression of PLGF,s Flt-1 and P27 protein were compared between the groups.Results The first part:The correlation between plasma PLGF levels and perinatal outcomes in patients with preeclampsia1.Results in preterm group:(1)Compared with the preterm PE1 group,plasma BUN,Cr,c Tn I,24-hour proteinurine and random proteinurine were significantly higher,but the gestational ages of delivery and plasma ALB levels were significantly lower than these in the preterm PE2 group.(2)In the preterm PE2 group,disease incidence such as maternal complications,hypoproteinemia,neonatal complications and neonatal sepsis was significantly higher than in the preterm PE1 group.(3)In the preterm PE2 group,1-minute Apgar score of newborns,birthweight,head circumference,bust and length were significantly lower than in the preterm PE1 group.However,the days in NICU,head to chest ratio and LAC were significantly higher than those in the preterm PE1 group.2.Results in term group:(1)In term PE2 group,plasma ALT,BUN,Cr,UA,CK,LDH,BNP,24-hour proteinurine and random proteinurine were significantly higher,but the plasma ALB levels were significantly lower than those in the term PE1 group.(2)The incidence of maternal complications and FGR in term PE2 group was significantly higher than those in term PE1 group.(3)In term PE2 group,newborn birthweight and bust were significantly lower,but the head to chest ratio of the newborn was significantly higher than those in the term PE1 group.The second part:The correlation between plasma PLGF levels,placental pathology and expression of important factors in patients with preterm preeclampsia1.Immunohistochemical staining results:(1)The placental PLGF protein was no difference between the groups.(2)The placental s Flt-1 protein in the preterm PE2 group was significantly higher than that in the preterm group and preterm PE1 group.(3)The placental P27 protein in the PE patients is mainly expressed in the nucleus of syncytiotrophoblast.The pacental P27 protein in preterm PE2 group was significantly higher than that in the preterm group and the preterm PE1 group.2.Placental pathological results:(1)The placenta with syncytial knots(SK)in the preterm PE2 group increased significantly.The incidence of terminal villi with SK which exceeded 100 % was significantly higher than that in the preterm PE1 group.(2)In the preterm PE2 group,the incidence of syncytial knots exceeded 50% or exceeded70% was significantly higher than these in the preterm group.(3)The incidence of multiple placental infarctions,villous fibrin and villous interstitial thrombosis in preterm PE2 group was higher than those in preterm PE1 group,but there is no difference betweem two groups.Conclusions1.The PE patients with early plasma PLGF levels<12pg/m L are more likely to occur proteinurine,liver and kidney damage and other perinatal complications including FGR,hypoalbuminemia,neonatal sepsis and so on.The newborns of the patients may be accompanied by lower birthweight and longer NICU hospitalization.Therefore,they should be closely monitored.2.The abnormally increased expression of s Flt-1 and P27 protein in placenta of PE patients with plasma PLGF levels<12 pg/m L may be the fundamental mechanism that causing placental disfunction and clinical characteristics.3.The pathological changes of placenta in PE patients with plasma PLGF levels< 12pg/m L mainly perform abnormally increased syncytial knots,which was accompanied by placental disfunction,FGR and so on.Therefore,the PE patients with plasma PLGF levels < 12pg/m L may be accompanied by abnormal expression of placental important factors(s Flt-1,P27,etc.),combined with more significant placental pathological changes,which will cause adverse perinatal outcomes.Plasma PLGF levels should be measured in PE patients.The high-risk patients with PLGF<12pg/m L needs to further strengthen the dynamic assessment of intrauterine fetal status and placental function and prepare for early prevention of perinatal complications such as perinatal asphyxia and FGR.