| Hypertensive disorder complicating pregnnacy(HDCP) with unknown etiology is a characteristic disease of gestation, severely threatening health of mother and foetus.Preeclampsia (PE)is severely phase of HDCP,can developing to eclampsia and is important cause of mother and foetus died.HDCP'S symptom quickly disappear after placental expulsion,and the patient of gestational trophoblastic disease can also complicate with hypertensive disorder complicating pregnnacy.These demonstrate that it has no exactly relationship between disease happening and foetus existing,and placenta is played important role between disease happenning and developping. In this patho- physiological course,now it is few study that what kinds of factors are operating and what pathological change are happening in placenta.Basing on"the theory of vascular endothelium scathe"and"the theory of blood shortage of placenta-syncytiotrophoblast", we study the expression of t-PA and PAI-1in placenta,which acts important role in the course of vascular endothelium scathe and placenta development,and discuss their role in HDCP.Objective: Tissue-type plasminogen activator (t-PA) and its inhibitor plasminogen activator inhibitor type-1 (PAI-1) are a couple of important fibrinolysin factors. During gestational period, trophocyte and endotheliocyte can secrete them. There is argument on the staudy of expression of t-PA and PAI-1 in placenta of HDCP. This experiment used HE stain and immunohistochemistry to study:(1)the pathological change by electron microscope and discuss the pathological reason of HDCP.(2) measure placental levels of t-PA and PAI-1 in vascular endothelium cells and syneytiotrophoblast cells from patients with preeclampsia,as well as to investigate their role in the pathogenesis of hypertensive disorder complicating pregnancy.(3)the relationship between the positive expression of t-PA and PAI-1 and pathological change in placental vascular endothelium cells and syneytiotrophoblast cells of preeclampsia.Methods: 1 Patients and groups: 30 normal pregnancy femme and 44 patients with preeclampsia(21 mind preeclampsia ,23 severe preeclampsia ) both deliveryed by cesarean section during 2005.12-2006.12 were choosed .Exclusion criteria were:(1)patients with brightism,chronicity hypertension,severe infect,immune disease and malignant tumor.(2) patient with obstetrics complication (like premature rupture of membrane,placenta praevia,intrauterine growth retardation ).2 sample collected: we collected 1×1×1cm~3 normal tissue from placenta center dring 5 minute after placental expulsion.Sample were fixed in 10% formalin ,routinely embedded with paraffin , preserve in -20℃.3 empirical method:Tissue sections were dealled with by HE stain and then observed by microscope to find the morphological change.Immunohistochemical analysis was employed to demonstrate the postitive expression of the t-PA and PAI-1 in placenta vascular endothelium and syncytiotrophoblast . The postitive expression of t-PA and PAI-1 in placenta vascular endothelium and syncytiotrophoblast were analysed in placentas that had pathologieal change and no pathologieal change.4 Statistical analysis: Statistical analysis was performed with the SAS V8 statistical software. The comparison of Patient's characteristics was used with independent-sample t test; Theχ~2 test was used to compare rates between different groups. rank data was used with rank sum test; dependablity analysis was used with linearity tendencyχ~2 test, P<0.05 was considered as significantly in statistics.Results:1. There were significantly pathological changes in preeclampsia:(1)Villous stroma fibrosised and fibrinoid necrosised(P<0.0001);(2)villous vascular decreased and gored(P<0.0001); (3)cytotrophoblasts hyperplasiaed(P<0.0006), villous syncytial knots raised(P=0.002);(4)fibrin deposited(P=0.037<0.05) .2.Immunolocalization of t-PA and PAI-1 in all cases were observed mainly in syncytiotrophoblast,mesenchymocyte and vascular endothelial cells.They located in cytoplasm and cells membrane. In preeclampsia placentas,there was markedly higher expression of PAI-1 in syneytiotrophoblast cells and vascular endothelium cells than those in normal pregnancys(P<0.0001,P=0.0005). Morever , the positive expression increased as the preeclampsia advanecd,as well to show linear correlation(P=0.0013,P=0.0151).There was no markable difference in expression of t-PA in placental syncytiotrophoblast cells and placental vascular endothelium cells(P=0.0944,P=0.8630).3 1n preeclampsia placentas that had pathological changed,the positive expression of PAI-1 in syncytiotrophoblast cells and vascular endothelium cells was markedly higher than that in no pathological change placentas(P=0.0447,P=0.0257).However,it was markedly lower in former than that in latter of the positive expression of t-PA in placental vascular endothelium cells(P=0.012). There was no markable difference of expression of t-PA in placental syncytiotrophoblast cells in former than that in latter(P=0.1316).Conclusions : This experiment used HE stain and immunohistochemistry to study the pathological change in preeclampsia placentas and measure placental levels of t-PA and PAI-1 in vascular endothelium cells and syneytiotrophoblast cells from patients with preeclampsia,as well as investigate the relationship between the positive expression of t-PA and PAI-1 in placental vascular endothelium cell and syneytiotrophoblast cell and pathological change in placentas of patients with preeclampsia,to confirm:1. There was significantly pathological changes in HDCP:①Villous stroma fibrosised and fibrinoid necrosised;②villous vascular decreased and gored;③cytotrophoblasts hyperplasiaed, villous syncytial knots raised;④fibrin deposited .2. Abnormal expression of PAI-1 in placental vascular endothelium cells and syncytiotrophoblast cells might be a pathogenesis of HDCP.3. There was a consanguineous relationship between placental pathological changes of HDCP and the abnormal expression of t-PA and PAI-1 in Placentas.
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