The Expressions And Significance Of Adiponectin,and Plgf On Preeclampsia And Maternal Serum In Patients With Hypertensive Disorder Complicating Pregnancy

Objective: Hypertensive disorder complicating pregnancy (HDCP ) is a pregnancy-specific disease, which leads to the main cause for the death of pregnancies and neonates. But up to date,the etiology of hypertensive disorder complicating pregnancy is unknown.Now it is widely recognized that HDCP is originated in pathophysiological changes of the placenta and a variety of factors result in HDCP development and lead to fetal-maternal immune imbalance, shallow trophoblast implantation placental vascular recast barrier, placental hypoperfusion and hypoxia,immune damage.At last,it results in different levels of systemic vascular endothelial damage and multi-system, multi-organ damage. Adiponectin is a fat factor,which could regulate the metabolism of the energy and play an important role in protecting the endothelial tissue by multiple mechanisms such as the insulin-sensitizing,anti-oxidation, anti-atherosclerosis and anti-inflammatory. As a transcription factor.Placental growth factor (PLGF) expresses abundantly in the placental trophoblast and it can regulate the function of the trophoblast cells and endothelial cells .It will have abnormal expression in HDCP,which may lead to the occurrence and the development of HDCP.In this study, we want to learn the expression and the roles of adiponectin, PLGF in the placenta and maternal serum of HDCP ,in order to prevent this disease and provide a new theoretical basis.Methods:In this study,we choose the normal pregnant women who had obstetric examination in the Fourth Hospital of Hebei Medical University and were hospitalized there and the pregnant women with gestational hypertension, mild preeclampsia, severe preeclampsia as the subjects.All of them were admitted from March 2007 to March 2009:30 women in the normal late pregnancy which would give birth ahead cesarean section as the control group; 30 patients with gestational hypertension,30 patients with mild preeclampsia, 30 patients with severe preeclampsia as HDCPgroup(the pregnant women without other diseases).After placenta leaves from the pregnant women,we take the placenta villous tissue around the central 1cm×1cm×1cm, avoiding calcified areas and necrotic areas.Fully clean with normal saline,solutionfix with 10% neutral formalin more than 24 hours,routine paraffin-embedded 4μm serial sections. Use immunohistochemistry SP method to detected the expression of adiponectin and PLGF in placental tissue and grade according to the intracellular staining intensity and positive cell number.Use Enzyme-linked immunosorbentassay(ELISA) to determinate the level of adiponectin and placental growth factor in maternal serum.Use SPSS13.0 statistical software for the data.General information data for the clinical measurement is analysed by single-factor analysis of variance, count data by rank-suangm test,correlation by the spearman rank correlation. Makeα= 0.05 as the level of significance of difference.Results:1. The comparison of clinical general information: the average age of patients in each group and gestational age, were not statistically significant (P> 0.05) .2 HE staining: Normal placentaes of pregnant women: villus are smaller. Villus interstitial blood vessels are more and small arterial walls are smooth in placental villus and deciduas. The mild preeclampsia and severe preeclampsia group placentaes: villus in placenta are swelling ,thickening and reducing. Syncytiotrophoblast are nodular hyperplasia .Villus interstitial blood vessels are thickening in placenta but the density of them decreases in placenta.At the same time, small arterie has the emergence of acute atherosclerotic change, with infiltration of lymphocytes.3 Adiponectin expression3.1 Adiponectin expression in placenta : Adiponectin expression in syncytiotrophoblast and endothelial cells, mainly in the cytoplasm. The positive expression rate of adiponectin in the HDCP patients'placentas is 75.56% .In the control group, the positive expression rate is 66.67%.With the increasing clinical stage,the expression of adiponectin decreased in the placenta However, among all groups the level of adiponectin expression are different.The control group and HDCP groups had significant difference and in HDCP groups the expression of adiponectin in placenta are different: the expression level of adiponectin between gestational hypertension and mild preeclampsia group has no significant difference but in gestational hypertension and preeclampsia severe group, mild preeclampsia and severe preeclampsia group ,adiponectin have significant differences.3.2 Adiponectin expression in maternal serum:With the severity of the disease,the level of serum adiponectin would decrease.Serum adiponectin in the control group and HDCP has significant differences and serum adiponectin groups between the HDCP groups are significantly different.4 Placenta Growth Factor (PLGF) expression4.1 PLGF expression in placenta:PLGF expresses mainly expressed in syncytiotrophoblast,and sites in the cytoplasm and cell membrane. The positive expression rate of PLGF in the HDCP patients'placentas is 73.33% .In the control group, the positive expression rate is 93.33%. Compared with the control group, the expression of PLGF in the groups of HDCP,has significant differences. However, the expression level of PLGF in HDCP groups is different:no statistical significance bewteen gestational hypertension group and the mild preeclampsia group,statistical significant difference between gestational hypertension group and severe preeclampsia group, the mild pre-eclampsia group and severe preeclampsia group4.2PLGF Expression in maternal serum:the expression of serum PLGF in the control group and HDCP groups were significant differences.As the disease advances,the expression of serum PLGF is different: there were no significant differences between gestational hypertension group and mild preeclampsia group,mild preeclampsia and severe preeclampsia group.With the increase of disease serum PLGF decreases.5 Placental weight and neonatal weight: the weight of placenta in the control and HDCP groups was significantly different and with the progress of the disease,placental weight decreases with significant differences among the groups. Birth weight among the control and HDCP groups are different: significant difference between the control group and hypertensive group, gestational hypertension and preeclampsia severe group, mild preeclampsia and severe preeclampsia group,while gestational hypertension and preeclampsia there is no significant difference between gestational hypertension group and mild group.6 Correlation Analysis:6.1 The Correlation of Adiponectin and PLGF in placenta There were negatively correlated between the expression of adiponectin in placenta and the severity degree of HDCP (rs =- 0.422, p = 0.000 <0.05). There were negatively correlated between the expression of PLGF in placenta and the severity degree of HDCP ((rs =- 0.361,p=0.000 <0.05).Howere there were positive correlated between the expression of adiponectin and PLGF in placenta(rs=0.370,P<0.05).6.2The Correlation of Adiponectin and PLGF in pregnancy serum :There were negatively correlated between the expression of adiponectin in pregnancy serum and the severity degree of HDCP(rs =- 0.763,p<0.05). There were negatively correlated between the expression of PLGF in pregnancy serum and the severity degree of HDCP(rs=- 0.828, p <0.05).Serum adiponectin was positively correlated with serum PLGF (rs = 0.423, P <0.05).6.3Adiponectin expression in placental tissue and serum adiponectin expression was positively correlated (rs=0.482,p <0.05);PLGF expression in placenta and serum PLGF expression was positively correlated (rs = 0.865, p <0.05).6.4 The correlation among serum adiponectin,serum PLGF and fetal weight, placental weight,: Serum adiponectin was positively correlated with placental weight (rs = 0.378, p <0.05), but with no significant correlation with birth weight (rs = 0.241, p = 0.20> 0.05); serum PLGF and placental weight was positively correlated (rs = 0.632, p <0.05) and serum PLGF is also positively correlated with birth weight (rs = 0.582, p <0.05).Conclusion:1 With the progress of hypertensive disorders in pregnancy adiponectin and PLGF in the placenta and maternal serum expression decreased gradually, and with the severity of the disease they were negatively correlated,which suggests that the two factors play an important role. in the pathogenesis of hypertensive disorders in pregnancy2 Serum adiponectin levels were decreased with the severity of the trend, especially in mild preeclampsia, severe preeclampsia, when serum adiponectin decreased significantly, which indicates that serum lipid adiponectin responses to vascular endothelial damage ,and serum lipid adiponectin can be used to monitor the severity of hypertensive disorders in HDCP.3 Serum adiponectin was positively correlated with placental weight, but there is no relationship with birth weight, which suggests that maternal serum adiponectin in circulation can not easily spread to the fetus of cord blood through the placenta, so it is less likely.for maternal serum adiponectin to affect fetal growth.4 Serum PLGFwere positively correlated with fetal weight and placental weight which indicates to some extent,the levels of serum PLGF reflect the severity of the disease HDCP, so serum PLGF can become an important biological predictor for the prevention and determine the severity of HDCP patients and the neonate.5 Relevance: In pregnancy placental tissues and serum with HDCP, adiponectin was positively associated with PLGF. This shows that as the expression level of adiponectin decreases,endothelial cells are damaged, and proliferation and invasive trophoblast cells of endometrial are limited.As a result,PLGF generate less aggravated hypoxia and placental villous tissue damage, leading to the occurrence of preeclampsia and fetal development bad.