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【目的】通过了解胎盘病理变化与胎儿感染HBV的关系 ,探讨胎儿感染的机理。【方法】测量 16 0例足月妊娠孕妇胎盘大小、质量、脐长 ,并进行大体病理学检查。分组包括 30例胎儿感染组、胎儿血指标阴性者 80例为阴性对照组、正常孕妇 5 0例为正常组。对其中 6 1例HBV携带者孕妇胎盘进行详细的组织病理学观察 (包括胎儿感染组 2 8例及对照组 33例 ) ,分级诊断分析 ,用PCR、ELISA法检测胎儿血HBVDNA和HBsAg。【结果】①胎儿感染组平均胎盘体积为 (6 38± 179)cm3,小于对照组的 (713± 2 38)cm3,对照组平均胎盘体积小于正常组的 (72 3± 2 13)cm3,P 均小于 0 0 1;胎盘厚度、质量、脐长等在 3组中则无显著性差异 ;②胎盘大体病理学检查 :包括绒毛周围纤维素沉积、胎盘小灶梗死、胎盘边缘血肿、干绒毛动脉血栓形成、胎盘钙化及胎膜黄染等 ,3组均无显著性差异。③胎盘组织病理学显示 ,胎儿感染组纤维素样坏死为 2 9% ,绒毛血管增生 /充血为 5 0 % ,均高于对照组的 9%、15 % ,Hofbauer细胞阳性率为 46 % ,低于对照组的 79% ,P均小于 0 0 5。【结论】HBV感染 ,尤其是胎儿感染可能与胎盘体积缩小有关 ;HBV并不会引起胎盘特异性的大体病理学改变 ,胎儿感染与这些改变无关 ;胎盘组织中出现纤维素样坏死及绒毛血管增
【Objective】 To understand the relationship between fetal placental pathological changes and HBV infection and explore the mechanism of fetal infection. 【Methods】 The placental size, mass, length of umbilical cord in 160 pregnant women at term were measured and gross pathological examination was performed. Subgroup includes 30 cases of fetal infection, 80 cases of negative fetal blood indicators negative control group, normal pregnant women 50 cases of normal group. Histopathological examination (including 28 cases of fetal infection and 33 cases of control group) was carried out on 61 pregnant women with HBV carriers. The serum levels of HBVDNA and HBsAg were detected by PCR and ELISA. 【Results】 ①The mean placenta volume in fetal infection group was (6 38 ± 179) cm 3, which was smaller than that in control group (713 ± 2 38 cm 3). The mean placenta volume in control group was smaller than that in normal group (72 3 ± 2 13 cm 3) Were less than 0 0 1; placental thickness, quality, length of the umbilical cord in the three groups there was no significant difference; ② placental gross pathology: including the deposition of cellulose around the placenta, placental infarction, placental margin hematoma, Formation, placental calcification and fetal yellow dye, no significant difference between the three groups. Histopathology of placenta showed that the incidence of fibroepithelial necrosis was 29% in fetal infection group and 50% in villus hyperplasia / congestion, which were all higher than 9% and 15% in control group, and the positive rate of Hofbauer cells was 46% and low 79% of the control group, P were less than 0 0 5. 【Conclusion】 HBV infection, especially fetal infection may be related to the reduction of placental volume; HBV does not cause placental specific gross pathological changes, and fetal infection has nothing to do with these changes; placental tissue with fibrinoid necrosis and villous blood vessels increase