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目的探讨特发性胎儿生长受限(IFGR)患儿母血和脐血TNF-α及胎盘组织中X-连锁凋亡抑制蛋白(XIAP)的表达及其意义。方法选取郑州大学第三附属医院2010年7月-2011年7月行剖宫产分娩的IFGR孕妇34例作为实验组,同期因社会因素行剖宫产分娩的健康足月孕妇30例作为健康对照组。采用双抗体夹心酶联免疫吸附法(ELISA)测定2组母血、脐血TNF-α水平,免疫组织化学法检测2组胎盘组织中XIAP的表达。结果 1.实验组母血、脐血TNF-α水平[(90.12±6.43)μg.L-1,(98.73±7.29)μg.L-1]均明显高于健康对照组[(72.97±8.51)μg.L-1,(80.87±6.92)μg.L-1],差异均有统计学意义(Pa<0.05)。2.实验组XIAP在胎盘合体滋养细胞中的表达(114.56±5.17)明显低于健康对照组(144.40±7.31),差异有统计学意义(P<0.05)。3.实验组母血、脐血中TNF-α与胎盘组织中XIAP均呈负相关(Pa<0.05);健康对照组母血、脐血中TNF-α与胎盘组织中XIAP均无相关性(Pa>0.05)。4.实验组母血、脐血中TNF-α与新生儿体质量均呈负相关(Pa<0.05),健康对照组母血、脐血中TNF-α与新生儿体质量均无相关性(Pa>0.05)。5.实验组新生儿并发症显著高于健康对照组(P<0.05)。结论母血、脐血中TNF-α升高及胎盘组织中XIAP表达降低,可能通过促进胎盘滋养细胞过度凋亡参与IFGR的发病,并影响新生儿预后。
Objective To investigate the expression of TNF-α in maternal and umbilical cord blood and the expression of X-linked inhibitor of apoptosis protein (XIAP) in placenta of idiopathic fetal growth restriction (IFGR) patients and its significance. Methods From March 2010 to July 2011, 34 pregnant women undergoing cesarean delivery in the Third Affiliated Hospital of Zhengzhou University from July 2010 to July 2011 were selected as the experimental group. Thirty healthy pregnant women undergoing cesarean delivery during the same period were selected as healthy controls group. The levels of TNF-α in maternal blood and umbilical cord blood of two groups were detected by double antibody sandwich enzyme-linked immunosorbent assay (ELISA), and the expression of XIAP in two groups of placenta was detected by immunohistochemistry. Results 1. The levels of TNF-α in maternal blood and cord blood in experimental group were significantly higher than those in healthy control group [(90.12 ± 6.43) μg.L-1, (98.73 ± 7.29) μg.L-1] [(72.97 ± 8.51) μg.L-1, (80.87 ± 6.92) μg.L-1], the difference was statistically significant (Pa <0.05). The expression of XIAP in placental syncytiotrophoblast (114.56 ± 5.17) was significantly lower than that in healthy control group (144.40 ± 7.31), the difference was statistically significant (P <0.05). The levels of TNF-α in maternal serum and umbilical cord blood of experimental group were negatively correlated with the levels of XIAP in placenta (P <0.05). There was no correlation between TNF-α and XIAP in placenta Pa> 0.05). There was a negative correlation between TNF-αand neonatal body mass in maternal blood and umbilical cord blood of experimental group (P <0.05), while there was no correlation between TNF-α and neonatal body weight in maternal blood and cord blood of healthy control group Pa> 0.05). The experimental group neonatal complications were significantly higher than the healthy control group (P <0.05). Conclusion The increase of TNF-α in maternal blood and umbilical cord blood and the decrease of XIAP expression in placenta may play a role in the pathogenesis of IFGR by affecting the excessive apoptosis of placental trophoblast and affect the prognosis of neonates.