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目的探讨妊娠肝内胆汁淤积症(ICP)患者是否存在胎盘合体滋养细胞超微结构损伤及胎儿胆酸水平的变化。方法选取ICP患者10例(ICP组)和正常孕妇10例(正常组),采用细胞形态学计量方法观察两组孕妇胎盘合体滋养细胞体视学参数变化;采用循环酶法检测两组孕妇分娩胎儿的脐静脉血总胆酸水平。结果(1)ICP组胎盘合体滋养细胞微绒毛的数目及数密度分别为(21±12)个/视野及(1.9±1.3)μm-3,明显少于正常组的(35±11)个/视野及(4.1±3.2)μm-3,两组比较,差异有统计学意义(P<0.05);ICP组胎盘合体滋养细胞微绒毛平均体积及表面积密度分别为(0.1200±0.0050)μm3、(2.500±0.600)μm2/μm3,明显大于正常组的(0.0500±0.0010)μm3及(1.300±0.400)μm2/μm3,两组比较,差异有统计学意义(P<0.05)。(2)ICP组胎盘合体滋养细胞线粒体的平均体积、表面积密度及体积密度分别为(0.0200±0.0020)μm3、(0.600±0.010)μm2/μm3及(0.0800±0.0090)μm3/μm3,明显大于正常组的(0.0100±0.0050)μm3、(0.500±0.030)μm2/μm3及(0.0500±0.0020)μm3/μm3,两组比较,差异有统计学意义(P<0.05)。(3)ICP组胎盘合体滋养细胞内质网的平均体积、表面积密度及体积密度分别为(0.0200±0.0010)μm3、(0.900±0.010)μm2/μm3及(0.0900±0.0050)μm3/μm3,明显大于正常组的(0.0100±0.0030)μm3、(0.500±0.030)μm2/μm3及(0.0500±0.0010)μm3/μm3,两组比较,差异有统计学意义(P<0.05)。(4)ICP组胎儿脐静脉血总胆酸水平为(8.6±3.2)μmol/L,正常组为(4.6±1.5)μmol/L,两组比较,差异有统计学意义(P<0.05)。结论ICP患者高水平的胆酸可能损伤胎盘合体滋养细胞的细胞器,影响胎盘对胆酸的运输功能。
Objective To investigate the ultrastructural damage of placental syncytiotrophoblast and the changes of fetal bile acid levels in patients with intrahepatic cholestasis of pregnancy (ICP). Methods Ten patients with ICP (ICP group) and 10 normal pregnant women (normal group) were enrolled in this study. The changes of stereological parameters of placental syncytiotrophoblast cells in two groups were observed by cell morphology measurement. The circulating enzyme method was used to detect the fetuses Umbilical venous blood total acid levels. Results (1) The number and density of syncytiotrophoblastic trophoblasts in ICP group were (21 ± 12) / field and (1.9 ± 1.3) μm-3 respectively, which were significantly lower than those in normal group (35 ± 11) / (4.1 ± 3.2) μm-3, the difference was statistically significant (P <0.05). The average volume of microvilli and surface area density of syncytiotrophoblasts in ICP group were (0.1200 ± 0.0050) μm 3 and ± 0.600) μm2 / μm3, which was significantly higher than that of the normal group (0.0500 ± 0.0010) μm3 and (1.300 ± 0.400) μm2 / μm3 respectively. There was significant difference between the two groups (P <0.05). (2) The average volume, surface area density and bulk density of mitochondria of placental syncytiotrophoblasts in ICP group were (0.0200 ± 0.0020) μm3, (0.600 ± 0.010) μm2 / μm3 and (0.0800 ± 0.0090) μm3 / μm3, (0.0100 ± 0.0050) μm3, (0.500 ± 0.030) μm2 / μm3 and (0.0500 ± 0.0020) μm3 / μm3, respectively. There was a significant difference between the two groups (P <0.05). (3) The average volume, surface area density and bulk density of endoplasmic reticulum of syncytiotrophoblasts in ICP group were (0.0200 ± 0.0010) μm 3, (0.900 ± 0.010) μm 2 / μm 3 and (0.0900 ± 0.0050) μm 3 / μm 3 respectively The normal group had (0.0100 ± 0.0030) μm3, (0.500 ± 0.030) μm2 / μm3 and (0.0500 ± 0.0010) μm3 / μm3 respectively. There was significant difference between the two groups (P <0.05). (4) The umbilical blood total acid level in ICP group was (8.6 ± 3.2) μmol / L and (4.6 ± 1.5) μmol / L in normal group, the difference was statistically significant (P <0.05). Conclusion High levels of cholic acid in ICP patients may damage the organelles of placental syncytiotrophoblasts and affect the transport function of placenta to cholic acid.