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目的研究气候变化对重子痫前期胎盘形态学影响,探讨不同气候条件下重度子痫前期胎盘胎盘病理变化与围生儿并发症的关系。方法根据江西全年气候变化特点将一年分为三个季节组:冬季组(11-2月)、过度季节组(3-5月及9-10月)、夏季组(6-8月),收取各个季节组重度子痫前期病例,其中冬季组120例,过渡季节组98例,夏季组75例,分娩时称取胎盘重量、计算胎盘系数(胎盘重量与新生儿出生体重比值),记录新生儿体重、阿普加评分;同时在胎盘母面选取一块1cm×2cm胎盘组织,10%甲酫固定,制成超薄切片,利用生物体视学技术对胎盘绒毛进行组织形态计量学测定,并用Image-Pro图像软件进行分析。结果冬季组重度子痫前期纤维性坏死、合体细胞结节及毛细血管充血绒毛的百分比明显高于夏季组和过渡季节组,血管合体膜(VSM)绒毛百分比小于夏季组和过渡季节组,绒毛体积密度(Vv)、表面积密度(Sv)小于过渡季节和夏季组,表面积体积比(RSV)大于过渡季节组和夏季组,差异均有统计学意义(P<0.01或P<0.05);冬季组胎盘重量显著低于夏季组和过渡季节组,胎盘系数高于夏季组和过渡季节组,新生儿体重及阿普加评分低于夏季组和过渡季节组,新生儿死亡率高于夏季组和过渡季节组,差异均有统计学意义(P<0.01或P<0.05),夏季组和过渡季节组各项指标相比,差异均无统计学意义(P>0.05)。结论冬季重度子痫前期胎盘绒毛形态结构破坏严重,加剧了胎盘缺氧,致使围生儿不良结局增多。
Objective To study the effects of climate change on placental morphology in preeclampsia and to explore the relationship between placental placenta pathology and perinatal complications in patients with severe preeclampsia under different climatic conditions. Methods According to the climate change characteristics of Jiangxi Province, the year was divided into three seasons: winter (November-February), over-season (March-May and September-October), summer (June-August) The patients in each season group received severe preeclampsia, including 120 cases in winter group, 98 cases in transitional season group and 75 cases in summer group. The weight of placenta was taken at delivery and the placental index (placental weight to newborn birth weight) was recorded. Neonatal weight, Apgar score; at the same time in the placenta mother choose a piece of 1cm × 2cm placenta, 10% formazan fixed, made of ultra-thin sections, the use of biopsy technology placental villi histomorphometry, And analyzed with Image-Pro image software. Results The percentages of fibrous necrosis, syncytial cell nodules and capillary villus in severe preeclampsia in winter group were significantly higher than those in summer and transitional season. The percentage of villi in VSM group was lower than that in summer and transitional season, (Vv) and surface area density (Sv) were lower than those in the transitional season and the summer group, and the surface area volume ratio (RSV) was greater than that in the transitional and summer seasons (P <0.01 or P <0.05) The weight was significantly lower than the summer group and the transitional season group, the placental coefficient was higher than the summer group and the transitional season group, neonatal body weight and apgar score was lower than the summer group and the transitional group, neonatal mortality was higher than the summer group and the transitional season (P <0.01 or P <0.05). There was no significant difference in the indexes between the summer and the transitional season (P> 0.05). Conclusion Severe preeclampsia placenta villi morphological damage, aggravating placental hypoxia, resulting in increased perinatal unhealthy children.