本文選題：復(fù)發(fā)性流產(chǎn)　切入點：NGF　出處：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：通過測定NGF、VEGF在正常早孕婦女和有復(fù)發(fā)性流產(chǎn)史的早孕婦女絨毛、蛻膜組織中的表達及在血清中的水平,了解兩個因子與妊娠的相關(guān)性。 方法：隨機選擇2012年7月到2013年7月期間來山西醫(yī)科大學(xué)第一醫(yī)院婦產(chǎn)科門診就診的復(fù)發(fā)性流產(chǎn)婦女25例作為流產(chǎn)組,經(jīng)詳詢病史,結(jié)合其相關(guān)的檢查和化驗,被診斷為不明原因的復(fù)發(fā)性流產(chǎn)者,隨機選取同一時期行人工流產(chǎn)自愿終止妊娠的正常健康早孕婦女25例作為對照組,這些早孕婦女既往無不良生育史,至少有一胎正常足月分娩史,分別抽取兩組妊娠婦女空腹外周肘靜脈血,收集兩組妊娠婦女行人工流產(chǎn)后新鮮的絨毛組織和蛻膜組織,應(yīng)用酶聯(lián)免疫吸附試驗(ELISA)測定兩組妊娠婦女血清中NGF、VEGF水平；免疫組化法測定NGF、VEGF在兩組妊娠婦女絨毛、蛻膜組織中的表達,采用SPSS17.0統(tǒng)計軟件對所得資料進行分析,計量資料以均數(shù)±標準差(X±S)表示,組間比較采用方差分析和t檢驗,相關(guān)資料采用pearson相關(guān)分析,P0.05為差異具有統(tǒng)計學(xué)意義。 結(jié)果：1.對照組絨毛結(jié)構(gòu)排列整齊,胞核小且有多個,胞漿呈毛玻璃樣的為合體滋養(yǎng)細胞,細胞之間邊界清楚,胞核圓呈小泡狀的為細胞滋養(yǎng)細胞,合體滋養(yǎng)細胞和細胞滋養(yǎng)細胞分別排列于絨毛的外層和內(nèi)層,絨毛間質(zhì)可見小血管(見附錄圖1和圖5),蛻膜細胞呈多邊形或圓形排列,細胞間隙較大,胞核較小,可見到乳頭狀結(jié)構(gòu)的腺體,蛻膜間質(zhì)可見小血管(見附錄圖3和圖7)。而流產(chǎn)組絨毛結(jié)構(gòu)形態(tài)不規(guī)則、排列紊亂,合體滋養(yǎng)細胞、細胞滋養(yǎng)細胞減少,細胞萎縮變性,絨毛間質(zhì)水腫,血管減少,可見淋巴細胞、中性粒細胞浸潤(見附錄圖2和圖6),蛻膜細胞被擠壓變形,腺體結(jié)構(gòu)紊亂、血管淤血(見附錄圖4和圖8)。 2.在兩組妊娠婦女絨毛、蛻膜組織中均可發(fā)現(xiàn)NGF、VEGF表達的陽性顆粒,NGF、VEGF主要表達在絨毛滋養(yǎng)細胞的胞膜、胞漿,胞核未見明顯著色,且相對流產(chǎn)組而言,對照組染色程度深(見附錄圖1-8)。 3.NGF、VEGF在流產(chǎn)組孕婦絨毛、蛻膜組織中的表達及在血清中的水平均較對照組降低,兩組間比較,p均0.05,差異均有統(tǒng)計學(xué)意義(見表1和表2)。 4.NGF、VEGF在流產(chǎn)組和對照組血清中的水平呈正相關(guān)(rl=0.965,r2=0.733,p均0.05),絨毛和蛻膜組織中的表達不存在相關(guān)性(r3=0.378, r4=-0.049,r5=0.542, r6=-0.175,p均0.05)(見圖A-F)。結(jié)論：1.在兩組妊娠婦女絨毛、蛻膜組織中均可見到NGF、VEGF的陽性表達,血清里均可檢測到NGF、VEGF的濃度,說明NGF、VEGF與胎盤血管生成有關(guān)。 2.NGF、VEGF在流產(chǎn)組孕婦絨毛、蛻膜組織中的表達及在血清中的水平均較對照組降低,提示NGF、VEGF在絨毛、蛻膜組織中表達下降,血清中的水平下降,可能是導(dǎo)致復(fù)發(fā)性流產(chǎn)的原因之一。 3、NGF、VEGF在血清中水平呈正相關(guān),提示NGF可能通過促進VEGF的表達,而間接促成血管的生成。
[Abstract]:Objective: to determine the expression of NGF- VEGF in villi and decidua of normal early pregnant women and women with recurrent abortion, and to investigate the relationship between the two factors and pregnancy.Methods: from July 2012 to July 2013, 25 women with recurrent abortion were randomly selected as abortion group from the first Hospital of Shanxi Medical University, Department of Gynecology and Obstetrics and Obstetrics and Obstetrics.A total of 25 normal and healthy early pregnant women with voluntary termination of pregnancy during the same period were randomly selected as the control group, who were diagnosed as unexplained recurrent abortions. These early pregnant women had no history of adverse birth.With at least one normal full-term delivery history, the fasting peripheral cubitus vein blood was drawn from two groups of pregnant women, and fresh chorionic and decidua tissues were collected from the two groups of pregnant women after induced abortion.The serum levels of NGF #en1# in two groups of pregnant women were determined by Elisa, and the expression of VEGF in chorionic villi and decidua of the two groups were detected by immunohistochemical method. The data were analyzed by SPSS17.0 software.The measurement data were expressed as mean 鹵standard deviation X 鹵S, the analysis of variance and t test were used in the comparison between groups, and the correlation data were analyzed by pearson correlation analysis (P0.05).The result is 1: 1.In the control group, the chorionic villi were arranged neatly, the nuclei were small and multiple, the cytoplasm was glass-like syncytiotrophoblast, the boundary between the cells was clear, and the round of the nucleus was cytotrophoblastic.Syncytiotrophoblast and cytotrophoblast were arranged in the outer layer and inner layer of villi, respectively. Small vessels were found in the stroma of villi (see figure 1 and figure 5 of the appendix). Decidual cells were arranged in polygon or circle, with large intercellular space and small nucleus.Small vessels can be seen in decidual stroma and papillary glands (see figure 3 in appendix and figure 7 in figure 7).In the abortion group, the structure of villi was irregular, the arrangement was disordered, syncytiotrophoblast, cytotrophoblast decreased, cell atrophy, villous stroma edema, vascular decrease, lymphocyte,Neutrophil infiltration (see Appendix Fig. 2 and Fig. 6), decidual cells squashed and deformed, glandular structure disordered, and vascular congestion (see Appendix Fig. 4 and Fig. 8).2.In the villi of the two groups of pregnant women, the positive granules of NGF- VEGF expression were found in the villus, cytoplasm and nucleus of the chorionic trophoblastic cells, and the expression of NGF- VEGF was not found in the villus trophoblastic cells, and the expression of NGF- VEGF in decidual tissues was not obvious compared with that in the abortion group.The degree of staining in the control group was deep (see figure 1-8 in the appendix).3. The expression of NGF- VEGF in villi and decidua of pregnant women in abortion group was lower than that in control group, and the difference between the two groups was statistically significant (see Table 1 and Table 2).Conclusion 1.In both groups, the positive expression of VEGF in decidua and the concentration of VEGF in serum could be detected, which indicated that the expression of VEGF in placenta was related to the angiogenesis of placenta.2. The expression of VEGF in villi, decidua and serum of pregnant women with abortion was lower than that of control group, suggesting that the expression of VEGF in villi, decidual tissues and serum might be one of the causes of recurrent abortion.(3) the level of NGF in serum was positively correlated, suggesting that NGF may promote angiogenesis indirectly by promoting the expression of VEGF.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.21

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