Tchirikov M, Kertschanska S, Stürenberg H J, Schröder H J
Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
Placenta. 2002 Apr;23 Suppl A:S153-8. doi: 10.1053/plac.2002.0810.
Placental and fetal liver blood perfusions are reduced in intrauterine growth-restricted human fetuses. We hypothesized that changes in fetal liver blood supply can alter fetal growth. In nine ewes with twin pregnancies at a gestational age of 119+/-2 days, a stent (4 mm) was placed into the ductus venosus of one twin (DV(stent) group). Alternatively, in 17 near term sheep with twin (n=11) or singleton (n=6) pregnancies, a DV was blocked with an embolization coil (DV(coil) group) for about one week. The cell proliferation rate (pKi-67) was determined in the liver, heart, skeletal muscle, kidneys and placenta. The dilatation or occlusion of the DV did not change placental perfusion on the first day or later after surgery. The liver blood supply was decreased in the DV(stent) group by more than half from 499+/-371 to 278+/-219 ml min(-1) (mean+/-s.d., n=4), and increased two-fold in the DV(coil) group (P< 0.05). The percentage of liver/body weight was decreased from 3.9+/-0.6 per cent in control twin to 3.0+/-0.2 per cent (n=3) in the DV(stent) group. Occlusion of the DV lead to an increase in the percentage of liver/body weight from 3.4+/-0.8 per cent to 4.3+/-0.8 per cent (n=11, P< 0.05). Reduced liver blood supply in the DV(stent) group was associated with a decrease of cell proliferation in the liver from 12.43+/-2.31 to 6.5+/-0.62 (nuclei microm(2) 10(-4), n=3, P=0.058), in heart from 1.14+/-0.03 to 0.93+/-0.02 (nuclei microm(2) 10(-4), P< 0.05), and in skeletal muscle from 0.82+/-0.05 to 0.54+/-0.01 (nuclei microm(2) 10(-4), P< 0.05). The increased liver blood perfusion following occlusion of the DV increased cell proliferation sixfold in the liver, (n=9, P< 0.005) and twofold in heart muscle, skeletal muscle and the kidneys (P< 0.05), whereas no significant difference was seen in the placenta. The expression of mRNA for IGF-I and IGF-II in the liver was increased in the DV(coil) group. In conclusion, these results suggest that liver blood perfusion can regulate fetal growth.
宫内生长受限的人类胎儿的胎盘和胎儿肝脏血流量会减少。我们推测胎儿肝脏血液供应的变化会改变胎儿生长。在9只妊娠119±2天的双胎妊娠母羊中，将一个支架（4毫米）置入其中一个双胎的静脉导管（DV（支架）组）。另外，在17只接近足月的双胎（n = 11）或单胎（n = 6）妊娠绵羊中，用栓塞线圈阻塞静脉导管（DV（线圈）组）约一周时间。测定肝脏、心脏、骨骼肌、肾脏和胎盘的细胞增殖率（pKi - 67）。静脉导管的扩张或阻塞在手术后第一天及之后并未改变胎盘灌注。DV（支架）组的肝脏血液供应从499±371降至278±219毫升/分钟（平均值±标准差，n = 4），减少了一半以上，而DV（线圈）组增加了两倍（P < 0.05）。肝脏/体重百分比从对照双胎的3.9±0.6%降至DV（支架）组的3.0±0.2%（n = 3）。阻塞静脉导管导致肝脏/体重百分比从3.4±0.8%增加到4.3±0.8%（n = 11，P < 0.05）。DV（支架）组肝脏血液供应减少与肝脏细胞增殖从12.43±2.31降至6.5±0.62（细胞核/平方微米×10⁻⁴，n = 3，P = 0.058）、心脏从1.14±0.03降至0.93±0.02（细胞核/平方微米×10⁻⁴，P < 0.05）以及骨骼肌从0.82±0.05降至0.54±0.01（细胞核/平方微米×10⁻⁴，P < 0.05）相关。阻塞静脉导管后肝脏血液灌注增加，使肝脏细胞增殖增加了六倍（n = 9，P < 0.005），心肌、骨骼肌和肾脏增加了两倍（P < 0.05），而胎盘未见显著差异。DV（线圈）组肝脏中IGF - I和IGF - II的mRNA表达增加。总之，这些结果表明肝脏血液灌注可调节胎儿生长。
