Radboud University Nijmegen Medical Centre, Department of Obstetrics & Gynaecology, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Placenta. 2012 Aug;33(8):630-3. doi: 10.1016/j.placenta.2012.04.013. Epub 2012 May 31.
Decidual vasculopathy (DV) describes pathological findings seen in the spiral arteries in preeclampsia (PE). Morphologically, DV is characterized by fibrinoid necrosis and foamy macrophages within the vessel walls. The impact of the lesions on clinical outcome and placental pathology is unclear. We compared cases with DV to cases without these lesions on clinical outcome and placental histology in PE.
Placental sections from 107 patients admitted with PE at the Radboud University Nijmegen Medical Centre, during the years 1995-2000, were analyzed. 25 cases were excluded due to incomplete records or multiple pregnancy. Cases with DV (n = 41) and without DV (n = 41) were compared for various clinical and placental histological parameters, using Mann-Whitney test. P-value < 0.05 was considered significant.
Clinically, DV related to higher diastolic blood pressure, shorter gestational age, lower birth weight and lower umbilical artery pH. Histologically, DV related to more accelerated villous maturity and perivascular inflammatory cell infiltration. No differences were found in maternal biochemical variables (protein-to-creatinine ratio, constituents of HELLP syndrome), fetal-maternal interface parameters (placenta weight, infarctions, hematoma, calcifications), or neonatal outcome measures (birth weight centile, APGAR scores, and perinatal death).
In PE, the presence of DV related to placental accelerated villous maturity, perivascular inflammatory cell infiltration, and adverse maternal and fetal outcome without affecting neonatal survival. Whether or not DV results from or raises the risk on severe preeclampsia remains to be elucidated.
蜕膜血管病变（DV）描述了子痫前期（PE）中螺旋动脉的病理发现。从形态学上看，DV 的特征是血管壁内纤维蛋白样坏死和泡沫状巨噬细胞。病变对临床结局和胎盘病理学的影响尚不清楚。我们比较了有和无这些病变的子痫前期病例的临床结局和胎盘组织学。
分析了 1995 年至 2000 年间在拉德堡德大学奈梅亨医学中心因 PE 住院的 107 名患者的胎盘切片。由于记录不完整或多胎妊娠，25 例被排除在外。比较了有 DV（n = 41）和无 DV（n = 41）的病例，使用 Mann-Whitney 检验比较了各种临床和胎盘组织学参数。p 值<0.05 被认为有统计学意义。
临床方面，DV 与舒张压升高、妊娠周数缩短、出生体重降低和脐动脉 pH 值降低有关。组织学上，DV 与绒毛成熟加速和血管周围炎症细胞浸润有关。在母体生化指标（蛋白/肌酐比值、HELLP 综合征成分）、胎儿-母体界面参数（胎盘重量、梗死、血肿、钙化）或新生儿结局指标（出生体重百分位数、APGAR 评分、围产期死亡）方面无差异。
在 PE 中，存在 DV 与胎盘绒毛成熟加速、血管周围炎症细胞浸润以及不良的母婴结局有关，但不影响新生儿的存活率。DV 是否是严重子痫前期的结果或增加其风险仍有待阐明。
