母体胎盘梗死/绒毛膜板大量纤维蛋白沉积：一种母体抗胎儿排斥的表现？
Maternal floor infarction/massive perivillous fibrin deposition: a manifestation of maternal antifetal rejection?
机构信息
Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, Bethesda, MD, USA.
出版信息
Am J Reprod Immunol. 2013 Oct;70(4):285-98. doi: 10.1111/aji.12143. Epub 2013 Aug 1.
OBJECTIVE
Massive perivillous fibrin deposition (MPFD) and maternal floor infarction (MFI) are related placental lesions often associated with fetal death and fetal growth restriction. A tendency to recur in subsequent pregnancies has been reported. This study was conducted to determine whether this complication of pregnancy could reflect maternal antifetal rejection.
METHODS
Pregnancies with MPFD were identified (n = 10). Controls consisted of women with uncomplicated pregnancies who delivered at term without MPFD (n = 175). Second-trimester maternal plasma was analyzed for panel-reactive anti-HLA class I and class II antibodies. The prevalence of chronic chorioamnionitis, villitis of unknown etiology, and plasma cell deciduitis was compared between cases and controls. Immunohistochemistry was performed on available umbilical vein segments from cases with MPFD (n = 4) to determine whether there was evidence of complement activation (C4d deposition). Specific maternal HLA-antibody and fetal HLA-antigen status were also determined in paired specimens (n = 6). Plasma CXCL-10 concentrations were measured in longitudinal samples of cases (n = 28 specimens) and controls (n = 749 specimens) by ELISA. Linear mixed-effects models were used to test for differences in plasma CXCL-10 concentration.
RESULTS
(i) The prevalence of plasma cell deciduitis in the placenta was significantly higher in cases with MPFD than in those with uncomplicated term deliveries (40% versus 8.6%, P = 0.01), (ii) patients with MPFD had a significantly higher frequency of maternal anti-HLA class I positivity during the second trimester than those with uncomplicated term deliveries (80% versus 36%, P = 0.01); (iii) strongly positive C4d deposition was observed on umbilical vein endothelium in cases of MPFD, (iv) a specific maternal antibody against fetal HLA antigen class I or II was identified in all cases of MPFD; and 5) the mean maternal plasma concentration of CXCL-10 was higher in patients with evidence of MPFD than in those without evidence of MFPD (P < 0.001).
CONCLUSION
A subset of patients with MPFD has evidence of maternal antifetal rejection.
目的
绒毛膜板大量纤维蛋白沉积（MPFD）和母体胎盘梗死（MFI）是相关的胎盘病变，常与胎儿死亡和胎儿生长受限有关。据报道，这种妊娠并发症有复发倾向。本研究旨在确定这种妊娠并发症是否反映了母体对胎儿的排斥反应。
方法
鉴定出 MPFD 妊娠（n=10）。对照组由无并发症的足月分娩且无 MPFD 的孕妇组成（n=175）。分析妊娠中期母体血浆中 HLA Ⅰ类和Ⅱ类面板反应性抗体。比较病例组和对照组之间慢性绒毛膜羊膜炎、原因不明的绒毛膜炎和浆细胞蜕膜炎的发生率。对有 MPFD 的病例（n=4）的可用脐静脉段进行免疫组织化学染色，以确定是否有补体激活（C4d 沉积）的证据。还在配对标本（n=6）中确定了特定的母体 HLA 抗体和胎儿 HLA 抗原状态。通过 ELISA 检测病例（n=28 标本）和对照组（n=749 标本）的纵向样本中 CXCL-10 的浓度。使用线性混合效应模型检验血浆 CXCL-10 浓度的差异。
结果
（i）MPFD 病例胎盘的浆细胞蜕膜炎发生率明显高于无并发症的足月分娩病例（40%对 8.6%，P=0.01）；（ii）MPFD 患者在妊娠中期 HLA Ⅰ类阳性的母体频率明显高于无并发症的足月分娩病例（80%对 36%，P=0.01）；（iii）在 MPFD 病例中观察到强烈的 C4d 沉积在脐静脉内皮上；（iv）在所有 MPFD 病例中均发现针对胎儿 HLA 抗原Ⅰ类或Ⅱ类的特异性母体抗体；（v）有 MPFD 证据的患者的平均母体血浆 CXCL-10 浓度高于无 MPFD 证据的患者（P<0.001）。
结论
MPFD 的一部分患者有母体抗胎儿排斥反应的证据。
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