人类胎盘绒毛血管“适配”：与胎儿胎盘结局的关系。
Chorionic vascular "fit" in the human placenta: Relationship to fetoplacental outcomes.
机构信息
Institute for Basic Research, United States.
Placental Analytics LLC, United States.
出版信息
Placenta. 2017 Nov;59:13-18. doi: 10.1016/j.placenta.2017.08.008. Epub 2017 Aug 30.
BACKGROUND
Novel measures of the chorionic plate and vessels are used to test the hypothesis that variation in placental structure is correlated with reduced birth weight (BW) independent of placental weight (PW), suggesting functionally compromised placentas.
METHODS
916 mothers recruited to the Pregnancy, Infection and Nutrition Study delivering singleton live born infants at >30 gestational weeks had placentas collected, digitally photographed and weighed prior to formalin fixation. The fetal-placental weight ratio (FPR) was calculated as birthweight/placental weight. Beta (beta) was calculated as ln(PW)/ln(BW). Chorionic disk perimeter was traced and chorionic surface shape (CS) area was calculated. "Fit" was defined as the ratio of the area of the vascular to the full chorionic surface area. The sites at which chorionic vessels dived beneath the chorionic surface were marked to calculate the chorionic surface vessel (CV) area. The centroids of shapes, the distance between centroids and other measures of shape irregularities were calculated. Principal components analysis (PCA) created three independent factors. Factors were used in regression analyses to explore relations to birth weight, trimmed placental weight, FPR, and beta. Specific measures of shape irregularity were also examined in regression analyses for interrelationships and to predict birth weight, placental weight, FPR, and beta.
RESULTS
Variables related to disk size (CS area, perimeter) were correlated with BW, GA, trimmed PW and beta. "Fit" (the ratio of CV area to CS area), measures of shape irregularities, and the distance between the cord insertion and the centroids of surface and vascular areas were also correlated with one or more of the clinical outcome variables. PCA yielded three factors that had independent effects on birth weight, placental weight, the fetal-placental weight ratio, and beta (each p < 0.0001). Addition of GA did not alter the factors' associations with outcomes. Chorionic "fit" (ratio of areas), also included within the factor analysis, was a positive predictor of birth weight (p = 0.005) and FPR (p = 0.002) and a negative predictor of beta (p = 0.01). Fit was statistically significantly associated with greater distances between the umbilical cord insertion site and the CS (p < 0.001) and CV centroids (p < 0.001), and to lesser displacement between CS and CV centroids (p < 0.001).
CONCLUSIONS
Measures of CS and CV account for variation in placental efficiency defined by beta, independent of GA. Macroscopic placenta measurements can identify suboptimal placental development.
背景
新型的绒毛膜板和血管测量方法用于检验胎盘结构的变异与出生体重降低（BW）相关，而与胎盘重量（PW）无关的假设，这表明胎盘功能受损。
方法
在妊娠、感染和营养研究中招募了 916 名母亲，这些母亲在妊娠 30 周以上分娩单胎活产婴儿，在正式固定前收集胎盘并进行数字摄影和称重。胎儿-胎盘重量比（FPR）的计算方法为出生体重/胎盘重量。β（beta）的计算方法为 PW 的自然对数/ BW 的自然对数。绒毛膜盘周长被追踪，绒毛膜表面形状（CS）面积被计算。“拟合”定义为血管面积与完整绒毛膜表面积的比值。标记绒毛膜下血管进入绒毛膜表面的部位以计算绒毛膜表面血管（CV）面积。形状的质心、质心之间的距离以及其他形状不规则性的度量被计算出来。主成分分析（PCA）创建了三个独立的因子。因子用于回归分析，以探讨与出生体重、修剪胎盘重量、FPR 和β的关系。形状不规则性的特定度量也在回归分析中进行了检查，以探讨它们之间的关系，并预测出生体重、胎盘重量、FPR 和β。
结果
与盘大小（CS 面积、周长）相关的变量与 BW、GA、修剪后的 PW 和β相关。“拟合”（CV 面积与 CS 面积的比值）、形状不规则性的度量以及脐带插入点与表面和血管区域质心之间的距离也与一个或多个临床结局变量相关。PCA 产生了三个独立影响出生体重、胎盘重量、胎儿-胎盘重量比和β的因子（均 p < 0.0001）。添加 GA 并没有改变这些因素与结局的关联。绒毛膜“拟合”（面积比）也包含在因子分析中，是出生体重（p = 0.005）和 FPR（p = 0.002）的正预测因子，是β的负预测因子（p = 0.01）。拟合与脐带插入部位与 CS（p < 0.001）和 CV 质心（p < 0.001）之间的距离较大以及 CS 和 CV 质心之间的位移较小显著相关（p < 0.001）。
结论
CS 和 CV 的测量值可以解释由β定义的胎盘效率的变化，而与 GA 无关。大体胎盘测量值可以识别出胎盘发育不良。
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