Department of Pathology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
Virchows Arch. 2018 Apr;472(4):635-642. doi: 10.1007/s00428-018-2315-3. Epub 2018 Feb 9.
The placental tissues of pregnancy-induced hypertension (PIH) patients exhibit multiple infarctions, acute atherosis, distal villous hypoplasia, and increased syncytial knots. However, these findings are not observed in all cases of PIH; thus, the significance of these changes in PIH is still unclear. We studied the frequency of histopathological changes of placental tissue in the subgroups of PIH, such as mild and severe PIH and early-onset (< 34 weeks) and late-onset (≥ 34 weeks) PIH. One hundred seven cases of PIH diagnosed at the Shinshu University Hospital, Matsumoto, Japan, between 2008 and 2014 were collected. PIH includes preeclampsia and gestational hypertension. The pathologic changes evaluated in the placenta were multiple infarctions, acute atherosis, distal villous hypoplasia, and increased syncytial knots. Placental tissues of patients with early-onset PIH demonstrated acute atherosis resulting from the incomplete remodeling of the spiral arteries and distal villous hypoplasia and increased syncytial knots reflecting placental hypoxia/ischemia much more frequently than those with late-onset PIH (all p < 0.001). The frequencies of multiple infarctions did not show a statistical difference between early-onset PIH and late-onset PIH. Moreover, there were no significant differences in the frequencies of histopathological features of placental tissue between mild PIH and severe PIH. Early-onset PIH exhibited histopathological changes of placental tissue consistent with the two-stage disorder theory more frequently than late-onset PIH. These findings support the idea that early-onset PIH and late-onset PIH are distinct entities or different extremes of the PIH spectrum.
妊娠高血压（PIH）患者的胎盘组织表现出多发梗死、急性动脉粥样硬化、绒毛远端发育不良和合体滋养细胞结节增多。然而，并非所有 PIH 病例都存在这些发现，因此这些变化在 PIH 中的意义仍不清楚。我们研究了 PIH 亚组（如轻度和重度 PIH 以及早发型（<34 周）和晚发型（≥34 周）PIH）胎盘组织的组织病理学变化的频率。收集了日本松本市信州大学医院 2008 年至 2014 年间诊断的 107 例 PIH 病例。PIH 包括子痫前期和妊娠高血压。评估胎盘的病理变化包括多发梗死、急性动脉粥样硬化、绒毛远端发育不良和合体滋养细胞结节增多。早发型 PIH 胎盘组织中更频繁地出现由螺旋动脉不完全重塑引起的急性动脉粥样硬化以及绒毛远端发育不良和合体滋养细胞结节增多，反映胎盘缺氧/缺血（均 p<0.001），而晚发型 PIH 则较少见。早发型 PIH 与晚发型 PIH 之间多发梗死的频率没有统计学差异。此外，轻度 PIH 和重度 PIH 之间胎盘组织的组织病理学特征频率没有显著差异。早发型 PIH 比晚发型 PIH 更频繁地出现与两阶段紊乱理论一致的胎盘组织组织病理学变化。这些发现支持早发型 PIH 和晚发型 PIH 是不同实体或 PIH 谱的不同极端的观点。
