Department of Pathology, Diakonissenkrankenhaus Flensburg, Knuthstraße 1, 24939, Flensburg, Germany.
Department of Pathology, Medical School Hannover, Hannover, Germany.
Virchows Arch. 2020 Jul;477(1):73-81. doi: 10.1007/s00428-020-02765-0. Epub 2020 Feb 5.
Villitis of unknown etiology (VUE) and chronic deciduitis with plasma cells (CD) are supposed to be non infectious placental lesions caused by a pathologic immune reaction similar to a host versus graft mechanism. In some investigations, infection of human trophoblastic cells with human papilloma virus (HPV) has been described, and a relationship with miscarriage, preeclampsia, and chronic inflammatory placental lesions has been suspected. Infection with enterovirus, especially Coxsackievirus, has been observed in cases with spontaneous abortion and adverse perinatal outcome, respectively. We investigated 20 cases with VUE and 30 cases with chronic deciduitis with plasma cells. The placenta specimens were analyzed for expression of HPV capsid protein by immunohistochemistry, for presence of HPV DNA via polymerase chain reaction (PCR), and for presence of enterovirus mRNA using RT-PCR, respectively. VUE was associated with maternal diseases: atopic lesions in 21%, other autoimmune diseases in 15.5%, and obesity in 31.5%, respectively. Birth weight below the 10th percentile was detected in 63% of the cases with VUE. Chronic deciduitis was associated with preterm labor and preterm premature rupture of membranes (26%). Intrauterine fetal demise occurred in 5 cases with CD (18.5%). HPV DNA, HPV capsid protein, and enterovirus mRNA were not detected in all investigated VUE or CD cases. Our investigations show that a causal role for enterovirus and human papilloma virus in the development of VUE and CD is unlikely. Therefore, HPV vaccination is unlikely to reduce the incidence of VUE and CD in the future.
不明病因的绒毛膜炎（VUE）和伴有浆细胞的慢性蜕膜炎（CD）被认为是非传染性胎盘病变，由类似于宿主对移植物反应的病理性免疫反应引起。在一些研究中，已经描述了人类绒毛滋养层细胞感染人乳头瘤病毒（HPV），并且怀疑与流产、子痫前期和慢性炎症性胎盘病变有关。在自发性流产和不良围产期结局的病例中，分别观察到肠病毒（尤其是柯萨奇病毒）感染。我们研究了 20 例 VUE 和 30 例伴有浆细胞的慢性蜕膜炎。通过免疫组织化学分析胎盘标本中 HPV 衣壳蛋白的表达，通过聚合酶链反应（PCR）检测 HPV DNA 的存在，通过逆转录聚合酶链反应（RT-PCR）检测肠病毒 mRNA 的存在。VUE 与母体疾病有关：特应性病变占 21%，其他自身免疫性疾病占 15.5%，肥胖占 31.5%。VUE 病例中 63%的新生儿体重低于第 10 个百分位数。慢性蜕膜炎与早产和早产胎膜早破（26%）有关。CD 中有 5 例（18.5%）发生宫内胎儿死亡。在所有研究的 VUE 或 CD 病例中均未检测到 HPV DNA、HPV 衣壳蛋白和肠病毒 mRNA。我们的研究表明，肠病毒和人乳头瘤病毒在 VUE 和 CD 的发展中起因果作用的可能性不大。因此，HPV 疫苗不太可能降低未来 VUE 和 CD 的发病率。
