Placental Analytics LLC, New Rochelle, New York, USA; Institute for Basic Research, Staten Island, New York, USA; New York Presbyterian- Brooklyn Methodist Hospital, Brooklyn, New York, USA; Queens Hospital Center, Queens, New York, USA.
Department of Epidemiology and Biostatistics, MSU College of Human Medicine, 909 Wilson Road Room B645, East Lansing, MI, 48824, USA.
Semin Fetal Neonatal Med. 2020 Aug;25(4):101128. doi: 10.1016/j.siny.2020.101128. Epub 2020 Aug 28.
Obstetric endorsement of the utility of placental histologic examination remains infrequent, especially from obstetricians who do not have a placental pathologist as part of their own local clinical care team. Placental pathologic examinations are viewed as useless if they do not provide answers to urgent clinical questions. Increasingly, however, it is appreciated that while placental analysis should be considered with regard to its longer term value; results can assess lifelong risks of a wide range of diseases that have been tied to prenatal exposures (e.g., [1]), including distinguishing sex-specific differences in those risks. (e.g., [2]) This review will focus solely on acute fetal (?) inflammation, more specifically, the fetal neutrophil responses in umbilical cord, chorionic plate vessels and to some degree, the fetal system as a whole. This histologic fetal inflammatory response is often the most readily accessible aspect of "FIR" piece of FIRS (the fetal inflammatory response syndrome). Some researchers have defined FIRS by a combination of both cytokine (especially IL-6) levels and the histopathologic FIR (Musilova et al., 2018) [3]. As we and others have noted, many histology based FIR cases, even those associated with neurodevelopmental outcomes such as cerebral palsy, are clinically silent.(e.g., [4]) Current clinical diagnostic criteria may have high specificity as they are very good at identifying non-FIR cases. However, that high specificity is coupled with very low specificity, identifying only 10% of FIR (Doty et al., 2018 Jul) [5]. Our aim is to provide a conceptual framework for the readers of the journal to better understand how to answer the following questions: What is a neutrophil and how is it important in FIR? What is the differential diagnosis for histologic FIR? How long has there been FIR? What secondary processes may have been recruited (and when) to contribute to the final pathology and pathophysiology of the given pregnancy?
产科医生对胎盘组织学检查的实用性认可仍然很少见，尤其是那些没有胎盘病理学家作为其当地临床护理团队一部分的产科医生。如果胎盘病理检查不能提供紧急临床问题的答案，那么它们就被认为是无用的。然而，人们越来越认识到，虽然胎盘分析应该考虑其长期价值；但结果可以评估与产前暴露有关的一系列广泛疾病的终身风险（例如，[1]），包括区分这些风险的性别特异性差异。（例如，[2]）本综述将仅关注急性胎儿（？）炎症，更具体地说，是脐带、绒毛板血管中的胎儿中性粒细胞反应，在某种程度上，整个胎儿系统也是如此。这种组织学胎儿炎症反应通常是“FIR”的最容易获得的方面之一，即“FIRS”（胎儿炎症反应综合征）。一些研究人员通过细胞因子（特别是 IL-6）水平和组织病理学 FIR 的组合来定义 FIRS（Musilova 等人，2018 年）[3]。正如我们和其他人所指出的，许多基于组织学的 FIR 病例，即使与脑瘫等神经发育结局相关，临床上也是无声的。（例如，[4]）目前的临床诊断标准可能具有很高的特异性，因为它们非常善于识别非 FIR 病例。然而，这种高特异性伴随着非常低的特异性，仅识别 10%的 FIR（Doty 等人，2018 年 7 月）[5]。我们的目的是为该杂志的读者提供一个概念框架，以帮助他们更好地理解如何回答以下问题：什么是中性粒细胞，它在 FIR 中如何重要？组织学 FIR 的鉴别诊断是什么？FIR 存在多久了？可能已经招募了哪些继发性过程（以及何时），以促进特定妊娠的最终病理学和病理生理学？
