Ando K, Kanayama N
Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine.
Nihon Sanka Fujinka Gakkai Zasshi. 1993 Sep;45(9):1035-41.
The cause of abruptio placentae has not been elucidated yet. Although preeclampsia is frequently associated with abruptio placentae, the rate of abruptio placentae caused by preeclampsia has decreased recently. Many current reports have indicated that chorioamnionitis is an important cause of abruptio placentae. To clarify the relationship between chorioamnionitis and abruptio placentae, we performed immunostaining for fibronectin, fibronectin receptor and granulocyte elastase of placenta with or without abruptio placentae. In cases of abruptio placentae caused by chorioamnionitis, granulocyte elastase was stained strongly and fibronectin receptor was stained weakly in decidual cells, especially in the parts of granulocyte elastase invased. In III stage chorioamnionitis without abruptio placentae, granulocyte elastase was stained moderately and the intensity of fibronectin receptor did not decrease. There was no difference between fibronectin staining in all cases. When purified granulocyte elastase was added to the cultured decidual cells, the staining intensity of fibronectin receptor became weak in those cells. These results suggest that marked imbalance between neutrophil invasion and an inhibitor, such as alpha 1 antitrypsin, initiates granulocyte elastase release and promotes the reduction of the fibronectin receptor in decidual cells resulting in weakening of the adherence of decidual cells. This may be one of the mechanisms of abruptio placentae caused by chorioamnionitis.
胎盘早剥的病因尚未阐明。虽然子痫前期常与胎盘早剥相关，但近年来子痫前期所致胎盘早剥的发生率有所下降。许多近期报告表明，绒毛膜羊膜炎是胎盘早剥的一个重要原因。为了阐明绒毛膜羊膜炎与胎盘早剥之间的关系，我们对有或无胎盘早剥的胎盘进行了纤连蛋白、纤连蛋白受体和粒细胞弹性蛋白酶的免疫染色。在由绒毛膜羊膜炎引起的胎盘早剥病例中，蜕膜细胞中粒细胞弹性蛋白酶染色强烈，而纤连蛋白受体染色较弱，尤其是在粒细胞弹性蛋白酶侵入的部位。在无胎盘早剥的Ⅲ期绒毛膜羊膜炎中，粒细胞弹性蛋白酶染色中等，纤连蛋白受体强度未降低。所有病例中纤连蛋白染色无差异。当将纯化的粒细胞弹性蛋白酶加入培养的蜕膜细胞中时，这些细胞中纤连蛋白受体的染色强度变弱。这些结果表明，中性粒细胞浸润与诸如α1抗胰蛋白酶等抑制剂之间的明显失衡引发了粒细胞弹性蛋白酶的释放，并促进了蜕膜细胞中纤连蛋白受体的减少，从而导致蜕膜细胞黏附力减弱。这可能是绒毛膜羊膜炎所致胎盘早剥的机制之一。
