Leopardi O, Naughten W, Salvia L, Colecchia M, Matteelli A, Zucchi A, Shein A, Muchi J A, Carosi G, Ghione M
Department of Pathology, Ospedale Maggiore, Lodi, Italy.
Pathol Res Pract. 1996 Sep;192(9):892-8; discussion 899-900. doi: 10.1016/S0344-0338(96)80068-9.
A histological and morphometric study was conducted on 372 placentae out of a total 440 delivered in Zanzibar. Fibrin (F), intervillous space (IVS) and Villi (V) relative volumes were determined by the point-counting system and the ratio of syncytium to blood capillaries by the linear intercept method. Parasitemia load and inflammatory reaction were graded semiquantitatively by the use of a 1 mm square grid. Parasitised red cells identified active malaria (AM), the presence of malarial pigment only identified past malaria (PM), and the absence of both characterized non-malarial placentae (NM). AM(17.87%), PM(21.61%) and NM(60.52%) placentae did not vary significantly in weight. Newborns from AM had a significantly lower weight than those from PM and NM. Peripheral and placental parasitemia were not coincident. Placental parasitemia load increased parallel with birthweight. The latter decreased with the increasing severity of the inflammation, particularly with the prevalence of lymphocytes in the IVS. Significantly increased volume of F was found in AM and PM placentae, while no significant variation was noticed in IVS and V volumes. The syncytium/capillaries ratio was significantly increased in AM. We conclude that low birthweight in malaria is linked to IVS inflammation but not to F deposits or parasitemia load. Non-leukotactic lymphokines might play some role. Morphologic aspects bespeak for a less mature placenta than expected and this might represent an adaptive change.
对桑给巴尔440例分娩中的372例胎盘进行了组织学和形态计量学研究。采用点计数系统测定纤维蛋白（F）、绒毛间隙（IVS）和绒毛（V）的相对体积，采用线性截距法测定合体滋养层与血毛细血管的比例。使用1平方毫米的网格对寄生虫血症负荷和炎症反应进行半定量分级。识别出寄生红细胞为活动性疟疾（AM），仅存在疟色素为既往疟疾（PM），两者均无则为非疟疾胎盘（NM）。AM胎盘（17.87%）、PM胎盘（21.61%）和NM胎盘（60.52%）的重量无显著差异。AM组新生儿体重显著低于PM组和NM组。外周血和胎盘寄生虫血症不一致。胎盘寄生虫血症负荷与出生体重平行增加。出生体重随炎症严重程度增加而降低，尤其是IVS中淋巴细胞增多时。AM和PM胎盘的F体积显著增加，而IVS和V体积无显著变化。AM组合体滋养层/毛细血管比例显著增加。我们得出结论，疟疾中的低出生体重与IVS炎症有关，而与F沉积或寄生虫血症负荷无关。非趋化性淋巴细胞因子可能起一定作用。形态学方面表明胎盘比预期的不成熟，这可能代表一种适应性变化。
