Redline R W, Wilson-Costello D, Borawski E, Fanaroff A A, Hack M
Department of Pathology, Case Western University and University Hospitals of Cleveland, Ohio 44106, USA.
Arch Pathol Lab Med. 1998 Dec;122(12):1091-8.
Systematic placental examination has the potential to shed light on poorly understood antenatal processes that may increase the risk of neurologic impairment and cerebral palsy.
Using data from a retrospective case-control study, we analyzed placentas from 60 inborn, singleton, very low-birth-weight (<1.5 kg) infants delivered between 1983 and 1991 who had subsequent neurologic impairment at 20 months corrected age (42 with cerebral palsy and 18 with other neurologic abnormalities) and 59 control infants of comparable gestational age, birth weight, sex, and race. Three a priori hypotheses based on previous studies were that neurologic impairment would be increased with fetal vascular lesions with or without coexisting chorioamnionitis, decreased with chronic maternal vascular underperfusion, and increased when multiple placental abnormalities were seen in the same case.
We found 2 types of fetal placental vascular lesions to be associated with neurologic impairment, namely, recent nonocclusive thrombi of chorionic plate vessels (P < .04) and severe villous edema (P < .01). Chorionic plate thrombi were seen only with chorioamnionitis and accounted for the increased risk of neurologic impairment seen with chorioamnionitis. Maternal vascular lesions showed a biphasic relation to neurologic impairment in the subgroup of patients without chorioamnionitis. Mild lesions were increased in controls (inadequate vascular remodeling, P=.03, and accelerated maturation, P=.004). A more severe lesion, multiple villous infarcts, although not reaching significance, was increased in the neurologically impaired cases. Finally, in a test of 9 selected placental lesions, cases with cerebral palsy were more likely to have 2 or more lesions (P < .0001) and were less likely to have no lesions (P < .04) than control infants.
系统的胎盘检查有可能揭示人们了解不足的产前过程，这些过程可能会增加神经损伤和脑瘫的风险。
利用一项回顾性病例对照研究的数据，我们分析了1983年至1991年间出生的60例单胎、极低出生体重（<1.5千克）婴儿的胎盘，这些婴儿在矫正年龄20个月时有神经损伤（42例患有脑瘫，18例有其他神经异常），以及59例胎龄、出生体重、性别和种族相当的对照婴儿。基于先前研究提出的三个先验假设是，无论是否并存绒毛膜羊膜炎，胎儿血管病变都会增加神经损伤风险；慢性母体血管灌注不足会降低神经损伤风险；同一病例中出现多个胎盘异常时神经损伤风险会增加。
我们发现2种胎儿胎盘血管病变与神经损伤有关，即绒毛膜板血管近期非闭塞性血栓（P<.04）和严重绒毛水肿（P<.01）。绒毛膜板血栓仅在绒毛膜羊膜炎时出现，这解释了绒毛膜羊膜炎时神经损伤风险增加的原因。在无绒毛膜羊膜炎患者亚组中，母体血管病变与神经损伤呈双相关系。对照组中轻度病变增加（血管重塑不足，P=.03；成熟加速，P=.004）。一种更严重的病变，即多个绒毛梗死，虽然未达到统计学显著性，但在神经损伤病例中有所增加。最后，在对9种选定胎盘病变的检测中，与对照婴儿相比，脑瘫病例更有可能有2种或更多病变（P<.0001），且无病变的可能性更小（P<.04）。
