Redline R W, Zaragoza M, Hassold T
Department of Pathology, Case Western Reserve, Cleveland, OH, USA.
Hum Pathol. 1999 Jan;30(1):93-100. doi: 10.1016/s0046-8177(99)90307-6.
The management of patients with first-trimester spontaneous abortions is handicapped by two problems: difficulty in recognizing conceptions that abort because of abnormal karyotypes and an incomplete understanding of what causes abortions with normal karyotypes. Our goals in this study were to define features useful in distinguishing normal from abnormal karyotype and to identify pathological processes contributing to abortions with a normal karyotype. The study population consisted of 668 well-characterized first-trimester spontaneous abortions derived from a larger study of 1,054 consecutively karyotyped spontaneous abortions. Clinical factors increased in specimens with normal karyotype were maternal age younger than 20 years (P=.0003) and autoimmune markers (P=.0474). Developmental features associated with abnormal karyotype were developmental stage less than 6 weeks (P=.0017), hydropic villi greater than 1 mm (P=.0004), and villi with two or more dysmorphic features (P=.0001). Developmental stage greater than 11.5 weeks was increased with normal karyotype (P=.0001). Histological features increased in specimens with a normal karyotype were chronic intervillositis (P=.0003), increased perivillous fibrin deposition with intermediate trophoblast (P=.0006), decidual plasma cells (P=.0040), deciduitis without plasma cells (P=.0660), and chronic villitis (P=.1581). Overall, 19% of samples with a normal karyotype versus 8% with abnormal karyotype had one or more of these findings (P < .0001). Autoimmune markers, chronic intervillositis, and increased perivillous fibrin with intermediate trophoblast all had positive predictive values greater than 85% for normal karyotype, whereas dysmorphic villi had a positive predictive value of 90% for abnormal karyotype. Patients with recurrent spontaneous abortion and normal karyotype were more likely to have one or more of the histological features listed above (31%) than patients with normal karyotype and no prior abortions (13%) and patients with recurrent abortion and abnormal karyotype (11%).
难以识别因染色体核型异常而流产的妊娠，以及对正常核型流产的原因理解不完整。我们在本研究中的目标是确定有助于区分正常与异常核型的特征，并识别导致正常核型流产的病理过程。研究人群包括668例特征明确的孕早期自然流产病例，这些病例来自对1054例连续进行染色体核型分析的自然流产病例的更大规模研究。核型正常的标本中增加的临床因素有母亲年龄小于20岁（P = 0.0003）和自身免疫标志物（P = 0.0474）。与异常核型相关的发育特征有发育阶段小于6周（P = 0.0017）、水肿绒毛大于1毫米（P = 0.0004）以及具有两种或更多畸形特征的绒毛（P = 0.0001）。核型正常时发育阶段大于11.5周的情况增加（P = 0.0001）。核型正常的标本中增加的组织学特征有慢性绒毛间炎（P = 0.0003）、中间型滋养层周围纤维蛋白沉积增加（P = 0.0006）、蜕膜浆细胞（P = 0.0040）、无浆细胞的蜕膜炎（P = 0.0660）和慢性绒毛炎（P = 0.1581）。总体而言，核型正常的样本中有19%与核型异常的样本中有8%出现了这些发现中的一项或多项（P < 0.0001）。自身免疫标志物、慢性绒毛间炎以及中间型滋养层周围纤维蛋白增加对正常核型的阳性预测值均大于85%，而畸形绒毛对异常核型的阳性预测值为90%。与无既往流产史且核型正常的患者（13%）以及反复流产且核型异常的患者（11%）相比，反复自然流产且核型正常的患者更有可能出现上述一种或多种组织学特征（31%）。
