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轻度妊娠高血糖妇女的病理学胎盘病变 Histopathological placental lesions in mild gestational hyperglycemic and diabetic women
2011/8/11   双语园地 

Objective
To investigate and compare the incidence of histopathological placental lesions in mild gestational hyperglycemia, gestational diabetes and overt diabetes at term and preterm gestation. Research design and methods: One-hundred-and-thirty-one placental samples were collected from Diabetes mellitus (DM) positive screened patients. Two diagnostic tests, glycemic profile and 100g oral glucose tolerance test (OGTT) in parallel identified 4 groups normoglycemic, mild gestational hyperglycemia (MGH), gestational DM (GDM) or overt DM (DM). Placental tissue specimens and sections from 4 groups were obtained by uniform random sampling and stained with hematoxylin-eosin. Results: Placentas from MGH group presented 17 types of histopathological change and higher rates of syncytial nodes and endarteritis. GDM placentas presented only nine types of histopathological change, high rates of dysmaturity, low rates of calcification and no syncytial nodes. Overt DM placentas showed 22 types of histopathological change, 21 of which were present in the preterm period. There were histopathological similarities between MGH and DM placentas, but the former exhibited a higher incidence of endarteritis, which has been described as a "post-mortem" phenomenon. Conclusion: Our results confirmed that the distinct placental changes associated with DM and MGH depend on gestational period during which the diabetic insult occurs. It may reasonably be inferred that subclinical maternal hyperglycemia during pregnancy, as showed in MGH group, is responsible for increased placental endarteritis, a postmortem lesion in the live fetus.
 
 
目的
    本研意在调查长期和早产妊娠中,轻度妊娠高血糖、妊娠糖尿病和显性糖尿病妇女的病理学胎盘病变。研究设计和方法:搜集到糖尿病筛查阳性患者的131例胎盘样本,在4个并行的小组(血糖量正常、轻度妊娠高血糖[MGH]、妊娠糖尿病[GDM]、显性糖尿病[DM])进行2个诊断测试——患者的个人糖尿病资料以及100g口服糖耐量实验(OGTT)。通过统一的随机抽样和苏木精-伊红染色得到4个组的胎盘组织样本和切片。结果:轻度妊娠高血糖组的胎盘样本表现出了17种组织病理学变化,以及更高的合胞节点和动脉内膜炎的几率。妊娠糖尿病足的样本只表现出了9种组织病理学变化,高几率的胎儿发育不良,低几率的钙化以及并无合胞节点。显性糖尿病胎盘组织病理变化表现为22种,其中21种表现在早产期。轻度妊娠高血糖组和显性糖尿病组的胎盘样本在组织病理学上有相似处,但是前者的动脉内膜炎的发病率更高,可以称之为“事后剖析”现象。结论:我们的结果证实,与糖尿病与轻度妊娠高血糖相关的胎盘病理变化来源于妊娠期间的糖尿病发生。有理由推论,孕期出现的亚临床妊娠高血糖,就像轻度妊娠高血糖组表现的那样,应该是胎盘动脉内膜炎发病率的升高以及胎儿稍后病变的主要原因。
 
Diabetology & Metabolic Syndrome 2011, 3:19
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