【摘要】 目的　观察妊娠肝内胆汁淤积症 (intrahepaticcholestasisofpregnancy ,ICP)胎盘超微结构病理改变和表皮生长因子受体 (EGFR)的表达 ,研究胆汁酸对滋养细胞的毒性作用及其对胎儿生长发育的影响。　方法　透射电镜观察 2 2例ICP患者胎盘组织 ,其中ICP合并胎儿生长受限 (fetalgrowthrestriction ,FGR) 7例、ICP未合并FGR 15例 ,应用免疫组化方法和逆转录 聚合酶链反应 (RT PCR)技术测定胎盘滋养细胞表皮生长因子受体 (EGFR)的表达 ,并和 15例正常晚期胎盘比较。　结果　电镜显示 ,ICP胎盘合体滋养细胞较对照组微绒毛减少、内质网扩张、线粒体肿胀或髓鞘样改变 ,核染色质异常分布。ICP合并FGR组上述病理改变更为明显 ,绒毛间质毛细血管减少 ,并出现大量胶原原纤维。ICP合并FGR组胎盘EGFR免疫组化的平均A值 (0 .2 39± 0 .0 17)和ICP未合并FGR组EGFR免疫组化的平均A值 (0 .2 5 3± 0 .0 15 )均比对照组 (0 .384± 0 .0 16 )低 ,差异具非常显著性 (P<0 .0 1)。ICP合并FGR组胎盘EGFRmRNA指数 (0 .2 30± 0 .0 4 8)和ICP未合并FGR组EGFRmRNA指数 (0 .2 31± 0 .0 4 2 )表达均比对照组 (0 .4 6 0± 0 .0 5 1)低 ,差异具非常显著性 (P <0 .0 1) ,ICP合并FGR组与ICP未合并FGR组之间胎盘EGFR的表达无显著性差异 (P更多还原

【Abstract】 Objective The cytotoxic effect of bile acids on trophoblast and fetal development in intrahepatic cholestasis of pregnancy(ICP) were studied through the observation of ultrastructure changes and expression of epidermal growth factor receptor(EGFR) of placenta. Methods Twenty two ICP (7 with FGR and 15 without FGR) and 15 normal late pregnancies were selected. The placental ultrastructure was observed with transmission electron microscope. The expression of EGFR in placenta was determined by immunohistological method and the related quantity of EGFR mRNA was analysed by reverse transcription polymerase chain reaction (RT PCR). Results The morphological changes found in syncytiotrophoblast were the following: decrease in the number of superficial microvilli, dilatation of rough endoplasmic reticulum, tumefation or myelination of the mitochondria and abnormal distribution of chromatin. These changes of syncytiotrophoblast were more obvious in ICP with FGR. In addition, decrease in the number of capillaries and proliferation of degenerated collagenous fibrils in villi interstitium were also observed. Compared with the normal pregnancies, the expression of EGFR in placenta from ICP decreased significantly and there was no significant difference of EGFR expression in ICP with and without FGR. Conclusion Bile acids cause distinct injuries on trophoblast in a dose dependent manner and that maybe account for the decreased expression of placental EGFR in ICP.更多还原