姜丹 于晶功 孙寒冰

[摘要] 目的 探讨胎儿生长受限（fetal growth restriction，FGR）患者胎盘滋养细胞凋亡相关因子P53、bax、bcl-2的表达及意义。 方法 收集2014年3月～2017年6月大连市妇女儿童医疗中心剖宫产分娩患者的胎盘，其中正常妊娠晚期（对照组）、FGR（实验组）各50例。应用免疫组化S-P法检测两组胎盘滋养细胞凋亡相关因子P53、bcl-2、bax的表达。 结果 实验组bax蛋白表达明显高于对照组，差异有显著性（P<0.05），实验组bcl-2蛋白表达低于对照组，差异有显著性（P<0.05）。P53蛋白在正常妊娠晚期、FGR组均未见表达或仅有个别细胞表达，差异无显著性（P>0.05）。 结论 FGR患者胎盘滋养细胞凋亡是非P53依赖的凋亡，凋亡相关因子bax、bcl-2蛋白可能共同介导FGR胎盘滋养细胞的凋亡。

[关键词] FGR;凋亡;P53;bax;bcl-2

[中图分类号] R714.5          [文献标识码] B          [文章编号] 1673-9701（2020）15-0151-04

Expression of factors P53， bcl-2 and bax related to trophoblast cell apoptosis in FGR placenta

JIANG Dan1   YU Jinggong2   SUN Hanbing2   Liu Yuanyuan1   ZOU Na1

1.Department of Pathology， Dalian Municipal Women and Children's Medical Center， Dalian   116000， China; 2.Department of Pathology， Dalian Maternity Hospital， Dalian   116000， China

[Abstract] Objective To explore the expression and significance of factors P53， bax and bcl-2 related to trophoblast cell apoptosis in patients with fetal growth restriction（FGR） placenta. Methods Placentas of patients who experienced Cesarean section from March 2014 to June 2017 in Dalian Municipal Women and Children's Medical Center were collected， including 50 cases of normal late pregnancy（the control group） and 50 cases of FGR（the experimental group）. Immunohistochemical S-P method was used to detect the expression of factors P53， bcl-2 and bax related to trophoblast cell apoptosis in the two groups of placentas. Results The expression of bax protein in the experimental group was obviously higher than that in the control group， and the difference was significant（P<0.05）. The expression of bcl-2 protein in the experimental group was significantly lower than that in the control group（P<0.05）. P53 protein was not expressed in the normal late pregnancy and FGR groups or was only expressed in a few cells， with no significant difference（P>0.05）. Conclusion Apoptosis of placental trophoblast cells in FGR patients is non-P53-dependent apoptosis， and apoptosis-related factors bax and bcl-2 proteins may jointly mediate apoptosis of FGR placental trophoblast cells.

[Key words] FGR; Apoptosis; P53; Bax; Bcl-2

胎兒生长受限（fetal growth restriction，FGR）是产科常见并发症及严重影响围产儿预后甚至死亡的病理妊娠过程，其临床诊断标准为胎儿的出生体重低于同孕龄胎儿平均体重的第十个百分位数或两个标准差。FGR不仅影响胎儿发育，对儿童期、青春期等智力、体能等都有远期潜在影响。FGR的发病原因除外母体营养供应、胎盘转运、胎儿遗传等相对明确的病因外，还有约40%的患者发病病因尚不明确[1]。有文献报道，不明原因的FGR发生与胎盘滋养细胞侵袭不彻底有关[2]，绒毛发育障碍，侵袭过浅，母体则无法通过胎盘供应给胎儿充足的血液及营养。在FGR的发病机制中，有关滋养细胞凋亡异常及凋亡的调控机制被广为关注。在妊娠期的整个过程中均存在着胎盘的滋养细胞凋亡，任何凋亡状态的异常均会引起胎盘滋养细胞的侵袭障碍，导致FGR病理妊娠的发生[3]。本课题组经前期研究发现FGR胎盘滋养细胞存在凋亡增加的现象[4]，现用免疫组化方法检测凋亡相关因子p53、bax、bcl-2的表达与FGR胎盘滋养细胞凋亡的关系。……