妊娠期肝内胆汁淤积症患者胎盘组织中Smac、HSP70的表达及其临床意义探讨

发布时间：2018-03-13 03:39

本文选题：ICP　切入点：Smac　出处：《川北医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察妊娠期肝内胆汁淤积症(Intrahepatic Cholestasis of Pregnancy,ICP)患者与正常孕妇胎盘组织中Smac、HSP70的表达差异,探讨细胞线粒体氧化应激在ICP发病机制中的作用及临床意义,为进一步研究ICP发病机制,寻找预测ICP病情、监测胎儿宫内情况、预测新生儿预后和寻找临床终止妊娠的实验室指标。方法:收集2013年10月—2015年10月在川北医学院附属医院产科住院的ICP患者60例作为实验组(其中轻度组30例,重度组30例),选择同期住院的无内外科合并症及妊娠相关性疾病的单胎妊娠孕妇30例,作为对照组;均在临产前行剖宫产术终止妊娠,术中收集胎盘。对患者的一般资料、临床相关指标进行对比分析;使用免疫组化(一步法)检测胎盘组织中Smac、HSP70表达情况。结果:1、Smac在ICP组及对照组均有表达,主要表达在胎盘滋养细胞胞浆,重度ICP组阳性率为100.00%,轻度ICP组阳性率为83.33%,对照组阳性率为70.00%,3组在阳性表达率上差异有统计学意义(x~2=10.320,P0.01);3组在表达强度上差异有统计学意义(x~2=34.441,P0.01);Smac在ICP组表达强度明显高于对照组(x~2=78.750,P0.01);Smac在ICP重度组胎盘滋养细胞中表达强于轻度组,差异有统计学意义(x~2=11.978,P0.05)。2、HSP70在ICP组及对照组均有表达,主要表达在胎盘滋养细胞胞浆及胞核,其中重度ICP组阳性率为93.33%,轻度ICP组阳性率为83.33%,对照组阳性率为66.67%,3组在阳性表达率上差异有统计学意义(x~2=7.107,P0.05);3组在表达强度上差异有统计学意义(x~2=32.827,P0.01);ICP组表达强度高于对照组(x~2=19.167,P0.01);HSP70在ICP重度组胎盘滋养细胞中的表达强度高于ICP轻度组(x~2=14.000,P0.05)。3、HSP70与Smac在ICP组患者胎盘组织中的表达呈正相关(r=0.968,P0.05)。4、ICP组平均孕周36.59+1.58周,对照组平均孕周39.02+1.66周,两组孕周比较,差异有统计学意义(t=6.780,P0.01)。结论:1、Smac在ICP组及对照组胎盘组织中均有表达,ICP组胎盘中表达明显增强,ICP重度组表达高于轻度组,提示Smac在ICP组的表达明显增强,且与疾病程度正相关;2、HSP70在ICP组及对照组胎盘组织中均有表达,ICP组HSP70表达强于对照组,且ICP重度组表达明显高于轻度组,提示HSP70在ICP组表达且与病情呈正相关;3、氧化应激相关蛋白HSP70和Smac在ICP组患者胎盘组织滋养细胞中的表达呈正相关,提示线粒体氧化应激反应可能在ICP发病机制中起着重要作用,二者极有可能共同参与了ICP的发生、发展。
[Abstract]:Objective: to investigate the expression of Smaca HSP70 in placental tissues of intrahepatic Cholestasis of pregnancy-induced cholestasis of pregnancy and normal pregnant women, and to explore the role of mitochondrial oxidative stress in the pathogenesis of ICP and its clinical significance in order to further study the pathogenesis of ICP. To find out how to predict the condition of ICP and monitor the fetal intrauterine condition. Methods: from October 2013 to October 2015, 60 ICP patients hospitalized in obstetrical department of affiliated Hospital of North Sichuan Medical College were collected as experimental group (30 cases in mild group). In the severe group, 30 pregnant women with single pregnancy without internal and surgical complications and pregnancy-related diseases were selected as the control group, all the patients were treated with cesarean section to terminate pregnancy, and placenta was collected during the operation, and the general data of the patients were collected. The expression of Smaca HSP70 in placenta tissue was detected by immunohistochemistry (one step method). Results the expression of Smac in ICP group and control group was detected, mainly in the cytoplasm of placenta trophoblast. The positive rate of severe ICP group was 100.000.The positive rate of mild ICP group was 83.33, and the positive rate of control group was 70.003.33.The positive rate of ICP group was significantly higher than that of ICP group. The expression of Smac in placental trophoblastic cells in the severe ICP group was higher than that in the mild group, and the expression of SMAC in the placental trophoblastic cells in the severe ICP group was higher than that in the mild group. The difference was statistically significant in the expression of HSP70 in ICP group and control group, mainly in the cytoplasm and nucleus of placental trophoblast. The positive rate of severe ICP group was 93.33, that of mild ICP group was 83.33, and the positive rate of control group was 66.67%. The expression of HSP70 in placental trophoblastic cells in severe ICP group was higher than that in mild ICP group (P 0.05N. 3HSP70). There was a positive correlation between HSP70 expression and Smac expression in placental tissue of ICP group. The average gestational week was 36.59 1.58 weeks in ICP group. The average gestational age in the control group was 39.02 1.66 weeks, and the difference between the two groups was statistically significant. Conclusion the expression of Smac in ICP group and control group is significantly increased. The expression of SMAC in severe ICP group is significantly higher than that in mild group. It was suggested that the expression of Smac in ICP group was higher than that in control group, and the expression of HSP70 was significantly higher in ICP group and control group than in control group, and the expression of HSP70 in severe ICP group was significantly higher than that in mild group. The results suggest that the expression of HSP70 in ICP group is positively correlated with the severity of ICP, and that the expression of oxidative stress-related protein HSP70 and Smac in placental trophoblast of ICP group is positively correlated, suggesting that mitochondrial oxidative stress may play an important role in the pathogenesis of ICP. Both are likely to participate in the occurrence and development of ICP.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.255

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