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임신한 흰쥐에서 자궁동맥 결찰에 의한 혈관내피성장인자의 변동
김용욱(Yong Wook Kim),이종건(Jong Kun Lee),이재성(Jae Sung Lee),최옥춘(Ok Choon Choi),노덕영(Duck Yeong Ro),김태응(Tae Eung Kim),정재근(Jae Geun Jung),신종철(Jong Chul Shin) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.12
N/A Objective : During pregnancy, the impaired placental perfusion causes complications such as preeclampsia, intrauterine growth restriction and fetal death in utero. In order to investigate the maternal and fetal response to the impaired placental perfusion, the author induced the impaired placental perfusion by the ligation of the rat uterine artery and investigated its effect on the expression of VEGF (vascular endothelial growth factor) in the placenta and serum VEGF level. Methods : The rats on day 15 of gestation were used for the experiment. They were divided into two groups. The control group consists of the 20 rats that underwent laparotomy without uterine artery ligation. The experimental group consists of the 20 rats that underwent laparotomy and the uterine artery ligation by silk on day 15 of gestation. On day 16, 17, 18 and 19 of gestation, the placental tissues were obtained. The Mrna expressions of the VEGF in the placenta were measured by the relative RT-PCR in the control and experimental group. The localization and intensity of immunohistochemical staining of VEGF in placenta were determined in both groups and the maternal serum levels of VEGF were also measured in both groups. Results : The Mrna expressions of VEGF120 and VEGF164 were significantly increased 48 hours after the ligation (day 17 of gestation) but the Mrna expression of VEGF188 was not changed after the ligation. There was no difference in the location and intensity of immunohistochemical staining of VEGF in the placenta between control and experimental groups. The serum VEGF levels of control group were 9 times as high as those of non-pregnant rats. The significant increases of the serum VEGF levels were noted 48 and 72 hours after the ligation (day 17 and 18 of gestation) but the significant increase was not noted 96 hours after the ligation (day 19 of gestation) as compared to control group. Conclusion : This study demonstrated firstly that the experimentally induced reduction of placental perfusion increased expressions of VEGF in the placenta and maternal serum. The results support that the measurement of maternal serum VEGF levels in pregnancy may help the diagnosis of placental insufficiency.
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자궁내 발육지연을 동반한 중증자간전증의 태반내 말단융모 기질에서 α-smooth muscle actin과 collagen IV의 발현 및 태아모세혈관의 울혈
정대영,이영,이종건,이종승,유영옥,필신혜,이형근 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.1
목적 : 자간전증은 자궁태반 혈류장애를 일으키는 질환 중에서 산과적으로 비교적 흔한 질환이며, 태반혈류장애와 같은 태반의 기능적 장애는 결국 말단융모 (terminal villi)의 병리 생물학적 변화를 초래한다. 따라서 자궁 내 태아발육지연을 동반한 중증자간전증과 정상임신의 태반내 말단융모 기질과 태아모세혈관을 비교함으로써 자간전증을 동반한 자궁 내 태아발육지연의 태반 병태생리를 규명하고자 본 연구를 시행하였다. 연구방법 : 17명의 자궁 내 태아발육지연을 동반한 중증자간전증환자를 실험군으로, 그리고 유사한 임신주수의 산모 17명을 대조군으로 나누어, 각 군의 태반에서 조직절편을 채취하여, mouse monoclonal α-smooth muscle actin antibody와 mouse monoclonal antihuman collagenIV를 1차 항체로 사용하며, 면역조직화학염색 후 α-smooth muscle actin과 collagenIV의 발현을 비교하였고, 태아모세혈관 울혈에 대한 관찰은 헤마톡실린과 에오진으로 염색(H-E stain) 후 비교하였다. 두 군간의 비교는 출생체중과 태반무게는 independent student t-test, 면역화학염색 및 태아모세혈관 비교는 Chi-square test를 하였으며 통계적 유의성은 p$lt;0.05에 두었다. 결과 : 각 군의 임상적 특징 중 출생시 태아의 체중, 태반무게에서 실험군의 평균값이 대조군의 평균값보다 유의하게 낮았다. 실험군의 말단융모기질 내에서 α-smooth muscle actin과 collagenIV의 발현이 대조군보다 유의하게 높았다. 말단융모기질 내에서 태아모세혈관 울혈정도도 실험군의 태반모세혈관에서 유의하게 높게 나타났다. 결론 : 자간전증을 동반한 태아발육지연군에서 태반융모 기질 내에 유의한 형태학적 변화가 있는 것으로 생각되며, 특히 태아발육지연군에서 α-smooth muscle actin과 collagenIV의 발현과 모세혈관울혈 빈도 등이 높은 것은 이들 환자에서 말단융모의 혈관외수축계의 존재를 의미하는 것으로 사료된다. Objective : Preeclampsia is the major cause of prenatal mortality and morbidity. The functional disorder of uteroplacental insufficiecy is caused by the impaired uteroplacental blood flow and diffusion barrier in the villi. Functional disorders like placental circulating disorders results in morphological changes of terminal. villi as functional unit of placenta. We studied to investigate the differences in villous stoma of placental terminal villi and fetal capillary between growth restricted pregnancies with severe preeclampsia and normal preterm pregnancies. Method : Terminal villi was examined using light microscopy and by immunohistochemical localization of matrix molecule (α-smooth muscle actin and collagenIV) and the immunoreactivity of α-smooth muscle actin and collagenIV were evaluated in 17 cases of severe preeclampsia with intrauterine growth restriction as a study group and in 17 cases of gestational age matched normotensive preterm pregnancies as a control group. Fetal capillary congestion in terminal villi was also evaluated by Hematoxylin-Eosin staining. The patterns of immunohistochemical staining were all determinated in a visual qualitative manner (0-25% : -, 25-50% : +, 50-75% : ++, 75-100% : +++) by one pathologist. Congestion was considered to be present in a failed where the majority ($gt;90%) of the capillaries demonstrated densely packed erythrocyte. Result : Expression of α-smooth muscle actin in the terminal villous stroma was significantly increased in study group compared with control group (P=0.0001). Expression of collagen IV in the terminal villous stroma was significantly increased in study group compared with control group (P=0.0001). Fetal capillary congestion was also significantly increased in study group compared with control group (P=0.049). Conclusion : The result suggests that there be the structural or biochemical difference in the villous stroma between normotensive preterm pregnancies and severe preeclampsia with intrauterine growth restriction and that the extravascular contractile system might be in the villous stroma in the severe preeclampsia intrauterine growth restriction.
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