Relationship Between The Levels Of Placental Adiponectin Receptor2Protein And Its Ultrastructure Changes In Patients With Hypertensive Disorder Complicating Pregnancy

Objective:Hypertensive disorder complicating pregnancy (HDCP) is a pregnancy-specific disease, it is also one of the common obstetric complications, the incidence of it in China is between9.4and10.4%, and in foreign countries the incidence is between7and12%. HDCP has caused7.1/100000maternal deaths. This disease has serious impact on the mother and fetus. It can cause fetal growth restriction, fetal distress, postpartum hemorrhage, combined heart and kidney disease, and even lead to the death of mother and the fetus. The pathogenesis of HDCP is not clear so far, it may involve a variety of factors such as the mother, placenta and fetus, which including abnormal trophoblast invasion, immunomodulatory dysfunction, endothelial cell injury, genetic factors and nutritional factors. But there is not any single one to explain the causes and mechanisms of HDCP. The abnormal trophoblast invasion and the vascular endothelial cell damage are considered to be the two key factors in the pathogenesis of the disease. Now, with further study, people have widely recognize the important role of the placenta between the mother and the fetus. At the same time, adiponectin protein also attracts wide attention, it is secreted by fat cells and existed in human serum, which plays the role of anti-inflammatory, anti-atherosclerotic, improving insulin resistance, lowering blood sugar and pressure, protecting vascular endothelial and others. However, there are few reports of pathological pregnancy, especially about the placenta ultrastructure of patients with hypertensive disorder complicating pregnancy. Similarly, the study of adiponectin receptor proteins are still insufficient, which are target organs of adiponectin protein. The study mainly by observing the placental adiponectin receptor2protein expression and placental ultrastructural changes explore the relationship between the expression of placental adiponectin receptor2protein and its ultrastructure changes in patients with HDCP.Methods:For immunohistochemistry, formalin-fixed paraffin-embedded placenta tissue blocks were obtained from40patients with HDCP who underwent caesarean section at the First Hospital of Hebei Medical University (Shijiazhuang, China) from2011to2012(10gestational hypertensions,10mild preeclampsias and20severe preeclampsias). The study also included20normal pregnant women during the third trimester of pregnancy at the same time as control group. For electron microscopy, the patients were also from the same cases. The level of adiponectin receptor2protein was detect by immunohistochemistry and the structure changes in placental ultrastructurein including the placental syncytiotrophoblast and the microvilli, the mitochondria and endoplasmic reticulum morphological were observed by transmission electron microscopy.Results:1The gestational age of the gestational hypertension group and the mild preeclampsia group was lower than that in the contorl group (P<0.05), the severe preeclampsia group’s gestational age was significantly lower than that in the the contorl group (P<0.01). The blood pressure of the severe preeclampsia group and that in the gestational hypertension group and the mild preeclampsia group was significantly higher than that in the the contorl group (P<0.01). The severe preeclampsia group’s blood pressurre was significantly higher than that in the gestational hypertension group and the mild preeclampsia group (P<0.01).2The AdipoR2protein existed in the placenta syncytiotrophoblast cytoplasm of the three study objects. The AdipoR2protein expression in the severe preeclampsia group was lower than that in the mild preeclampsia group and the gestational hypertension group (P<0.05), and it was also significantly lower than that in the contorl group (P<0.01)). There was no difference in the AdipoR2protein expression between the gestational hypertension group and the mild preeclampsia group and the control group. 3Compared with the control group, the microvillus at the bottom of syncytiotrophoblast of the gestational hypertension group was sparse, disarranged, a few of vacuolar degeneration and lipid granules were in the cytoplasm, heterochromatin also occurred. In the mild preeclampsia group and severe preeclampsia group, the microvillus at the bottom of syncytiotrophoblast was sparse, swollen and severely disarranged. The mitochondria was swollen, part of the crest and membrane fused and missed. The endoplasmic reticulum were dilated, particle fusion and degranulation occurred, there are a lot of vacuolar degeneration, the deposition of lipid granules were increased.Conclusions:1The gestational age, systolic blood pressure, diastolic blood pressure and mean arterial pressure of the patients with hypertensive disorder complicating pregnancy changed with the progression of the disease, these factors jointly or separately play a role in the development of the disease.2The abnormal AdipoR2proteins expression in hypertensive disorder complicating pregnancy patients proved it contribute to the pathology of this disease, and this indirectly confirmed adiponectin contribute to the occurrence and development of it, detected the serum adiponectin timely can help us to understand the progression of the disease, and to predict the severity of disease, timely intervene.3The microstructure of placenta in hypertensive disorder complicating pregnancy was changed, which led to Material exchange barriers, transportation and synthesis function of placenta may be affected, so fetus could be injured subsequently. Therefore, preventing decompensation of the placenta is the key to the prevention of adverse pregnancy outcomes.