PDF(Pubmed)
Abstract：
We have suggested that adipocytes in uterine scars may affect the development of the placenta accrete spectrum (PAS). In the experimental part, we explored adipocytes in the uterine wall by the twelfth sexual cycle after surgery. In the clinical part, we investigated adipocyte clusters in the cesarean scar of pregnant women with and without PAS. The uterine wall was evaluated in gross and histological sections using morphometry, histochemistry (hematoxylin and eosin stain, Mallory stain), and immunohistochemistry for FABP4 (adipocyte markers), CD68, CD163, CD206 (macrophages), CD 34 (endothelium), cytokeratin 8 (epithelium), aSMA (smooth muscle cells). The design included an experimental study on Sprague-Dawley rats (n = 18) after a full-thickness surgical incision on the seventh (n = 6), 30th (n = 6), and 60th day (n = 6). The clinical groups include pregnant women without uterine scars (n = 10), pregnant women with a uterine scar after previous cesarean sections (n = 10), and women with PAS (n = 11). Statistical processing was carried out using nonparametric methods. Comparisons were conducted using the Mann-Whitney U-test and Kruskal-Wallis test. Statistical significance was considered at p < 0.05. On the seventh day, the rat uterine horn was enveloped by adipose tissue, which contained crown-like structures with FABP4+, CD68+, CD206+, and CD163+ cells. FABP4+ cells in the uterine wall were absent by the 30th day. The number of CD206+ and CD163+ cells in the adipose tissue decreased by the 30th day. On the 60th day, the attachment of fat tissue was revealed in the form of single strands. The serous layer around the damaged area totally recovered on the 60th day. FABP4+ cells were not detected in the uterine wall samples from pregnant women without a previous cesarean section. Adipocytes were found in the scar during non-complicated pregnancy and with PAS. Reducing the number of CD68+ cells in adipocyte clusters, there were in myometrium with PAS. Increased CD206+ and CD163+ cells were revealed in uterine adipocyte clusters of the group. According to the experimental finding, adipocytes should be absent in the uterine wall by the 12th sexual cycle after a full-thickness surgical incision. The presence of adipocyte clusters in cesarean scar indicated the disturbance of cell interaction. Differences in the numbers of CD206 and CD163 cells in adipocyte clusters between groups with and without PAS may be indirect evidence that uterine adipocytes affect the development of PAS.
摘要：
我们认为子宫疤痕中的脂肪细胞可能会影响胎盘植入谱（PAS）的发育。在实验部分,我们探讨了手术后第12个性周期子宫壁的脂肪细胞。在临床部分，我们调查了有和没有PAS的孕妇剖宫产瘢痕中的脂肪细胞簇。使用形态学在大体和组织学切片中评估子宫壁，组织化学(苏木精和曙红染色，马洛里污渍)，和FABP4（脂肪细胞标志物）的免疫组织化学，CD68，CD163，CD206（巨噬细胞），CD34（内皮），细胞角蛋白8（上皮），aSMA(平滑肌细胞)。该设计包括对Sprague-Dawley大鼠（n=18）在第七（n=6）全层手术切口后的实验研究，30(n=6)，第60天（n=6）。临床组包括没有子宫疤痕的孕妇（n=10），先前剖宫产后有子宫疤痕的孕妇（n=10），和女性PAS（n=11）。使用非参数方法进行统计处理。使用Mann-WhitneyU检验和Kruskal-Wallis检验进行比较。在p<0.05时考虑统计学显著性。第七天，大鼠子宫角被脂肪组织包裹，包含带有FABP4+的冠状结构，CD68+,CD206+,和CD163+细胞。到第30天，子宫壁中的FABP4细胞不存在。第30天时脂肪组织中CD206+和CD163+细胞的数目下降。在第60天，脂肪组织的附着以单链的形式显示。第60天，受损区域周围的浆液层完全恢复。在未进行过剖宫产的孕妇的子宫壁样品中未检测到FABP4细胞。在非复杂性妊娠和PAS期间，在疤痕中发现了脂肪细胞。减少脂肪细胞簇中CD68+细胞的数量，子宫肌层有PAS。在该组的子宫脂肪细胞簇中显示出增加的CD206和CD163细胞。根据实验发现,全层手术切口后，到第12个性周期，子宫壁中应该没有脂肪细胞。剖宫产瘢痕中脂肪细胞簇的存在表明细胞相互作用的紊乱。有和没有PAS的组之间脂肪细胞簇中CD206和CD163细胞数量的差异可能是子宫脂肪细胞影响PAS发展的间接证据。
