内科

目的探讨低分子肝素辅助治疗对胎儿生长受限（FGR）患者胎盘超微结构及血管内皮生长因子（VEGF）表达的影响。方法选取2020年1月至2021年1月我院收治的FGR患者80例为研究对象，随机分成实验组与对照组，每组40例。对照组患者给予常规治疗，实验组患者在对照组的基础上给予低分子肝素治疗，治疗10 d为1个疗程，共治疗3个疗程。随访两组患者至其分娩结束，检测比较两组患者的胎盘超微结构情况与胎盘VEGF表达情况；比较两组患者的胎儿不良结局。结果对照组患者胎盘合体滋养细胞表面微绒毛排列整齐，部分缺失，胞质内粗面内质网、线粒体扩张，细胞核形态规则，绒毛间质毛细血管较少；实验组患者胎盘合体滋养细胞表面呈现大量排列整齐的微绒毛，胞质内可见丰富粗面内质网、线粒体，细胞核形态规则，核染色质致密并且均匀分布，绒毛间质毛细血管扩张明显。实验组患者胎盘组织滋养细胞、绒毛间质细胞、内皮细胞的VEGF表达水平均明显高于对照组，差异有统计学意义（P＜0.05）。实验组患者胎儿不良结局的总发生率（5.0%）低于对照组（20.0%），差异有统计学意义（P＜0.05）。结论在常规治疗的基础上，低分子肝素治疗可明显改善胎儿生长受限患者的胎盘超微结构和血管内皮生长因子蛋白表达水平，从而促进胎儿生长发育，改善患者的妊娠结局。

ObjectiveTo investigate the effect of adjuvant therapy with low molecular weight heparin on placental ultrastructure and expression of vascular endothelial growth factor (VEGF) in patients with fetal growth restriction (FGR). MethodsEighty patients with FGR admitted to our hospital from January 2020 to January 2021 were selected as the research objects, and they were randomly divided into experimental group and control group, with 40 cases in each group. The control group was given conventional treatment, and the experimental group was treated with low molecular weight heparin on the basis of the control group, with 10 days as a course of treatment and 3 treatment courses for both groups. The two groups of patients were followed up until the end of delivery, and placental ultrastructure and placental VEGF expression were detected and compared between the two groups. The adverse fetal outcomes of the two groups were compared. ResultsIn the control group, the microvilli on the surface of placental syncytiotrophoblasts were arranged neatly and partially missing, the rough endoplasmic reticulum and mitochondria in the cytoplasm expanded, the nuclear morphology was regular, and the capillary in the villi interstitial was less. In the experimental group, the surface of placental syncytiotrophoblasts of patients showed a large number of neatly arranged microvilli, abundant rough endoplasmic reticulum, mitochondria in the cytoplasm, regular morphology of the nucleus, dense and distributed nuclear chromatin, and obvious telangiectasis in the villi interstitial. In the experimental group, the expression levels of VEGF in trophoblast cells, villi interstitial cells and endothelial cells of the placental tissues were significantly higher than those of the control group, with statistically significant differences (P＜0.05). The total incidence of adverse fetal outcomes in the experimental group (5.0%) was lower than that in the control group (20.0%), with a statistically significant difference (P＜0.05). ConclusionOn the basis of conventional treatment, low molecular weight heparin therapy can significantly improve the placental ultrastructure and vascular endothelial growth factor protein expression level in patients with fetal growth restriction, thereby promoting fetal growth and improving pregnancy outcome.