urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.25.1.7LSEVENurmj-2083Research ArticleОригинальные статьи | Original articlesOriginal articlesПатологоанатомические особенности плацент при хронической артериальной гипертензии и ассоциированной с ней преэклампсиейMorphological Features of Placentas in Chronic Arterial Hypertension and Associated Preeclampsiahttps://orcid.org/0000-0001-9656-350XАзаренковаЕ. А.AzarenkovaE. A.

Евгения Андреевна Азаренкова  — заведующий учебно-методическим отделом 

Екатеринбург 

Evgeniia A. Azarenkova  — Head of the Educational and Methodological Department 

Ekaterinburg 

jennysplean@mail.ruhttps://orcid.org/0000-0002-3268-7981СемёновЮ. А.SemenovY. A.

Юрий Алексеевич Семёнов — доктор медицинских наук, доцент, ректор

Екатеринбург 

Yuriy A. Semenov — Doctor of Sciences (Medicine), Associate Professor, Rector

Ekaterinburg 

u-sirius@mail.ruhttps://orcid.org/0000-0002-3531-3491АнтоновВ. Н.AntonovV. N.

Владимир Николаевич Антонов — доктор медицинских наук, доцент, профессор кафедры терапии, институт дополнительного профессионального образования 

Челябинск 

Vladimir N. Antonov — Doctor of Sciences (Medicine), Associate Professor, Professor of the Department of Therapy, Institute of Continuing Professional Education 

Chelyabinsk 

ant-vn@yandex.ruhttps://orcid.org/0000-0003-3251-6944СычуговГ. В.SychugovG. V.

Глеб Вячеславович Сычугов — кандидат медицинских наук, доцент кафедры патологической анатомии и судебной медицины имени профессора В. Л. Коваленко; заместитель главного врача по медицинской части 

Челябинск 

Gleb V. Sychugov — Candidate of Sciences (Medicine), Associate Professor of the Department of Pathological Anatomy and Forensic Medicine named after Professor V. L. Kovalenko; Deputy Chief Physician for Medical Affairs 

Chelyabinsk 

docsgv@yandex.ruСычуговА. Г.SychugovA. G.

Александр Глебович Сычугов — заведующий отделением патоморфологии и цитодиагностики 

Екатеринбург 

Aleksandr G. Sychugov — Head of the Department of Pathomorphology and Cytodiagnostics 

Ekaterinburg 

sychugovsag@gmail.comУральский научно-исследовательский институт охраны материнства и младенчестваРоссияUral Research Institute for Maternal and Child HealthRussian FederationУральский государственный медицинский университетРоссияUral State Medical UniversityRussian FederationЮжно-Уральский государственный медицинский университетРоссияSouth Ural State Medical UniversityRussian FederationЮжно-Уральский государственный медицинский университет; Челябинское областное патологоанатомическое бюроРоссияSouth Ural State Medical University; Chelyabinsk Regional Pathological Anatomy BureauRussian Federation2026270220262517–17Copyright © Азаренкова Е.А., Семёнов Ю.А., Антонов В.Н., Сычугов Г.В., Сычугов А.Г., 20262026Азаренкова Е.А., Семёнов Ю.А., Антонов В.Н., Сычугов Г.В., Сычугов А.Г.Azarenkova E.A., Semenov Y.A., Antonov V.N., Sychugov G.V., Sychugov A.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/2083 Введение

 Введение. Преэклампсия (ПЭ) является серьезным осложнением гестации, центральное место в патогенезе которого занимает дисфункция плаценты. Сходство механизмов развития хронической артериальной гипертензии (ХАГ) и ПЭ обусловливает интерес к изучению морфологических особенностей плацент у этих пациенток.

Материалы и методы

Материалы и методы. Выполнено гистологическое и иммуногистохимическое (ИГХ) исследование плацент с оценкой экспрессии VEGF, PlGF и ангиотензиногена. В группу 1 вошли плаценты женщин с ХАГ (n = 24); 2 — с ХАГ и ПЭ (НПЭ) (n = 26); 3 — без гипертензивных расстройств беременности (ГРБ) (n = 20). Статистический анализ выполнен с использованием программного комплекса IBM SPSS Statistics 26.0 (США).

Результаты

Результаты. При гистологическом исследовании в группе 2 выявлено статистически значимое увеличение частоты встречаемости децидуальной артериопатии (p = 0,007) и отека ворсин (p = 0,005) по сравнению с группой 1. В группе 1 значимо чаще встречались инфаркты ворсин (p = 0,005) и отложение фибриноида (р = 0,016) по сравнению с группой 3. Наиболее высокие показатели VEGF, PlGF отмечены в группе пациенток без ГРБ (р1:3 < 0,0001 и p2:3 < 0,0001), а уровень экспрессии ангиотензиногена, напротив, ниже у беременных группы 3 (р1:3 < 0,0001 и p2:3 < 0,0001). Уровни экспрессии VEGF, PlGF и ангиотензиногена были статистически значимо выше в группе 2 по сравнению с группой 1 (p < 0,0001).

Обсуждение

Обсуждение. Проведенное исследование демонстрирует различия в архитектонике тканей плацент при ХАГ и НПЭ: для ХАГ характерны структурные признаки хронической плацентарной недостаточности, а при НПЭ доминируют маркеры острой эндотелиопатии и нарушенной плацентации. Данные, полученные при ИГХ-исследовании, демонстрируют дерегуляцию ангиогенеза и вазоконстрикцию в плаценте, а также эндотелиальную дисфункцию при ГРБ. 

 Introduction

 Introduction. Preeclampsia (PE) is serious complication of gestation, the central place in the pathogenesis of which is placental dysfunction. The similarity of the pathogenetic mechanisms of chronic arterial hypertension (CAH) and PE determines interest in studying the morphological features of placentas in these patients.

Materials and methods

Materials and methods. Histological and immunohistochemical (IHC) study of placentas was performed, assessing expression levels of VEGF, PlGF, angiotensinogen. Group 1 included placentas from women with CAH (n = 24), Group 2 — from women with CAH and PE (SPE) (n = 26), and Group 3 included placentas from patients without hypertensive disorders of pregnancy (HDP) (n = 20).

Results

Results. Histological examination revealed statistically significant increase in the incidence of decidual arteriopathy (p = 0.007) and villous edema (p = 0.005) in Group 2 compared with Group 1. Group 1 had significantly higher incidence of villous necrosis (p = 0.005) and fibrinoid deposition (p = 0.016) compared with Group 3. When assessing expression level of IHC markers, highest levels of VEGF and PlGF expression were observed in group of patients without HDP (p1 : 3 < 0.0001 and p2 : 3 < 0.0001), while level of angiotensinogen expression, in contrast, was lower in pregnant women from Group 3 (p1 : 3 < 0.0001 and p2 : 3 < 0.0001). The expression levels of VEGF, PlGF, and angiotensinogen were statistically significantly higher in Group 2 compared to Group 1 (p < 0.0001).

Discussion

Discussion. This study demonstrates different morphological profiles of placental tissue in CAH and SPE: isolated CAH is characterized by signs of chronic placental insufficiency, while SPE is dominated by markers of acute endotheliopathy and impaired placentation. IHC data demonstrate dysregulated angiogenesis and vasoconstriction in placenta, as well as significant endothelial dysfunction in HDP. 

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The authors declare that there are no conflicts of interest present.