趋化因子MCP-1和RANTES与不明原因复发性流产的关系研究

Study on the correlation of chemokines MCP-1 and RANTES with unexplained recurrent spontaneous abortion

目的 分析不明原因复发性流产(URSA)的危险因素,观察单核细胞趋化蛋白-1(MCP-1)、调节活化正常T细胞表达和分泌因子(RANTES)与URSA的关系。方法 选择70例URSA患者作为URSA组,同期正常妊娠孕妇70例作为正常妊娠组。比较两组的临床资料,包括年龄、孕产次、家族遗传史、吸烟饮酒史、体质量指数(BMI)、从事职业、受教育程度等;采用酶联免疫吸附试验(ELISA)检测两组血清中的RANTES以及MCP-1水平。分析URSA发生的危险因素;比较两组血清MCP-1、RANTES水平, URSA组中不同胎龄、流产次数患者血清MCP-1、RANTES水平。结果 单因素分析显示, URSA组中年龄≥35岁、BMI≥24 kg/m^(2)、有吸烟史、有饮酒史、受教育程度初中及以下占比分别为62.9%、67.1%、61.4%、57.1%、65.7%,较正常妊娠组的30.0%、27.1%、18.6%、17.1%、37.1%更高(P<0.05)。多因素Logistic回归分析显示,患者BMI≥24 kg/m^(2)、年龄≥35岁、有吸烟及饮酒史、受教育程度初中及以下是导致URSA的危险因素(OR>1, P<0.05)。URSA组患者血清MCP-1、RANTES水平分别为(127.31±70.12)、(220.98±69.51)ng/L,低于正常妊娠组的(239.20±75.64)、(412.34±82.47)ng/L(P<0.05)。URSA组中,随流产次数增加,血清MCP-1、RANTES水平降低,比较差异具有统计学意义(P<0.05)。URSA组中,不同胎龄患者的血清MCP-1、RANTES水平比较,差异无统计学意义(P>0.05)。结论 BMI偏高、年龄偏大以及有吸烟及饮酒史、受教育程度低等因素是导致URSA的危险因素,血清RANTES以及MCP-1异常表达与URSA的发生关系密切。对于URSA患者,妊娠早期及时检测血清中RANTES和MCP-1水平,可能成为URSA胚胎丢失及免疫治疗效果的临床观察指标。

Objective To analyze the risk factors of unexplained recurrent spontaneous abortion(URSA),and observe the correlation of chemokines monocyte chemotactic protein-1(MCP-1)and regulated upon activation normal T cell expressed and secreted(RANTES)with unexplained recurrent spontaneous abortion(URSA).Methods 70 patients with URSA were selected as the URSA group,and another 70 pregnant women with normal pregnancy in the same period were selected as the normal pregnancy group.The clinical data of the two groups were compared,including age,gravidity and parity,family genetic history,history of smoking and drinking,body mass index(BMI),occupation,and education level,etc.The levels of RANTES and MCP-1 in the serum of the two groups were detected by enzyme-linked immunosorbent assay(ELISA).The risk factors for the occurrence of URSA were analyzed.Comparison was made on serum MCP-1 and RANTES levels between the two groups,and the serum MCP-1 and RANTES levels of patients with different gestational ages and number of abortions in the URSA group.Results Univariate analysis showed that≥35 years of age,BMI≥24 kg/m^(2),smoking history,drinking history,junior high school education or below accounted for 62.9%,67.1%,61.4%,57.1%and 65.7%in URSA group,which were higher than 30.0%,27.1%,18.6%,17.1%and 37.1%in the normal pregnancy group(P<0.05).Multivariate Logistic regression analysis showed that BMI≥24 kg/m^(2),≥35 years of age,history of smoking and drinking,and education level of junior high school or below were the risk factors for URSA(OR>1,P<0.05).The serum levels of MCP-1 and RANTES in URSA group were(127.31±70.12)and(220.98±69.51)ng/L,which were lower than(239.20±75.64)and(412.34±82.47)ng/L in normal pregnancy group(P<0.05).In URSA group,the serum levels of MCP-1 and RANTES decreased with the increase of abortion times,and the difference was statistically significant(P<0.05).In URSA group,there was no significant difference in serum MCP-1 and RANTES levels among patients of different gestational ages(P>0.05).Conclusion High BMI,older age,history of smoking and drinking,and low education level are risk factors for URSA,and the abnormal expression of serum RANTES and MCP-1 is closely related to the occurrence of URSA.In patients with URSA,timely detection of serum RANTES and MCP-1 levels in early pregnancy may be a clinical indicator of URSA embryo loss and the effect of immunotherapy.