血清孕酮、转化生长因子-β、共刺激分子可溶性B7-H3在自发性流产病人中的表达及预测价值分析

Expression and predictive value of serum progesterone, TGF-β and sB7-H3 in patients with spontaneous abortion

目的探讨血清孕酮、转化生长因子-β(TGF-β)、共刺激分子可溶性B7-H3(sB7-H3)在自发性流产(SA)病人中的表达及预测价值。方法选取周口市西华县妇幼保健院2015年5月至2018年1月妊娠者240例作为研究对象,根据妊娠情况分为SA病人35例作为观察组,正常妊娠者205例作为对照组。妊娠第6周、第7周、第10周、第12周检测对比两组血清孕酮、TGF-β、sB7-H3水平,logistic回归分析SA影响因素,Pearson相关系数分析血清孕酮、TGF-β、sB7-H3间相关性,受试者工作特征曲线(ROC曲线)分析血清孕酮、TGF-β、sB7-H3对SA的预测价值。结果两组年龄、既往流产史、甲状腺功能差异有统计学意义(P<0.05);观察组妊娠第7周、第10周、第12周孕酮(26.38±4.12)μg/L、(28.13±5.66)μg/L、(30.16±6.16)μg/L、TGF-β(4407.60±710.38)ng/L、(5801.20±953.25)ng/L、(6531.52±1,280.92)ng/L、sB7-H3(901.52±250.56)ng/L、(1308.27±339.78)ng/L、(1718.03±417.38)ng/L水平低于对照组(29.84±5.28)μg/L、(33.29±6.38)μg/L、(38.95±8.88)μg/L、(5151.07±780.19)ng/L、(6776.44±995.61)ng/L、(8032.10±1500.17)ng/L、(1176.17±281.44)ng/L、(1675.91±378.75)ng/L、(2183.08±470.18)ng/L(P<0.05);年龄≥30岁、既往流产史、甲状腺功能异常、血清孕酮、TGF-β、sB7-H3是SA发生的独立危险因素(P<0.05);血清TGF-β与sB7-H3呈正相关,孕酮与TGF-β、sB7-H3呈正相关(P<0.05);ROC曲线显示,第7周血清孕酮预测SA的AUC值最高0.864,大于TGF-β、sB7-H3。结论SA病人血清孕酮、TGF-β、sB7-H3呈低表达,因子间协同作用可能是造成流产的主要原因,临床加强高危SA病人上述因子监测,对超早期干预、改善妊娠结局具有重要意义。

Objective To investigate the expression and predictive value of serum progesterone(P),transforming growth factor-β(TGF-β)and costimulatory molecule soluble B7-H3(sB7-H3)in patients with spontaneous abortion(SA).Methods A total of 240 cases of pregnant women in The Xihua County Maternal and Child Health Hospital of Zhoukou City from May 2015 to January 2018 were selected as the research objects.According to the pregnancy status,35 cases with SA were used as the observation group,and 205 cases with normal pregnancy were used as the control group.The levels of serum P,TGF-βand sB7-H3 in the two groups were measured and compared at the sixth,seventh,tenth,twelfth weeks of pregnancy,logistic regression was used to analyze SA influencing factors,Pearson correlation coefficient was used to analyze the correlation among serum P,TGF-βand sB7-H3,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum P,TGF-βand sB7-H3 to SA.Results The differences in age,previous miscarriage history,and thyroid function between the two groups were statistically significant(P<0.05);P level in the observation group was(26.38±4.12)μg/L,(28.13±5.66)μg/L and(30.16±6.16)μg/L,respectively at the 7 th,10 th,and 12 th week of pregnancy,TGF-βlevel was(4407.60±710.38)ng/L,(5801.20±953.25)ng/L and(6531.52±1280.92)ng/L respectively,sB7-H3 level was(901.52±250.56))ng/L,(1308.27±339.78)ng/L,(1718.03±417.38)ng/L,which were lower than those in the control group[P level:(29.84±5.28)μg/L,(33.29±6.38)μg/L and(38.95±8.88)μg/L,respectively;TGF-βlevel:(5151.07±780.19)ng/L,(6776.44±995.61)ng/L and(8032.10±1500.17)ng/L,respectively;sB7-H3 level(1176.17±281.44)ng/L,(1675.91±378.75)ng/L and(2183.08±470.18)ng/L,respectively](P<0.05);age>30 years old,history of miscarriage,abnormal thyroid function,serum P,TGF-β,and sB7-H3 were independent risk factors for SA(P<0.05);serum TGF-βwas positively correlated with sB7-H3,and P was positively correlated with TGF-βand sB7-H3(P<0.05);ROC curve showed that the AUC value of serum P predicted SA at week 7 was the highest 0.864,which was greater than TGF-β,sB7-H3.Conclusion There are abnormal expression of P,TGF-βand sB7-H3 in patients with SA,the synergism among factors may be the main cause of abortion,it is of great significance to strengthen the clinical monitoring of the above factors in high-risk patients with SA for ultra-early intervention and improvement of pregnancy outcomes.