血清微小核糖核酸-4286与幽门螺旋杆菌感染的子痫前期患者妊娠结局的关系

Relationship between serum microRNA-4286 and pregnancy outcome in preeclampsia patients infected with Helicobacter pylori

目的分析血清微小核糖核酸-4286(miR-4286)与幽门螺旋杆菌(Hp)感染的子痫前期(PE)患者妊娠结局的关系。方法选择Hp感染的孕妇89例[Hp组;年龄24~40岁,平均年龄31.67岁;孕前体质量指数(BMI)21.30~31.55 kg/m^(2),平均孕前BMI 25.47 kg/m^(2)]和204例Hp感染的PE患者(Hp+PE组;年龄24~40岁,平均年龄31.87岁;孕前BMI 21.01~31.55 kg/m^(2),平均孕前BMI 25.69 kg/m^(2))作为研究对象。采用实时荧光定量聚合酶链式反应(RT-qPCR)法检测miR-4286表达水平。随访获取Hp感染的PE患者妊娠结局,并分析miR-4286与其妊娠结局的关系。结果Hp组妊娠28周第1天(T2)和妊娠30周第1天(T3)的miR-4286水平均高于Hp+PE组(1.95±0.39 vs 1.82±0.26、2.28±0.31 vs 1.92±0.33。P=0.003、0.000),Hp组和Hp+PE组T3时点的miR-4286水平均高于T2时点(2.28±0.31 vs1.95±0.39、1.92±0.33 vs 1.82±0.26。P=0.000、0.001),Hp组miR-4286水平升高程度[0.38(0.56)]高于Hp+PE组[0.06(0.57)](P=0.000)。Hp+PE组中有121例妊娠结局不良(结局不良组),83例妊娠结局良好(结局良好组)。结局不良组PE确诊时收缩压(SBP)、舒张压(DBP)、24 h尿蛋白和剖宫产占比均高于结局良好组,分娩孕周低于结局良好组[(155.64±11.89)mmHg vs(151.75±11.34)mmHg、(101.25±6.16)mmHg vs(97.93±8.79)mmHg、(2.69±0.52)g vs(2.06±0.29)g、85.95%vs 65.06%、(34.79±2.06)周vs(37.94±0.97)周。P=0.020、0.002、0.000、0.000、0.000]。结局不良组PE确诊时(T1)、T2和T3时点的miR-4286水平均低于结局良好组(1.37±0.15 vs 1.66±0.23、1.75±0.26 vs 1.92±0.24、1.84±0.34 vs 2.02±0.28。P=0.000、0.000、0.000),两组miR-4286水平随时间进展呈升高趋势,结局不良组miR-4286水平升高程度[0.45(0.52)]高于结局良好组[0.32(0.45)](P=0.028)。T1时点miR-4286判断妊娠结局不良的受试者工作特性(ROC)曲线下面积高于T2和T3时点的miR-4286(0.864 vs 0.688、0.864 vs 0.674。P=0.000、0.000)。SBP>154 mmHg[优势比(OR)=2.784,P=0.035]、24 h尿蛋白>2.37 g(OR=7.628,P=0.000)和剖宫产(OR=6.087,P=0.001)是Hp+PE患者妊娠结局不良的独立危险因素,分娩孕周>37周(OR=0.047,P=0.000)和T1时点的miR-4286>1.47(OR=0.091,P=0.000)是Hp+PE患者妊娠结局不良的独立保护因素。结论PE确诊时miR-4286水平>1.47与Hp+PE患者妊娠结局良好有关。

Objective To analyze the relationship between serum microRNA-4286(miR-4286)and pregnancy outcome of preeclampsia(PE)patients infected with Helicobacter pylori(Hp).Methods A total of 89 Hp-infected pregnant women[Hp group:aged 24-40 years old with mean age of 31.67 years old;pre-pregnancy body mass index(BMI)of 21.30-31.55 kg/m^(2)with mean pre-pregnancy BMI of 25.47 kg/m^(2)]and 204 Hp-infected PE pregnant women(Hp+PE group:aged 24-40 years old with mean age of 31.87 years old;pre-pregnancy BMI of 21.01-31.55 kg/m^(2)with mean pre-pregnancy BMI of 25.69 kg/m^(2)],were enrolled.The expression level of miR-4286 was measured by real-time fluorescence quantitative polymerase chain re-action(RT-qPCR).The pregnancy outcome of PE patients with Hp infection was followed up,and the relationship between miR-4286 and pregnancy outcome was analyzed.Results The levels of miR-4286 on the first day of 28th week(T2)and30th week(T3)of pregnancy in Hp group were higher than those in Hp+PE group(1.95±0.39 vs 1.82±0.26,2.28±0.31 vs1.92±0.33.P=0.003,0.000],levels of miR-4286 in T3 of Hp group and Hp+PE group were higher than those in T2(2.28±0.31 vs 1.95±0.39,1.92±0.33 vs 1.82±0.26.P=0.000,0.001),and the increase of miR-4286 level in Hp group[0.38(0.56)]was higher than that in Hp+PE group[0.06(0.57),P=0.000].There were 121 poor pregnancy outcomes(poor outcome group)and83 good pregnancy outcomes(good outcome group)in Hp+PE group.The proportion of systolic blood pressure(SBP),diastolic blood pressure(DBP),24-hour urinary protein and cesarean section in poor outcome group were higher than those in good outcome group,and gestational age of delivery was lower than that in good outcome group[(155.64±11.89)mmHg vs(151.75±11.34)mmHg,(101.25±6.16)mmHg vs(97.93±8.79)mmHg,(2.69±0.52)g vs(2.06±0.29)g,85.95%vs 65.06%,(34.79±2.06)weeks vs(37.94±0.97)weeks.P=0.020,0.002,0.000,0.000,0.000].The levels of miR-4286 at PE diagnosis(T1),T2 and T3 in poor outcome group were lower than those in good outcome group(1.37±0.15 vs 1.66±0.23,1.75±0.26 vs 1.92±0.24,1.84±0.34 vs2.02±0.28.P=0.000,0.000,0.000).The level of miR-4286 in 2 groups increased with time,and miR-4286 in poor outcome group[0.45(0.52)]was higher than that in good outcome group[0.32(0.45)](P=0.028).The area under receiver operating characteristic(ROC)curve of miR-4286 at T1 was higher than that at T2 and T3(0.864 vs 0.688,0.864 vs 0.674.P=0.000,0.000).The SBP>154 mmHg[odds ratio(OR)=2.784,P=0.035],24 h urinary protein>2.37 g(OR=7.628,P=0.000)and cesarean section(OR=6.087,P=0.001)were independent risk factors for poor pregnancy outcome in Hp+PE patients,and gestational age of delivery>37 weeks(OR=0.047,P=0.000)and miR-4286>1.47 at T1(OR=0.091,P=0.000)were independent protective factors for adverse pregnancy outcomes in Hp+PE patients.Conclusion It is demonstrated that the level of miR-4286>1.47 at time of PE diagnosis is associated with good pregnancy outcome in Hp+PE patient.