胎儿生长受限孕妇血清与胎盘Gas6、Endoglin、PLAC-1表达水平及其临床意义

Expression levels and clinical significance of growth arrest-specific protein 6,Endoglin,and placental specific protein 1 in serum and placenta of pregnant women with fetal growth restriction

目的分析胎儿生长受限(FGR)孕妇血清及胎盘中生长阻滞特异性蛋白6(Gas6)、Endoglin、胎盘特异性蛋白1(PLAC-1)表达水平,并探讨其临床意义。方法选取2022年5月至2024年9月确山县人民医院收治的81例FGR孕妇为FGR组,按照1∶1配对原则,另选取同期81例无FGR孕妇为对照组。比较两组孕妇的基线资料和胎盘相关指标(Gas6 mRNA、Endoglin mRNA、PLAC-1 mRNA、胎盘厚度、胎盘质量),采用Pearson法分析胎盘各指标表达与胎盘厚度、胎盘质量、新生儿体质量的相关性,比较两组孕妇不同孕期的血清各指标水平,采用Pearson法分析孕妇血清与胎盘各指标表达的相关性,采用受试者工作特征曲线(ROC)分析血清各指标对FGR的预测价值。结果FGR组孕妇的新生儿体质量、PLAC-1 mRNA、胎盘厚度、胎盘质量[(2.13±0.32)kg、0.50±0.11、(1.90±0.66)cm、(0.38±0.10)kg]明显低于对照组[(3.23±0.29)kg、1.00±0.06、(2.51±0.57)cm、(0.59±0.08)kg],胎盘Gas6 mRNA、Endoglin mRNA(1.42±0.24、1.38±0.16)明显高于对照组(1.04±0.05、1.06±0.07),差异均有统计学意义(P<0.05);胎盘Gas6 mRNA、Endoglin mRNA与胎盘厚度、胎盘质量、新生儿体质量呈负相关(P<0.05),PLAC-1 mRNA与胎盘厚度、胎盘质量、新生儿体质量呈正相关(P<0.05);FGR组孕妇孕早、中、晚期的血清Gas6、Endoglin明显高于对照组,PLAC-1明显低于对照组,差异均有统计学意义(P<0.05);孕早、中、晚期血清Gas6、Endoglin、PLAC-1表达与对应指标胎盘中表达量均呈正相关(P<0.05);经ROC分析结果显示,孕早、中、晚期血清Gas6、Endoglin、PLAC-1联合预测FGR的曲线下面积(AUC)分别为0.890、0.913、0.936,均优于单一指标,且血清各指标联合预测FGR的AUC随着孕期的推进依次增大,至孕晚期联合预测AUC为0.936,为最大。结论FGR孕妇血清及胎盘组织中Gas6、Endoglin、PLAC-1表达异常,且血清各指标联合检测对FGR具有一定预测价值,可作为临床早期评估FGR的辅助指标。

Objective To analyze the expression levels of growth arrest-specific protein 6(Gas6),Endoglin,and placental specific protein 1(PLAC-1)in the serum and placenta of pregnant women with fetal growth restriction(FGR),and to explore their clinical significance.Methods Eighty-one pregnant women with FGR admitted to the Peo-ple's Hospital of Queshan from May 2022 to September 2024 were selected as the FGR group,and 81 pregnant women without FGR in the same period were selected as the control group according to the 1∶1 matching principle.The base-line data and placental-related indicators(Gas6 mRNA,Endoglin mRNA,PLAC-1 mRNA,placental thickness,placental mass)between the two groups of pregnant women were compared.Pearson's method was used to analyze the correlation between the expression of each placental indicator and placental thickness,placental mass,and neonatal body mass.The levels of serum indicators in different pregnant periods of the two groups of pregnant women were compared,and Pear-son's method was used to analyze the correlation between serum indicators and placental expression.The receiver operat-ing characteristic curve(ROC)was used to analyze the predictive value of serum indicators for FGR.Results The neona-tal body mass,PLAC-1 mRNA,placental thickness,and placental mass in the FGR group were(2.13±0.32)kg,0.50±0.11,(1.90±0.66)cm,(0.38±0.10)kg,which were significantly lower than(3.23±0.29)kg,1.00±0.06,(2.51±0.57)cm,(0.59±0.08)kg in the control group,while the placental Gas6 mRNA and Endoglin mRNA were 1.42±0.24,1.38±0.16,significantly higher than 1.04±0.05,1.06±0.07 in the control group(P<0.05).Placental Gas6 mRNA and Endoglin mRNA were negatively correlated with placental thickness,placental mass,and neonatal body mass(P<0.05),while PLAC-1 mRNA was positively correlated with placental thickness,placental mass,and neonatal body mass(P<0.05).Serum Gas6 and Endoglin in pregnant women with FGR were significantly higher than those in the control group in the early,middle,and late stages of pregnancy,while PLAC-1 was significantly lower than that in the control group,with statistically significant differences(P<0.05).The expression of serum Gas6,Endoglin,and PLAC-1 in the early,middle,and late stages of pregnancy was positively correlated with the corresponding expression levels in the placenta(P<0.05).ROC analysis showed that the area under the curve(AUC)of the combined detection of serum Gas6,Endoglin,and PLAC-1 in the early,middle,and late stages of pregnancy for predicting FGR was 0.890,0.913,and 0.936,respectively,which was superior to that of each individual index.The AUC of the combined detection increased sequentially with the progression of pregnancy,reaching a maximum of 0.936 in the late stage of pregnancy.Conclusion The expression of Gas6,Endoglin,and PLAC-1 in serum and placental tissue of pregnant women with FGR is abnormal,and the com-bined detection of the serum indicators has certain predictive value for FGR,which can be used as an auxiliary indicator for early clinical evaluation of FGR.