GNA13在侵入性胎盘植入性疾病中的表达及临床价值

The expression and clinical value of GNA13 in invasive placenta accreta spectrum disorders

目的:探讨鸟嘌呤核苷酸结合蛋白α亚基13(GNA13)在侵入性胎盘植入性疾病(PAS)妊娠晚期外周血和胎盘中的表达及意义。方法:采用病例对照的研究方法,选择2021年9月至2023年6月在广西医科大学第一附属医院产科住院剖宫产并经临床和病理诊断为PAS的32例患者作为研究对象(PAS组),以分娩孕周、胎盘位置、剖宫产史及是否合并内科疾病为条件,匹配同期非PAS剖宫产孕妇32例作为对照组。应用酶联免疫吸附试验(ELISA)检测孕妇血清GNA13水平,免疫组化(IHC)和蛋白免疫印迹法(western blotting)检测胎盘GNA13的表达。受试者工作特征曲线(ROC)分析GNA13的诊断效能。结果:PAS组外周血中GNA13表达水平显著高于对照组(P<0.05)。ROC曲线下面积(AUC)为0.734(95%CI:0.593~0.876),血GNA13辨别PAS的最佳阈值为201.53 ng/mL,灵敏度为96%,特异度为52%。GNA13定位于胎盘绒毛滋养层细胞。PAS组胎盘GNA13表达显著低于对照组(P<0.05)。结论:GNA13具有成为侵入性PAS的产前预测指标的潜力。PAS滋养细胞侵袭、迁移能力增强可能与GNA13低表达有关。

Objective:To investigate the expression and significance of Guanine nucleotides binding protein al-pha 13(GNA13)in the late pregnancy peripheral blood and placental tissue of patients with invasive placenta ac-creta spectrum disorders(PAS).Methods:A case-control study method was used.Patients diagnosed with PAS by clinical and pathological examination at the First Affiliated Hospital of Guangxi Medical University from Sep-tember 2021 to June 2023 formed the study group(PAS group,n=32),and the control group(n=32)consisting of cesarean section pregnant women without PAS,was matched according to the gestational age at delivery,placen-tal location,history of cesarean section and the presence of concurrent medical diseases.Enzyme-linked immuno-sorbent assay(ELISA)was used to detect the serum GNA13 levels,and immunohistochemistry assay(IHC)and western blotting were used to detect the placental GNA13 expression.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of GNA13.Results:The expression level of GNA13 in the pe-ripheral blood of the PAS group was significantly higher than that in the control group(P<0.05).The area under the ROC curve(AUC)was 0.734(95%CI:0.593-0.876).The optimal threshold for distinguishing PAS with blood GNA13 was 201.53 ng/ml,with a sensitivity of 96%and a specificity of 52%.GNA13 was localized in the trophoblast cells of the placental villi.The expression of GNA13 in the placenta tissue of the PAS group was sig-nificantly lower than that of the control group(P<0.05).Conclusion:GNA13 has the potential to become a pre-natal predictive indicator for invasive PAS.The enhanced invasion and migration capacity of PAS trophoblast cells may be associated with low expression of GNA13.