Case-control Study Of The Relating Factors And Expression Of UPA,uPAR,PAI-1 In Gestational Trophoblastic Disease

Objective To study incidence of gestational trophoblastic disease(GTD) and itsrelating factors.The aim of current study was to investigate the expression levels ofuPA,uPAR and PAI-1 in GTD and to explore the relationship of expressions of themwith GTD.Methods ⑴The data of 25796 pregnant women treated from1991 to 2002were analyzed retrospectively. The data of 85 cases of gestational trophoblasticdisease were study by 1:2matching case-control study. ⑵The expression of uPA,uPAR and PAI-1 were detected with in situ hybridization method in 15 cases ofnormal villi,42 cases of hydatidiform moles(HM),30 cases of invasive molar(IM),and24 cases of choriocarcinomas(CC).Results Part 1 The incidence rate of GTD was between 120～505 per 100000annually.The mean incidence rate was 329 per 100000.There was significantcorrelate with age,and the incidence rate of GTD was higher under 20 and above 40age.By Logistic analysis ,it was shown in blood group A the relative risk was 2.843times(P=0.0008);with the pregnant age increasing the relative risk was increased2.279 times(P=0.0127);with the economy developing the relative risk was decreased48.90%(P<0.0001);and in the pre-pregnancy , exposure factors from the firstpregnancy, aborter,term dilivery to hydatidiform moles the relative risk was increased45.00%(P=0.0110).Part 2 The expression of uPA and uPAR were significantly increasedin HM,IM, and CC than in normal villi(P<0.001 for uPA,P<0.001 for uPAR), yet theexpression of PAI-1 was no difference(p=0.499).There were significantly differenceof the expression of uPA and uPAR among HM,IM and CC(P<0.05 for uPA,P<0.001for uPAR). UPA and uPAR expression were significantly higher in the patients withmalignantly transfromed molar pregnancy than in the patients without malignantlytransfromed molar pregnancy (P<0.001 for uPA,P=0.000 for uPAR).Compared withpatients at stageⅠ,patients at stage Ⅲ(WHO) had significantly increasedexpression of uPA(P=0.027).The level of uPA was no difference in WHOprognostic scoring system.The expression of uPAR was not associated withWHO stage of GTT and WHO prognostic scoring system. Conclusion ⑴The mean incidence rate of GTD was 329 per 100000,and itwas easy occurrenced in both sides of reproductive age. ⑵Many relating factorssuch as the blood group, reproductive age, the exposure factors of pre-pregnancy andeconomic state effect in GTD. ⑶The over-expression of uPA and uPAR in GTDmay be associated with the malignant transformation of HM and the behavior oftrophoblastic tumor.