| BackgroundUnexplained abortion and recurrent spontaneous abortion are common complications during pregnancy.Their incidence of the diseases have increased significantly in recent years,and the development tends to be younger.It has become a serious social problem.It is necessary to find one or more biomarkers to predict the development of fetus in clinic.It can help clinicians to guide pregnant women in the early stage of pregnancy.Previous studies have shown that the decrease of serum macrophage inhibitory cytokine 1(MIC-1)and pregnancy associated plasma protein A(PAPP-A)levels can be used to predict abortion in women with asymptomatic pregnancy at 6-10 weeks of pregnancy.The two biomarkers may have an important biological role in the early pregnancy,which may be a useful clinical biomarkers for abortion and other early pregnancy complications.At the same time,human chorionic gonadotropin beta subunit(P-HCG)is a commonly used clinical biomarker for a number of early pregnancy complications.ObjectiveTo analysis the differences of serum MIC-1,PAPP-A and ?-HCG in agnogenic abortion and recurrent spontaneous abortion,and study the role of the three biological biomarkers in the process of pregnancy,in order to explore its predictive effect in abortion and recurrent spontaneous abortion.Methods1.From January 2016 to May 2017,800 women in the first trimester of pregnancy(6 to 12 weeks)were collected,and all the participants were pregnant women with single fetal heart beating confirmed by ultrasound,and chromosomes(including couples,foetus and placenta)are normal.Of the 800 cases,there were 82 cases of abortion,of which 18 were recurrent spontaneous abortion,and were accepted as recurrent spontaneous abortion group.The other 64 cases were spontaneous abortion of non-recurrent abortion,which was considered as abortion group.Other 206 pregnant women had symptoms of threatened abortion(such as abdominal pain,vaginal bleeding),and the remaining 512 cases of asymptomatic pregnant women.Among them,32 cases of termination of pregnancy,such as stillbirth,fetal malformation,pregnancy induced hypertension and preeclampsia,480 cases of normal pregnancy were successful in the end.100 of the 480 normal pregnant women who had no threatened abortion were randomly selected as the control group.All participants in the study were informed before the study was carried out and signed the informed consent.2.We collected serum samples of pregnant women at(6-12)weeks.About 8 milliliters of venous blood were collected,and the average distribution was placed in 2 non anticoagulant tubes,and the serum was collected after centrifugation.One of the tubes was detected by the ALPCO instrument in the United States,and the electrochemiluminescence was used to mensurate the ?-HCG.Another tube at room temperature to be static,blood after stratification of 2500r centrifugal 10min,the supernatant liquid of EP catheter,stored in the-70?for using.PAPP-A and MIC-1 were determined by enzyme linked immunosorbent assay(ELISA)by R&D system in the United States.3.In order to correct the change of the levels of the three analytes during pregnancy,we have expressed the data as the median of normal(multiples of the normal median,MOMs)value.Result1.The three biomarkers of MIC-1,PAPP-A and ?-HCG in recurrent spontaneous abortion group were significantly lower than those in the control group(p<0.05).Meanwhile,the serum MIC-1 level in recurrent spontaneous abortion group was lower than that in abortion group(p=0.035).Only two markers of MIC-1 and PAPP-A in the abortion group were significantly lower than those in the control group(p<0.05),but there was no significant difference in the ?-HCG between the abortion group and the control group,as well as between the abortion group and the recurrent spontaneous abortion group.2.The level of serum MIC-1 and PAPP-A plays a protective role in pregnancy,and the decrease in serum levels is a risk factor for abortion group and recurrent spontaneous abortion group.In this study,although the level of serum ?-HCG in recurrent spontaneous abortion group is significantly lower than that in control group,the decrease of its level is not enough to constitute a risk factor for recurrent spontaneous abortion,for there was no statistically significant in the odds ratio(OR)(P>0.05).3.There was a certain predictive effect on abortion by combining MIC-1 with PAPP-A.The sensitivity of combined prediction was 60.9%,the specificity was 86%,the area under the curve was 0.751,and the cut-off point was-0.04.There was a great predictor for recurrent spontaneous abortion,the combined prediction of recurrent miscarriage occurred as sensitivity 94.4%,the specificity was 76%,the area under the curve was 0.926,the cut-off point was-2.61.ConclusionThe serum levels of macrophage inhibitory cytokine 1(MIC-1)and pregnancy associated protein-A(PAPP-A)are significantly decreased in unexplained recurrent spontaneous abortion group and abortion group,and the serum level of MIC-1 in recurrent spontaneous abortion women is significantly lower than that in the abortion women.The serum level of P-HCG is significantly lower in recurrent abortion women than that in the control group,but there is no significant difference between the abortion group and the control group.MIC-1 and PAPP-A play protective roles in process of pregnancy,the decrease in serum levels of two is a risk factor for unexplained abortion and recurrent spontaneous abortion.The combination of the two serum markers demonstrates a certain predictive effect on abortion and a great predictive effect on recurrent spontaneous abortion. |
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