| Background and ObjectiveAbortion is the most common complication of pregnancy and refers to the condition in which the embryo is terminated before it reaches viability.abortion occurs in about 10-15% of pregnant women.Abortion may be a single or multiple.Recurrent abortion refers to spontaneous abortion occurring three or more times in a row with the same sexual partner.However,both the American Society of Reproductive Medicine and the European Society of Human Reproductive and Embryonic Sciences believe that recurrent spontaneous abortion(RSA)occurs when two or more abortions occur.Studies have reported that if only clinical abortion confirmed by ultrasound or histology is included,the prevalence rate is 0.8%?1.4%.Increasing biochemical losses can increase the prevalence rate to 2%?3%.At present,it is still difficult to accurately estimate the prevalence of RSA.However,in recent years,the incidence of recurrent abortion is on the rise.The occurrence of the early RSA significantly affects the emotions of women and their partners,increases personal anxiety and sense of failure.In addition,repeated loss of pregnancyincreases the risk of uterine adhesions and infertility.However,the etiology of RSA is complex,and it is difficult to diagnose the etiology clinically,which has become one of the difficult problems in the field of Obstetrics and gynecology.In recent years,it has been found that vascular endothelial growth factor(VEGF)is essential for oocyte maturation,trophoblast cell proliferation,embryo implantation and development,placental angiogenesis and maternal and fetal vascular growth in the early pregnancy.HIF1-? can be used as a mediator of oxygen tension to participate in trophoblast differentiation in early pregnancy.It has been proved that high expression of CD81 can inhibit the proliferation,migration,invasion and angiogenesis of trophoblasts,and affect the spiral artery remodeling process related to the pathogenesis of eclampsia(PE),and reduce the invasive ability of trophoblasts.Whether the occurrence of the early RSA is related to CD81 has not been reported at home and abroad.This study compared the changes of CD81,vascular endothelial growth factor and HIF1-?in villi of the early RSA patients and normal women,and explored the correlation between CD81,HIF-1a,vascular endothelial growth factor and their predictive role in the occurrence of the early RSA.Materials and methods 1 Research objects and groupingThirty patients with the early RSA who were admitted to the obstetrics clinic of the Third Affiliated Hospital of Zhengzhou University during January 2017 to January2018 were selected,and 30 pregnant women who had the same gestational weeks and required termination of pregnancy were screened.All subjects were Han nationality,aged 21-45(30.430±5.143)years old,gestational weeks <12 weeks,no abnormalities in TORCH before pregnancy,no hepatitis,human immunodeficiency and other viral infections.This study was approved by the Medical Ethics Committee of the Third Affiliated Hospital of Zhengzhou University.The study was divided into RSA group and normal early pregnancy group,and the specific groups are as follows.RSA group: All of the included patients had a history of two or more uninduced natural abortion and the B-ultrasound confirmed the embryo was stopped when they visit a doctor.The objects who have fetal chromosomal abnormalities,genital abnormalities,anticardiolipin antibodies positive,TORCH test results showed recent infection,abnormal thyroid function,abnormal blood coagulation,recent exposure to heavy metals and other poisons,major events in recent life were excluded.normal early pregnancy Group: Choose the normal early pregnant women who were treated for termination of unplanned pregnancy in the same period.B-visible gestational sac and original cardiovascular pulsation had at least 1 normal pregnancy history and no history of adverse pregnancy such as spontaneous abortion.2 Method(1)The levels of CD81,HIF-1? and VEGF in placental villus were determined by real-time PCR and Western blot.(2)Pearson correlation analysis was used to understand the correlation between CD81,VEGF and HIF-1?.(3)The ROC curve was used to evaluate the predictive value of CD81,VEGF and HIF-1? for recurrent spontaneous abortion.3 Statistical analysisSPSS21.0 and Medcalc software were used for statistical analysis.Kolmogorov-Smirnov test was used to test the normality of data(P> 0.05 is normal distribution).The Kolmogorov-Smirnov Z rank sum test is used when it is not in conformity with the normal distribution.The measurement data are described by(M,IQR)and the measurement data of the normal distribution are expressed by(M,IQR).Pearson correlation analysis was used to analyze the relationship between the factors,P < 0.05 was statistically significant.The predictive value of RSA was analyzed by ROC curve,and the difference was statistically significant(P < 0.05).Results 1 Comparison of the general dataThere was no significant difference in age,menopause time,pregnancy times,parity,systolic blood pressure,diastolic blood pressure and BMI between the RSA group and the normal early groups(P > 0.05).2 Real-time fluorescence quantitative PCR analysis the expressionof CD81,HIF-1alpha and VEGFThe levels of CD81 and HIF-1? mRNA in the villus tissues of RSA group(2.203±0.814,1.042±0.347)were higher than that in the normal early pregnancy group(1.553±0.513,0.842±0.347).the level of VEGF mRNA(0.406±0.246)was lower than that of the normal early pregnancy group(0.682±0.269),and the differences were statistically significant(P<0.05),respectively.3 Western blotanalysis the expressionof CD81,HIF-1? and VEGFThe levels of CD81 and HIF-1? protein in women's villus tissues in RSA group(0.472±0.082,0.616±0.070)were higher than those in normal early pregnancy group(0.382±0.088,0.519±0.087).In the normal early pregnancy group,the VEGF protein level(0.324±0.056)was lower than that in the normal early pregnancy group(0.375±0.076),and the difference was statistically significant(P<0.05),respectively.4 Correlation analysis was used to understand the correlation between CD81,VEGF and HIF-1?in RSA group.In the Pearson correlation analysis,VEGF was negatively correlated with CD81 in the RSA group and positively correlated with HIF-1?;There were no correlations between the factors in the normal early pregnancy group.5 The ROC curve was used to evaluate the predictive value of CD81,VEGF and HIF-1? for recurrent spontaneous abortion.Comparing the area difference,95% CI,Z value,P value and NRI value between CD81,HIF-1?,VEGF and any two factors in the combination of CD81,HIF-1?and VEGF,it was found that there was no significant difference in the effect of predicting RSA between any two factors(P> 0.05),and there was statistical significance between any factor and the combined prediction of the three factors(P < 0.05,NRI < 0).Comparing the area difference,95% CI,Z value,P value and NRI value of CD81,HIF-1?,VEGF protein and any two factors in combination,it showed that there was no significant difference in predicting RSA between CD81,HIF-1?and the expression of VEGF protein(P> 0.05),and there was statistical significance between any factor and the combined prediction of CD81,HIF-1?and VEGF protein(P< 0.05,NRI< 0).Conclusions1.High expression of CD81,HIF-1? mRNA and low expression of VEGF mRNA in the villus tissues of RSA group in early pregnancy.2.High expression of CD81,HIF-1? protein and low expression of VEGF protein in the villus tissues of women in RSA group during early pregnancy,.3.RSA group in the during early pregnancy,the expression of VEGF expression was negatively correlated with CD81 and positively correlated with HIF-1?.4.ROC curve predicts the occurrence of RSA during early pregnancy,and the combined predictive value of CD81,VEGF and HIF-1? is better than single factor. |
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