阴道超声检测联合miR-23、miR-518b对稽留流产结局的预测价值  

Predictive value of vaginal ultrasonography combined with miR-23 and miR-518b for the outcome of indolent abortion

作　　者：王晓丹 WANG Xiaodan(Hebei Handan Central Hospital,Handan,Hebei 056001,China)

机构地区：[1]河北省邯郸市中心医院,河北邯郸056001

出　　处：《中国优生与遗传杂志》2023年第3期558-564,共7页Chinese Journal of Birth Health & Heredity

基　　金：河北省邯郸市科学技术研究与发展计划项目(19422052113-15)。

摘　　要：目的探讨稽留流产患者的阴道超声特征、胎盘绒毛组织中miR-23和miR-518b的表达及其对流产结局的预测价值。方法选取于2020年1月至2022年8月河北省邯郸市中心医院妇产科门诊及住院,停经9周左右,行阴道超声检查的100例稽留流产患者,根据稽留流产结局分为稽留流产成功组(50例)和稽留流产失败组(50例)。比较分析两组的miR-23和miR-518b水平以及超声检查指标:螺旋动脉(SA)、子宫动脉(UTA)的搏动指数(PI)、阻力指数(RI)和收缩期峰值流速(PS);多因素Logistic回归分析影响稽留流产患者流产失败的因素;采用RT-PCR法检测胎盘绒毛组织和外周血中miR-518b和miR-23的表达;绘制受试者操作特征(ROC)曲线分析阴道超声联合外周血miR-518b和miR-23对稽留流产的预测价值;构建列线图模型并验证。结果稽留流产失败组的miR-23、miR-518b、SA和UTA中的PS水平高于稽留流产成功组,稽留流产失败组的SA和UTA中的RI水平低于稽留流产成功组(P<0.05),行多因素Logistic回归分析结果,miR-23水平、miR-518b水平、SA中的RI、SA中的PS、UTA中的RI、UTA中的PS均为稽留流产患者流产失败的因素(P<0.05);稽留流产失败组的胎盘绒毛和外周血中miR-518b和miR-23的表达水平明显升高(P<0.001)。胎盘绒毛中miR-518b和miR-23的表达与外周血中miR-518b和miR-23的表达呈正相关(P<0.001)。阴道超声联合miR-23和miR-518b对稽留流产的AUC值为0.821,灵敏度为78.96%,特异度为87.52%,对稽留流产的预测效果最好(P<0.001)。根据多因素分析结果建立列线图模型,结果显示训练集和验证集的C-index分别为0.885、0.860,受试患者的特征曲线下面积(AUC)分别为0.817、0.795。结论经阴道超声指标比较多,干扰因素较少,对稽留诊断准确性也有一定的判断价值,但早期疾病超声指标不典型很容易误判,所以联合miR-23、miR-518b对稽留流产有较高的预测价值。Objective To investigate the vaginal ultrasound characteristics,miR-23 and miR-518b expression in placental villi tissue and their predictive value for miscarriage outcome in patients with induced abortion.Methods One hundred patients with induced abortion who were outpatients and inpatients of the Department of Obstetrics and Gynecology,Hebei Handan Central Hospital,from January 2020 to August 2022,who were about 9 weeks of menopause and underwent vaginal ultrasonography were selected and divided into successful induced abortion group(50 patients)and failed induced abortion group(50 patients)according to the outcome of induced abortion.The levels of miR-23 and miR-518b and ultrasonographic indices:pulsatility index(PI),resistance index(RI)and peak systolic flow rate(PS)of spiral artery(SA)and uterine artery(UTA)were compared and analyzed between the two groups;multi-factor Logistic regression was used to analyze the factors affecting abortion failure in patients with retained abortion;RT-PCR was used to detect placental villi tissue The expression of miR-518b and miR-23 in placental villous tissue and peripheral blood was detected by RT-PCR;the predictive value of vaginal ultrasound combined with peripheral blood miR-518b and miR-23 for abortion was analyzed by plotting the subject operating characteristic curve(ROC);the column line graph model was constructed and validated.Results The levels of miR-23,miR-518b,RI in SA and PS in UTA were higher in the group with failed abortion than in the group with successful abortion,and the levels of RI in SA and UTA were lower in the group with failed abortion than in the group with successful abortion(P<0.05),and the results of multi-factor Logistic regression analysis were performed.PS in SA,RI in UTA,and PS in UTA were all factors of abortion failure in patients with recurrent abortion(P<0.05).The expression levels of miR-518b and miR-23 in placental villi and peripheral blood were significantly higher in the group with recurrent abortion failure(P<0.001).The expression

关 键 词：超声检查 miR-23 miR-518b 稽留流产 预测价值 

分 类 号：R714.21[医药卫生—妇产科学] R445.1[医药卫生—临床医学]