摘要
目的 探讨前置胎盘合并胎盘植入组织中高迁移率族蛋白B1(HMGB1)蛋白、促红细胞生成素产生肝细胞受体A5(EphA5)蛋白、血管内皮生长因子(VEGF)表达水平及临床意义.方法 回顾性选取2021年1月至2023年12月衡水市第二人民医院收治的前置胎盘合并胎盘植入患者60例作为病例组,并选取同期健康产妇60名作为对照组,比较两组临床资料(年龄、体重指数、孕周、孕次、产次、既往剖宫产次数、剖宫产间隔时间、既往流产次数、前置胎盘类型、胎盘主体位置)及胎盘组织中HMGB1蛋白、EphA5蛋白、VEGF表达水平,并对前置胎盘合并胎盘植入的危险因素进行多因素Logistic回归分析,同时采用受试者工作特征(ROC)曲线分析HMGB1蛋白、EphA5蛋白、VEGF对前置胎盘合并胎盘植入的预测价值.结果 病例组患者年龄、体重指数与对照组比较,差异均无统计学意义(P＞0.05);病例组患者孕周、孕次、产次、既往剖宫产次数、剖宫产间隔时间、既往流产次数、前置胎盘类型、胎盘主体位置与对照组比较,差异均有统计学意义(P＜0.05).病例组患者胎盘组织HMGB1蛋白、VEGF水平分别为1.35±0.34、0.90±0.24,均高于对照组(1.12±0.36、0.60±0.19),胎盘组织EphA5蛋白水平为0.75±0.26,低于对照组(2.05±0.66),差异均有统计学意义(P＜0.05).经二元Logistic回归分析显示,孕周、孕次、产次、既往剖宫产次数、剖宫产间隔时间、既往流产次数、前置胎盘类型、胎盘主体位置、HMGB1蛋白、EphA5蛋白、VEGF均是前置胎盘合并胎盘植入的独立影响因素(P＜0.05).ROC曲线分析显示,胎盘组织HMGB1蛋白、EphA5蛋白、VEGF、三者联合预测前置胎盘合并胎盘植入的曲线下面积(AUC)分别为0.817、0.814、0.764、0.956,且三者联合的敏感度为78.30％,特异度为100.00％.结论 前置胎盘合并胎盘植入组织中可见HMGB1蛋白、VEGF表达升高,EphA5蛋白表达降低,前置胎盘合并胎盘植入影响因素较多,而胎盘组织HMGB1蛋白、EphA5蛋白、VEGF是前置胎盘合并胎盘植入的危险因素,3种指标联合对前置胎盘合并胎盘植入具有较高的预测价值.
Abstract
Objective To investigate the expression and clinical significance of high mobility group box 1(HMGB1)protein,erythropoi-etin-producing hepatocellular receptor A5(EphA5)protein and vascular endothelial growth factor(VEGF)in placenta previa with placenta ac-creta.Methods A total of 60 patients with placenta previa combined with placenta accreta admitted to the Second Peoples Hospital of Hengshui from January 2021 to December 2023 were retrospectively selected as the case group,and 60 healthy puerpera in the same period were selected as the control group.The clinical data(age,body mass index,gestational age,gestational frequency,parity,previous cesarean section frequency,interval between cesarean sections,previous miscarriages,type of placenta previa,placental body position)and the expression levels of HMGB1 protein,EphA5 protein and VEGF in placental tissue were compared between the two groups.The risk factors of placenta previa complicated with placenta accrete was analyzed using multivariate Logistic regression analysis.The predictive value of HMGB1 protein,EphA5 protein and VEGF for placenta previa complicated with placenta accreta was analyzed using receiver operating characteristic(ROC)curve.Results There were no statistically significant differences in age and body mass index between the case group and the control group(P＞0.05);there were statistically significant differences in gestational age,gestational frequency,parity,previous cesarean section frequency,interval between cesarean sections,previous miscarriages,type of placenta previa,and placental body position between the case group and the control group were statistically signifi-cant(P＜0.05).The levels of HMGB1 protein,VEGF in placental tissue of patients in the case group were 1.35±0.34 and 0.90±0.24,re-spectively,which were higher than those in the control group(1.12±0.36 and 0.60±0.19),the EphA5 protein in placental tissue was 0.75±0.26,which was lower than that of the control group(2.05±0.66),and the differences were statistically significant(P＜0.05).Binary Logis-tic regression analysis showed that gestational age,gravidity,parity,number of previous cesarean sections,interval time between cesarean sec-tions,number of previous abortions,type of placenta previa,main location of placenta,HMGB1 protein,EphA5 protein and VEGF were inde-pendent influencing factors of placenta previa complicated with placenta accreta(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of HMGB1 protein,EphA5 protein,VEGF and the combination of the three in predicting placenta previa with placenta accreta were 0.817,0.814,0.764 and 0.956,respectively,and the sensitivity and specificity of the combination of the three were 78.30％and 100.00％,respectively.Conclusion The expression of HMGB1 protein and VEGF is increased and the expression of EphA5 protein is decreased in placenta previa complicated with placenta accreta.There are many influencing factors for placenta previa complicated with placenta accreta,and HMGB1 protein,EphA5 protein and VEGF in placental tissue are risk factors for placenta previa complicated with placenta accreta.The combination of the three indicators has a high predictive value for placenta previa complicated with placenta accreta.
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