血小板糖蛋白IIb/IIIa基因多态性A2携带者妊娠中期复发性自然流产风险高

[High risk of recurrent spontaneous abortion during second trimester in women carriers of polymorphism A2 in platelet glycoprotein IIb/IIIa].

作者信息

Ivanov P, Komsa-Penkova R, Ivanov I, Konova E, Kovacheva K, Stoĭkov S, Popov I

出版信息

Akush Ginekol (Sofiia). 2008;47(4):3-9.

PMID:19230252

Abstract

The aim of this study was to evaluate the role of polymorphism A2 (PLA2) in platelet glycoprotein IIb/IIIa (GP IIb/IIIa) in the development of recurrent spontaneous abortion (RSA)--miscarriages before 20th week of gestation (wg) of pregnancy. The carriage status of PLA2 in GP IIb/IIIa, single and in combination with FVL and FII G20210A was investigated in 56 women with recurrent miscarriages before 10 g, in 38 women with RSA from 10 to 20 wg and in 98 healthy women with at least one uncomplicated full-term pregnancy. The significant prevalence of carriage of PLA2 in GP IIb/IIIa in women with RSA in first 20 wg was found with high risk or miscarriage (OR = 4.32; 95% CI: 2.10-8.97, p < 0.0001). However, after adjustment for combined carriage of other thrombophilic factors (PLA2 and FVL or PLA2 with FII G20210A) the risk was still high (OR = 2.07; 95% CI: 0.98-4.40 p = 0.058), but not significant. The similar results (OR = 2.632; 95% CI: 1.140-6.104, p = 0.021) were found for women with recurrent miscarriages in the first 10 wg. The prevalence of PLA2 adjusted for combined carriage of other thrombophilic factors was also not significant. The carriage status of PLA2 in GP IIb/IIIa in women with RSA in the period from 10 to 20 wg was significantly higher as compared to controls (OR = 8.79; 95% CI: 3.477-22.605, p < 0.0001). The prevalence, adjusted for combined carriage of other thrombophilic factors (PLA2 with FVL or PLA2 with FII G20210A) was also significantly higher (OR: 2.990; 95% CI: 1.178-7.613, p = 0.018). These results confirm the impact of PLA2 polymorphism on RSA in the period of 10 to 20 wg, and its contribution to RSA in the first 10 wg in combination with other thrombophilic mutations. The results support the suggestion of testing women with miscarriages in first 20 wg for PLA2 carriage and application of appropriate prophylactic antiplatelet drug therapy for next planned pregnancy.

摘要

本研究旨在评估血小板糖蛋白IIb/IIIa（GP IIb/IIIa）中多态性A2（PLA2）在复发性自然流产（RSA）——妊娠20周前流产中的作用。在56例妊娠10周前复发性流产的女性、38例妊娠10至20周复发性流产的女性以及98例至少有一次正常足月妊娠的健康女性中，研究了GP IIb/IIIa中PLA2的携带状态，以及其与因子V Leiden突变（FVL）和凝血因子II G20210A（FII G20210A）单独或联合存在的情况。发现在妊娠前20周复发性流产的女性中，GP IIb/IIIa中PLA2的携带率显著升高，流产风险高（比值比[OR]=4.32；95%置信区间[CI]：2.10 - 8.97，p<0.0001）。然而，在对其他血栓形成倾向因素（PLA2与FVL或PLA2与FII G20210A联合携带）进行校正后，风险仍然较高（OR = 2.07；95% CI：0.98 - 4.40，p = 0.058），但不显著。在妊娠前10周复发性流产的女性中也发现了类似结果（OR = 2.632；95% CI：1.140 - 6.104，p = 0.021）。对其他血栓形成倾向因素联合携带进行校正后的PLA2携带率也不显著。与对照组相比，妊娠10至20周复发性流产女性中GP IIb/IIIa中PLA2的携带状态显著更高（OR = 8.79；95% CI：3.477 - 22.605，p<0.0001）。对其他血栓形成倾向因素（PLA2与FVL或PLA2与FII G20210A联合携带）进行校正后的携带率也显著更高（OR：2.990；95% CI：1.178 - 7.613，p = 0.018）。这些结果证实了PLA2多态性在妊娠10至20周期间对RSA的影响，以及其在妊娠前10周与其他血栓形成倾向突变联合时对RSA的作用。研究结果支持对妊娠20周前有流产史的女性进行PLA2携带检测，并对下次计划妊娠应用适当的预防性抗血小板药物治疗这一建议。