Ivanov Petar D, Komsa-Penkova Regina S, Konova Emiliana I, Kovacheva Katia S, Simeonova Maria N, Popov Jordan D
Department of Chemistry and Biochemistry and Physics and Biophysics, University of Medicine, 1 St. Kliment Ohridski Street, Pleven, Bulgaria.
Blood Coagul Fibrinolysis. 2009 Mar;20(2):134-40. doi: 10.1097/MBC.0b013e32832545f3.
To investigate the impact of maternal-inherited thrombophilia: effects of factor V Leiden (FVL) and prothrombin gene mutation (FII 20210G>A) on the development of recurrent pregnancy loss in embryonic and postembryonic periods. A total of 153 patients were analysed for FVL and FII 20210G>A according to placenta gestation: 94 women with embryonic loss prior 10 weeks of gestation and 59 women with postembryonic (early fetal) loss occurring between 10 and 14 weeks of gestation. The control group consisted of 100 healthy women, with at least one uncomplicated full-term pregnancy. FVL prevalence was not significantly associated with pregnancy loss prior to 10 weeks of gestation (9.6%) compared with controls (7%) [odds ratio (OR) 1.41; 95% confidence interval (CI) 0.454-4.416, P > 0.05], but it was much more pronounced in women with postembryonic loss (10-14 weeks of gestation) - 18.6% (OR 3.05; 95% CI 1.010-9.387, P = 0.047). FII 20210G>A was significantly higher in both groups with embryonic (17%) and early fetal losses (16.9%) as compared to controls (3%) (OR 6.63; 95% CI 1.731-29.752, P = 0.003; OR 6.60; 95% CI 1.572-31.856, P = 0.006). FII 20210G>A is significantly associated with an increased risk of early recurrent pregnancy loss throughout the entire first trimester. FVL was significantly higher only in early fetal period after starting of the placentation process, but not associated with embryonic recurrent pregnancy loss. These results suggested that the first trimester should be viewed rather as a heterogeneous interval, with different relation to FVL in the embryonic and postembryonic fetal period. Genetic testing should be applied according to the diverse contribution of thrombophilic markers to embryonic and postembryonic period.
因子V莱顿突变（FVL）和凝血酶原基因突变（FII 20210G>A）对胚胎期和胚胎后期复发性流产发展的影响。根据胎盘妊娠情况，对153例患者进行FVL和FII 20210G>A分析：94例妊娠10周前胚胎丢失的女性和59例妊娠10至14周发生胚胎后期（早期胎儿）丢失的女性。对照组由100名健康女性组成，她们至少有一次无并发症的足月妊娠。与对照组（7%）相比，FVL患病率与妊娠10周前的流产无显著相关性（9.6%）[比值比（OR）1.41；95%置信区间（CI）0.454 - 4.416，P>0.05]，但在胚胎后期丢失（妊娠10 - 14周）的女性中更为明显 - 18.6%（OR 3.05；95% CI 1.010 - 9.387，P = 0.047）。与对照组（3%）相比，FII 20210G>A在胚胎丢失组（17%）和早期胎儿丢失组（16.9%）中均显著更高（OR 6.63；95% CI 1.731 - 29.752，P = 0.003；OR 6.60；95% CI 1.572 - 31.856，P = 0.006）。FII 20210G>A与整个孕早期早期复发性流产风险增加显著相关。FVL仅在胎盘形成过程开始后的早期胎儿期显著更高，但与胚胎复发性流产无关。这些结果表明，孕早期应被视为一个异质性时期，在胚胎期和胚胎后期胎儿期与FVL的关系不同。应根据血栓形成倾向标志物对胚胎期和胚胎后期的不同贡献进行基因检测。
