在早期妊娠评估单位就诊的有胎儿存活证据但随后流产的女性中，血浆 MIC-1 和 PAPP-a 水平降低。
Plasma MIC-1 and PAPP-a levels are decreased among women presenting to an early pregnancy assessment unit, have fetal viability confirmed but later miscarry.
机构信息
Translational Obstetrics Group, Department of Obstetrics and Gynaecology, Mercy Hospital for Women, University of Melbourne, Heidelberg, Victoria, Australia.
出版信息
PLoS One. 2013 Sep 12;8(9):e72437. doi: 10.1371/journal.pone.0072437. eCollection 2013.
BACKGROUND
We have recently shown first trimester Macrophage inhibitory cytokine-1 (MIC-1) and Pregnancy Associated Plasma Protein-A (PAPP-A) serum concentrations are depressed among asymptomatic women destined to miscarry. Here we examined whether plasma levels of MIC-1 and PAPP-A are depressed among women presenting to an Early Pregnancy Assessment Unit (EPAU), noted to have a confirmed viable fetus, but subsequently miscarry.
METHODS
We performed a prospective cohort study, recruiting 462 women in the first trimester presenting to EPAU and had fetal viability confirmed by ultrasound. We obtained plasma samples on the same day and measured MIC-1, PAPP-A and human chorionic gonadotrophin (hCG), grouping the cohort according to whether they later miscarried or not. To correct for changes in analyte levels across gestation, we expressed the data as Multiples of the normal Median (MoMs).
RESULTS
We recruited 462 participants presenting to EPAU at 5-12 weeks gestation. Most (80%) presented with symptoms of threatened miscarriage (e.g. abdominal pain, vaginal bleeding). 34 (7.4%) subsequently miscarried. Median plasma MIC-1 levels among those who miscarried were 50% of those with ongoing pregnancies (Miscarriage cohort MoM 0.50 (25(th)-75(th) centiles: 0.29-1.33) vs ongoing pregnancies MoM 1.00 (0.65-1.38); p=0.0025). Median plasma PAPP-A MoMs among those who miscarried was 0.57 (0.00-1.12), significantly lower than those with ongoing pregnancies (MoMs 1.00 (0.59-1.59); p=0.036). Plasma hCG levels were also significantly depressed among those who miscarried compared to those with ongoing pregnancies. However, the performance of MIC-1 as a diagnostic marker to predict miscarriage in this cohort was modest, and not improved with the addition of hCG.
CONCLUSION
MIC-1 and PAPP-A levels are significantly depressed in women presenting to EPAU with ultrasound evidence of fetal viability, but later miscarry. While they are unlikely to be useful as predictive biomarkers in this clinical setting, they probably play important roles in the maintenance of early pregnancy.
背景
我们最近发现，在无症状但注定要流产的女性中，早孕期巨噬细胞抑制细胞因子-1（MIC-1）和妊娠相关血浆蛋白-A（PAPP-A）的血清浓度降低。在此，我们研究了在因超声确认胎儿存活而就诊于早孕评估单位（EPAU）但随后流产的女性中，MIC-1 和 PAPP-A 血浆水平是否降低。
方法
我们进行了一项前瞻性队列研究，招募了 462 名在 EPAU 就诊且超声确认胎儿存活的初产妇。我们在同一天采集血浆样本，并测量了 MIC-1、PAPP-A 和人绒毛膜促性腺激素（hCG），根据是否随后流产将队列分组。为了校正妊娠期间分析物水平的变化，我们将数据表示为正常中位数的倍数（MoM）。
结果
我们招募了 462 名在 5-12 周妊娠时就诊于 EPAU 的参与者。大多数（80%）有先兆流产（如腹痛、阴道出血）的症状。34 例（7.4%）随后流产。流产组的 MIC-1 中位血浆水平为持续妊娠者的 50%（流产组 MoM0.50（25 百分位数至 75 百分位数：0.29-1.33）vs 持续妊娠者 MoM1.00（0.65-1.38）；p=0.0025）。流产组的 PAPP-A 中位血浆 MoM 为 0.57（0.00-1.12），明显低于持续妊娠者（MoM1.00（0.59-1.59）；p=0.036）。与持续妊娠者相比，流产者的 hCG 水平也明显降低。然而，在该队列中，MIC-1 作为预测流产的诊断标志物的性能一般，并且与 hCG 联合使用也没有改善。
结论
在因超声确认胎儿存活而就诊于 EPAU 但随后流产的女性中，MIC-1 和 PAPP-A 水平明显降低。虽然它们在这种临床环境下不太可能作为预测生物标志物，但它们可能在维持早期妊娠中发挥重要作用。
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