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[STR基因分型诊断在葡萄胎与非葡萄胎妊娠中的临床应用]

[Clinical application of STR genotyping diagnosis for hydatidiform mole and nonmolar gestation].

作者信息

Zheng X Z, Qin X Y, Wang P, Xu F, Ma J H, Wang X L, Chen S W, Feng W Q, Zhu L, Yin C H, Wu B Q

机构信息

Department of Pathology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China.

出版信息

Zhonghua Bing Li Xue Za Zhi. 2018 Aug 8;47(8):609-615. doi: 10.3760/cma.j.issn.0529-5807.2018.08.008.

Abstract

To investigate the value of short tandem repeat (STR) genotyping in the diagnostic workup of molar and non-molar gestations with correlation of histological characteristics. Six hundred and fifty-six cases were selected based on clinically suspected hydropic abortion and/or molar pregnancy from July 2015 to September 2017 at Beijing Obstetrics and Gynecology Hospital. DNA was extracted from dissected chorionic villi and paired maternal endometrial FFPE tissue samples by Simplex OUP™ FFPE DNA Tissue Kit. STR genotyping was performed by PowerPlex 16 HS system. DNA genotyping was informative in 649 of 656 cases, leading to identification of 215 hydatidiform mole gestations and 434 non-molar gestations. Most of non-molar gestations (375 cases, 86.4%) were diploid hydropic abortion. Various trisomy syndromes were found (53 cases, 12.2%), including trisomy 2, 3, 4, 7, 8, 13, 16 and 21. Only 2(0.5%) digynic triploid gestations were detected. Moreover, 4 cases (0.9%) of uniparental disomies (homologous or heterologous) were found. There were 196 cases with histologic diagnostic suspicious of hydatidiform moles were accurate sub-classified. Among them, 59 cases hydatidiform moles were under-diagnosed as diploid hydropic abortions, and 28 cases diploid hydropic abortions were over-diagnosed as hydatidiform moles.Compared with partial moles(PHM), there were no specific histomorphological features between the various types of non-molar gestations and partial moles for definitive diagnostic separation. There was no significant difference in the expression of p57(kip2) among PHM, trisomy and diploid hydropic abortions group (=0.247). STR genotyping can distinguish non-molar gestations from early hydatidiform moles, and efficiently avoid misdiagnosis based only on histological evaluation. Therefore, using STR genotyping, not only can the overdiagnosis of non-molar pregnancy be avoided, but also individualized management can be offered to patients including monitoring of serum hCG.

摘要

探讨短串联重复序列(STR)基因分型在葡萄胎和非葡萄胎妊娠诊断检查中的价值,并与组织学特征进行相关性分析。选取2015年7月至2017年9月在北京妇产医院临床怀疑为稽留流产和/或葡萄胎妊娠的656例病例。采用Simplex OUP™ FFPE DNA组织试剂盒从解剖的绒毛膜绒毛和配对的母体子宫内膜FFPE组织样本中提取DNA。通过PowerPlex 16 HS系统进行STR基因分型。656例病例中有649例DNA基因分型结果可提供信息,共鉴定出215例葡萄胎妊娠和434例非葡萄胎妊娠。大多数非葡萄胎妊娠(375例,86.4%)为二倍体稽留流产。发现了各种三体综合征(53例,12.2%),包括21三体、13三体、8三体、7三体、4三体、3三体、2三体和16三体。仅检测到2例(0.5%)双雌三倍体妊娠。此外,发现4例(0.9%)单亲二体(同源或异源)。196例组织学诊断怀疑为葡萄胎的病例得到了准确的亚分类。其中,59例葡萄胎被误诊为二倍体稽留流产,28例二倍体稽留流产被误诊为葡萄胎。与部分性葡萄胎(PHM)相比,各种类型的非葡萄胎妊娠与部分性葡萄胎之间没有明确的组织形态学特征用于明确诊断区分。PHM、三体和二倍体稽留流产组之间p57(kip2)的表达无显著差异(P=0.247)。STR基因分型可以区分非葡萄胎妊娠和早期葡萄胎,并有效避免仅基于组织学评估的误诊。因此,使用STR基因分型不仅可以避免非葡萄胎妊娠的过度诊断,还可以为患者提供包括监测血清hCG在内的个体化管理。

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