Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
The Center for Human Reproduction, New York, N.Y., USA.
Arch Gynecol Obstet. 2020 Mar;301(3):831-836. doi: 10.1007/s00404-020-05461-1. Epub 2020 Feb 27.
Increased serum C-protein (CRP) levels reduce fecundity in healthy eumenorrheic women with 1-2 pregnancy losses. Subclinical systemic inflammation may impede maternal immune tolerance toward the fetal semi-allograft, compromising implantation and early embryonic development. Some miscarriages with normal karyotypes could, therefore, be caused by inflammation. Whether pre-pregnancy CRP relates to karyotypes of spontaneously aborted products of conception (POCs) was investigated.
A study cohort of 100 infertile women with missed abortions who underwent vacuum aspirations followed by cytogenetic analysis of their products of conception tissue was evaluated at an academically affiliated fertility center. Since a normal female fetus cannot be differentiated from maternal cell contamination (MCC) in conventional chromosomal analyses, POC testing was performed by chromosomal microarray analysis. MCC cases and incomplete data were excluded. Associations of elevated CRP with first trimester pregnancy loss in the presence of a normal fetal karyotype were investigated.
Mean patients' age was 39.9 ± 5.8 years; they demonstrated a BMI of 23.9 ± 4.6 kg/m and antiMullerian hormone (AMH) of 1.7 ± 2.4 ng/mL; 21.3% were parous, 19.1% reported no prior pregnancy losses, 36.2% 1-2 and 6.4% ≥ 3 losses. Karyotypes were normal in 34% and abnormal in 66%. Adjusted for BMI, women with elevated CRP were more likely to experience euploid pregnancy loss (p = 0.03). This relationship persisted when controlled for female age and AMH.
Women with elevated CRP levels were more likely to experience first trimester miscarriage with normal fetal karyotype. This relationship suggests an association between subclinical inflammation and miscarriage.
在有 1-2 次妊娠丢失的健康月经正常的女性中，血清 C 反应蛋白（CRP）水平升高会降低生育能力。亚临床全身性炎症可能会阻碍母体对胎儿半同种异体移植物的免疫耐受，从而影响着床和早期胚胎发育。因此，一些染色体核型正常的流产可能是由炎症引起的。本研究旨在探讨孕前 CRP 是否与自然流产产物（POC）的核型有关。
在一家学术附属的生育中心，评估了 100 名因稽留流产而接受真空抽吸术并随后对其 POC 组织进行细胞遗传学分析的不孕妇女的研究队列。由于在常规染色体分析中无法区分正常女性胎儿与母体细胞污染（MCC），因此对 POC 进行了染色体微阵列分析。排除 MCC 病例和不完整数据。研究了 CRP 升高与正常胎儿核型妊娠丢失的关系。
患者的平均年龄为 39.9±5.8 岁；BMI 为 23.9±4.6kg/m，抗苗勒管激素（AMH）为 1.7±2.4ng/ml；21.3%的患者有过生育史，19.1%的患者没有过妊娠丢失史，36.2%的患者有 1-2 次妊娠丢失，6.4%的患者有≥3 次妊娠丢失。核型正常者占 34%，异常者占 66%。校正 BMI 后，CRP 升高的患者更有可能经历正常核型的妊娠丢失（p=0.03）。当控制女性年龄和 AMH 后，这种关系仍然存在。
CRP 水平升高的女性更有可能在早期妊娠因正常胎儿核型而流产。这种关系提示亚临床炎症与流产之间存在关联。
