Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea.
Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Am J Reprod Immunol. 2022 Jul;88(1):e13557. doi: 10.1111/aji.13557. Epub 2022 May 12.
This study aimed to determine whether various novel plasma mediators of immune regulation associated with inflammation could independently predict the clinical outcome of rescue cerclage in patients with cervical insufficiency (CI).
A total of 41 singleton pregnant women (17-25 weeks) who underwent rescue cerclage for CI were retrospectively evaluated. Stored plasma samples were assayed for IGFBP-1, -2, -3, IL-6, latexin, LBP, lipocalin-2, M-CSF, MIP-1α, MMP-8, -9, pentraxin 3, resistin, S100A8, S100A8/A9, thrombospondin-2, TIMP-1, and TNFR2 levels. The primary outcome measures were spontaneous preterm birth (SPTB) at < 28 and < 34 weeks after cerclage placement.
Multivariate Firth's logistic regression analysis revealed that high levels of IGFBP-3 and S100A8/A9, and low levels of MIP-1α were significantly associated with SPTB at < 28 weeks after cerclage placement, whereas only low MIP-1α levels were significantly associated with SPTB at < 34 weeks, even after adjustment for baseline clinical covariates (e.g., cervical dilatation). For the prediction of SPTB at < 28 weeks, the area under the curves (AUC) of IGFBP-3, MIP-1α, and S100A8/A9 were of .686, .691, and .693, respectively. Similarly, the AUC of MIP-1 α was of .659 to predict SPTB at < 34 weeks.
These findings suggest that plasma IGFBP-3, MIP-1α, and S100A8/A9 can represent noninvasive independent biomarkers for identifying women with CI at high risk for SPTB following rescue cerclage. Nonetheless, further in large, multicenter clinical studies should be performed to confirm the clinical value of these biomarkers.
本研究旨在确定与炎症相关的各种新型免疫调节血浆介质是否可以独立预测宫颈机能不全（CI）患者行紧急宫颈环扎术的临床结局。
回顾性评估了 41 例因 CI 而行紧急宫颈环扎术的单胎妊娠孕妇（17-25 周）。检测储存的血浆样本中 IGFBP-1、-2、-3、IL-6、latexin、LBP、lipocalin-2、M-CSF、MIP-1α、MMP-8、-9、pentraxin 3、抵抗素、S100A8、S100A8/A9、血栓调节蛋白-2、TIMP-1 和 TNFR2 的水平。主要结局指标为紧急宫颈环扎术后<28 周和<34 周的自发性早产（SPTB）。
多变量 Firth 逻辑回归分析显示，IGFBP-3 和 S100A8/A9 水平高，MIP-1α 水平低与紧急宫颈环扎术后<28 周的 SPTB 显著相关，而仅 MIP-1α 水平低与紧急宫颈环扎术后<34 周的 SPTB 显著相关，即使在调整基线临床协变量（如宫颈扩张）后也是如此。对于预测<28 周的 SPTB，IGFBP-3、MIP-1α 和 S100A8/A9 的曲线下面积（AUC）分别为 0.686、0.691 和 0.693。同样，MIP-1α 的 AUC 为 0.659，可预测<34 周的 SPTB。
这些发现表明，血浆 IGFBP-3、MIP-1α 和 S100A8/A9 可以作为识别接受紧急宫颈环扎术的 CI 妇女发生 SPTB 风险较高的非侵入性独立生物标志物。尽管如此，仍需进一步在大型多中心临床研究中确认这些生物标志物的临床价值。
