赵雅堃,武红利,康文丽,苏媛媛,李雅钗,李瑞
ZHAO Yakun,WU Hongli,KANG Wenli,SU Yuanyuan,LI Yachai,LI Rui

• 1:河北大学
• 2:河北大学附属医院产科

摘要(Abstract)：

目的:探讨孕妇血清外体RNA(exosomal RNA)及甲胎蛋白(AFP)对诊断胎盘植入的价值。方法:凶险性前置胎盘的单胎孕妇76例,根据胎盘是否植入分为植入组(n=32)与非植入组(n=44),另选取既经有剖宫产史,此次妊娠胎盘位置正常且无其他妊娠合并症或并发症的单胎孕妇50例作为对照组;收集3组孕妇年龄、孕次、产次、剖宫产次及孕周等资料,并于入院时抽取孕妇静脉血,测定血清AFP水平;提取血清中的exosomal RNA,测定其浓度。结果:3组孕妇年龄、孕次、产次、剖宫产次及孕周比较,差异无统计学意义(P>0.05),植入组孕妇血清exosomal RNA及AFP浓度高于非植入组及对照组,差异有统计学意义(P<0.05),而非植入组与对照组比较差异无统计学意义(P>0.05)。结论:监测前置胎盘的单胎孕妇血清中exosomal RNA及AFP水平有助于产前诊断胎盘植入。
Objective:To investigate the value of serum exosomal RNA and AFP in the diagnosis of placenta accreta. Methods:76 pregnant women with risky placenta previa were divided into two groups:placenta accreta group( 32 cases),and non-placental implant group( 44 cases). In addition,50 pregnant women with singleton diagnosed as normal placenta site and no pregnancy complications as control group. The 3 groups of pregnant women were compared in terms of age,pregnancy times,birth times,cesarean section times,and gestational weeks,and collected venous blood when admitted to hospital; testing the level of serum AFP,then serum exosomal RNA was extracted and the concentration of exosomal RNA was determined. Result:There was no significant difference among the 3 groups of the general situation( P > 0. 05). The concentration of exosomal RNA and AFP in the implanted group were significantly higher than those in the non-implanted group and the control group,the difference was statistically significant( P < 0. 05),but there was no significant difference between the nonimplanted group and the control group( P > 0. 05). Conclusion:Monitoring level of exosomal RNA and AFP of placenta previa singleton pregnant women would be helpful for prenatal diagnosis of placenta accreta.

关键词(KeyWords)： 前置胎盘;孕妇;外体RNA;甲胎蛋白;产前诊断
placenta praevia;pregnant women;exosomal RNA;α-fetoprotein;prenatal diagnosis

Abstract:

Keywords:

基金项目(Foundation): 河北省科技成果重点推广计划项目(16ZF079)

作者(Author): 赵雅堃,武红利,康文丽,苏媛媛,李雅钗,李瑞
ZHAO Yakun,WU Hongli,KANG Wenli,SU Yuanyuan,LI Yachai,LI Rui

DOI: 10.19367/j.cnki.1000-2707.2017.03.022

参考文献(References)：

• [1]Shanks A,Mc Namara J,Hua M,et al.Discussion:predictors of massive blood loss from placenta accrete by Wright et al[J].Am J Obstet Gynecol,2011(1):8-10.
• [2]张方圆.胎盘植入的产前诊断[J].现代妇产科进展,2015(9):708-710.
• [3]李可爱.彩色多普勒超声诊断胎盘植入及漏诊原因分析[J].中国药物与临床,2016(8):1156-1157.
• [4]彭软,谢红宁,杨建波,等.胎盘植入的产前超声诊断及其影响因素[J].中国临床医学影像杂志,2010(1):67
• [5]陶春梅.彩超、MRI及AFP、CK产前诊断胎盘植入的价值[D].广州:广州医科大学,2012.
• [6]Mc Pherson E,Thomas GD,Manlick C,et al.Extreme values of maternal serum analytes in second trimester screening:looking beyond trisomy and NTD’s[J].J Genet Counsel,2011(11):396-399.
• [7]李凌燕,甘兰,张惠钦,等.动态监测孕妇血清中β-h CG、HPL浓度对筛查早期不良妊娠及预测结局的作用[J].中国医学创新,2012(30):33-34.
• [8]李卓,康炜,李蕊,等.人血清Exosome的分离及其miRNA检测的临床价值[J].中华检验医学杂志,2015(8):557-561.
• [9]黄一颖,段涛.母血中胎儿DNA预测前置胎盘合并粘连的探讨[J].现代妇产科进展,2006(12):854-857.
• [10]龚护民,茹美燕.植入性凶险型前置胎盘12例临床分析[J].海南医学,2011(5):87-89.
• [11]叶志海,肖小敏.监测妊娠中晚期孕妇血清甲胎蛋白水平的临床意义[J].新医学,2004(10):616-618.
• [12]李玉静,刁振宇,薛平平,等.血清中胎盘来源外泌体的分离与鉴定[J].医学研究生学报,2015(6):632-636.
• [13]Wu S,Kocherginsky M,Hibbard JU.Abnormal placentation:twenty-year analysis[J].Am J Obstet Gynecol,2005(5):1458-1461.
• [14]Kassem GA,Alzahrani AK.Maternal and neonatal outcomes of placenta previa and placenta accreta:three years of experience with a two-consultant approach[J].Int J Womens Health,2013(5):803-810.
• [15]Mhyre JM,Shilkrut A,Kuklina EV,et al.Massive blood transfusion during hospitalization for delivery in New York State,1998-2007[J].Obstet Gynecol,2013(6):1288-1294.
• [16]Pan BT,Teng K,Wu C,et al.Electron microscopic evidence for externalization of the transferring receptor in vesicular form in sheep reticulocytes[J].J Cell Biol,1985(3):942-948.
• [17]Boon RA,Vickers KC.Intercellular transport of microRNAs[J].Arterioscler Thromb Vasc Biol,2013(33):186-192.
• [18]Salomon C,Yee SS,cholz-Romero K,et al.Extravillous trophoblast cells-derived exosomes promote vascular smooth muscle cell migration[J].Front Pharmacol,2014(5):175.
• [19]Delorme-Axford E,Donker RB,Mouillet JF,et al.Human placental trophoblasts confer viral resistance to recipient cells[J].Proc Natl Acad Sci USA,2013(29):12048-12053.
• [20]Patella F,Rainaldi G.MicroRNAs mediate metabolic stresses and angiogenesis[J].Cell Mol Life Sci,2012(69):1049-1065.

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