妊娠中期孕妇血清中Siglec-6、Gal-13、Netrin-1表达与凶险性前置胎盘合并胎盘植入的相关性

Correlation of expressions of Siglec-6, Gal-13, and Netrin-1 in serum of pregnant women in mid pregnancy with pernicious placenta previa combined with placenta accreta spectrum

摘要

目的 分析妊娠中期孕妇血清中唾液酸结合免疫球蛋白样凝集素6(Siglec-6)、半乳糖凝集素13(Gal-13)、轴突生长诱向因子1(Netrin-1)水平及与凶险性前置胎盘(PPP)合并胎盘植入(PAS)的相关性。方法 选择2020年1月至2023年12月期间在宜宾市第二人民医院接受剖宫产手术的176例确诊为PPP的孕妇为研究对象,根据术中所见及术后病理检查结果,将其分为PPP合并PAS组(71例)和单纯PPP组(105例);采用酶联免疫吸附试验法检测血清Siglec-6、Gal-13、Netrin-1水平;采用Spearman相关分析血清Siglec-6、Gal-13、Netrin-1水平与PPP合并PAS的相关性;采用多元Logistic回归分析影响PPP合并PAS的因素;绘制受试者工作特征(ROC)曲线得到血清Siglec-6、Gal-13、Netrin-1及联合诊断PPP合并PAS的曲线下面积(AUC),并用Z检验对其进行比较。结果 PPP合并PAS组血清Siglec-6水平高于单纯PPP组,血清Gal-13、Netrin-1水平低于单纯PPP组,差异有统计学意义(t值分别为6.266、5.611、4.567,P<0.05);PPP合并PAS组产次、剖宫产史及清宫次数均≥2次的比例高于单纯PPP组,差异有统计学意义(χ²值分别为5.151、10.836、15.515,P<0.05);血清Siglec-6与PPP合并PAS呈正相关性(r=0.613,P<0.001),Gal-13、Netrin-1水平与PPP合并PAS呈负相关性(r值分别为-0.518、-0.474,P<0.001);多元Logistic回归分析结果显示,剖宫产史≥2次、清宫次数1次、清宫次数≥2次、Siglec-6高水平为影响PPP合并PAS的危险因素(OR值分别为1.843、2.650、6.247、4.306,P<0.05),Gal-13、Netrin-1高水平为影响PPP合并PAS的保护因素(OR值分别为0.207、0.274,P<0.05);血清Siglec-6、Gal-13、Netrin-1联合诊断PPP合并PAS的AUC为0.941,大于三者单独诊断(Z值分别为2.539、3.753、4.163,P<0.001)。结论 凶险性前置胎盘合并胎盘植入患者血清Siglec-6水平显著升高,Gal-13、Netrin-1水平降低,三者水平变化对合并胎盘植入有一定的诊断参考价值。

Abstract

Objective To detect serum levels of sialic acid-binding immunoglobulin-like lectin 6 (Siglec-6), galectin-13 (Gal-13), and neuroaxon guidance factor-1 (also called Netrin-1) of pregnant women in mid pregnancy, and to analyze their correlations with risk of pernicious placenta previa (PPP) combined with placenta accreta spectrum (PAS). Methods A total of 176 pregnant women who were diagnosed as PPP and underwent cesarean section in our hospital from January 2020 to December 2023 were selected as study subjects. According to intraoperative findings and postoperative pathological examination results, these 176 PPP patients were divided into PPP combined with PAS group (71 cases) and simple PPP group (105 cases). Enzyme linked immunosorbent assay (ELISA) was applied to detect serum levels of Siglec-6, Gal-13 and Netrin-1. Spearman correlation was applied to analyze correlations between serum Siglec-6, Gal-13, Netrin-1 levels and PPP combined with PAS. Multiple Logistic regression analysis (stepforward method) was applied to obtain odds ratio (OR) and 95% confidence interval (95%CI) of factors affecting PPP combined with PAS. Receiver operating characteristic (ROC) curve was plotted to obtain the areas under the curve (AUCs) of serum Siglec-6, Gal-13, Netrin-1, and combination of the three indexes for diagnosing PPP with PAS, and Z-test was used to compare the data. Results The serum level of Siglec-6 of the pregnant women in the PPP combined with PAS group was significantly higher than that in the simple PPP group, while the serum levels of Gal-13 and Netrin-1 were significantly lower than those in the simple PPP group (t=6.266, 5.611 and 4.567 respectively, all P<0.05). The parity, and proportions of pregnant women with cesarean section history and frequency of curettage ≥ 2 in the PPP combined with PAS group were significantly higher than those in the simple PPP group, the differences were statistically significant (χ²=5.151, 10.836 and 15.515 respectively, all P<0.05). Spearman correlation analysis showed that serum Siglec-6 was positively correlated with PPP combined with PAS (r=0.613, P<0.001), while serum Gal-13 and Netrin-1 levels were negatively correlated with PPP combined with PAS (r=-0.518 and -0.474 respectively, both P<0.001). Multiple Logistic regression analysis shown that history of cesarean section≥2 times, frequency of curettage=1 time, frequency of curettage≥2 times, and high serum level of Siglec-6 were risk factors for PPP combined with PAS (OR=1.843, 2.650, 6.247 and 4.306 respectively, all P<0.05), while high serum levels of Gal-13 and Netrin-1 were protective factors for PPP combined with PAS (OR=0.207 and 0.274 respectively, both P<0.05). The AUC of the combination of serum Siglec-6, Gal-13 and Netrin-1 for diagnosing PPP combined with PAS was 0.941 (95%CI: 0.908-0.974), suggesting that the combined diagnostic value of the three was higher than that of individual diagnostic efficacy of single Siglec-6 (Z=2.539, P=0.011), single Gal-13 (Z=3.753, P<0.001), and single Netrin-1 (Z=4.163, P<0.001). Conclusion The serum level of Siglec-6 of the pregnant women with PPP combined with PAS significantly elevates, while the serum Gal-13 and Netrin-1 levels significantly decrease, and changes in the serum levels of the three indexes have some diagnostic reference value for PPP combined with PAS.

关键词

凶险性前置胎盘 / 胎盘植入 / 唾液酸结合免疫球蛋白样凝集素6 / 半乳糖凝集素13 / 轴突生长诱向因子1

Key words

pernicious placenta previa / placenta accreta spectrum / sialic acid-binding immunoglobulin-like lectin 6 / galectin-13 / neuroaxon guidance factor-1

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