RESUMEN
Pre-eclampsia (PE) is a complicated pregnancy-specific disease and is considered the primary reason for maternal and foetal mortality and morbidity. PE has a multifactorial pathogenesis but the causes of PE remain unclear. The functions of trophoblasts, including differentiation, proliferation, migration, invasion and apoptosis, are essential for successful pregnancy. During the early stages of placental development, trophoblasts are strictly regulated by several molecular pathways; however, an imbalance of these molecular pathways can lead to severe placental lesions and pregnancy complications. Certain microRNAs (miRs) are abnormally expressed in PE, with several miRs involved in the regulation of pregnancy-associated genes. The present review discusses the miRs regulating trophoblast function, how they affect the pathogenesis of PE and evaluating the possibility of miRs in screening, diagnosis and treatment of PE.
RESUMEN
The correlation of maternal serum alpha-fetoprotein (AFP) variants (AFP-L2, AFP-L3), free beta-human chorionic gonadotropin (free ß-hCG), and open neural tube defects (ONTDs) during the second trimester, and the screening efficiency of different risk models remain indistinct. We conducted a retrospective case-control study, and studied 57 pregnant women with ONTD fetuses and 569 pregnant women with normal fetuses. The receiver operating characteristic curve method indicated the best cutoff value and area under the curve (AUC). The predictive value of ONTD risk models by free ß-hCG, AFP, AFP-L2, and AFP-L3 was investigated via integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Compared to the control group, AFP, AFP-L2, and AFP-L3 levels were significantly higher, while free ß-hCG level was significantly lower in the study group. The triple-index model of free ß-hCG + AFP-L2 + AFP-L3 and the dual-index model of AFP-L2 + AFP-L3 showed the best predictive values, respectively (AUC = 0.905; AUC = 0.885). The order of the single-index model AUCs was AFP-L3 > AFP-L2 > AFP > free ß-hCG. The negative predictive value, false positive rate, and negative likelihood ratio of AFP-L2, AFP-L3 alone, or combined with free ß- hCG were better than those of AFP alone; however, the positive likelihood ratio was the opposite. The replacement of AFP by AFP-L2 or AFP-L3 combined with free ß-hCG increased the IDI and NRI for predicting ONTD. The top five DCAs were AFP-L2 + free ß-hCG, free ß-hCG, AFP-L3, AFP + free ß-hCG, and AFP. Indicators of maternal serum free ß-hCG, AFP-L2, and AFP-L3 in the second trimester exhibited high sensitivity and specificity screening for ONTD fetuses. Risk models constructed using AFP-L2 + AFP-L3 and AFP-L2 + AFP-L3 + free ß-hCG demonstrated better screening efficiency.
