Роль сывороточных маркеров в оценке состояния рубца на матке

Abstract

Objective. To analyze the levels of serum fibrosis markers, procollagen type I N-terminal propeptide (PINP) and procollagen type III N-terminal propeptide (PIIINP), in relation to birth outcomes in patients with uterine scar after one previous cesarean section (CS). Patients and methods. This prospective study included 76 women with uterine scar after one previous CS. All patients had their PINP and PIIINP levels determined upon admission. Depending on birth outcomes, patients were divided into two groups: the study group consisted of 36 women who had spontaneous vaginal delivery without complications, and the comparison group was represented by 40 women who underwent unplanned cesarean delivery due to the development of complications. Results. Patients with successful birth outcomes in the presence of uterine scar had significantly lower levels of serum fibrosis markers: PINP reached 46.1 ng/mL and PIIINP – 2.6 μg/L, while in the comparison group, these values were 64.1 ng/mL and 4.2 μg/L, respectively. Such peculiarity of values may be associated with elevated expression of type I and III collagens. This mechanism provoked rapid fibrosis development, which was clinically manifested by uterine scar rupture during labor. Conclusion. Serum markers of fibrosis (PINP and PIIINP) are promising indicators for their further study as part of the problem of uterine scar assessment, but more observations are needed. For the conclusive evidence of their informativeness, it is important to perform immunohistochemical analysis of scar tissue samples with quantitative estimation of type I and III collagens and to compare these findings with peripheral blood values. Key words: uterine scar, connective tissue disorder, fibrosis, collagen, procollagen type I N-terminal propeptide, procollagen type III N-terminal propeptide