The Changes Of Expression Of TGF-β1 And Its Receptors And CTGF In Uterine Decidual Tissues Of Patients With Caesarean Scar Pregnancy

Objective: In this study,we detect the expression of TGF-β1 and its receptors and CTGF in uterine decidual tissues of patients with caesarean scar pregnancy,the pregnancy caesarean section harem,as well as in patients with normal pregnant after vaginal delivery by protein immunoblot(Western blot)to analyse the differences and explore the specific mechanism of gestational sac implantation at the scar.Further more,we want to uncovered the pathogenesis of CSP form the viewpoint of molecular biology,in order to supply clew and foundation for the precaution and targeted therapy of CSP.Methods: Collected uterine decidual tissues(two specimens were taken form each case: scar or uterine isthmus decidua and uterine cavity decidua)of 90 patients who opt to terminate the pregnancy in the department of Obstetrics and Gynecology,Second Hospital of Hebei Medical University between June 2018 to December 2019,which was divided into three groups,including 30 cases of caesarean scar pregnancy(CSP group),30 cases of intrauterine early pregnancy group with caesarean section(cas group)and 30 cases of the normal early pregnancy after vaginal delivery(del group).Western blot was used to detect the expression of TGF-β1 and its receptors and CTGF in uterine decidual tissues of the three groups(two specimens).Results: 1 Comparison of TGF-β1 expression: 1.1 Comparison of TGF-β 1 expression in exuvial tissues at the uterine isthmus or scar in each group and its own intrauterine exuvial tissues: In CSP group,the relative value of TGF-β1 in the scar decidua 1.33(0.97,1.78)was higher than that in uterine cavity decidua 0.80(0.72,1.34),with statistical significance(P < 0.05).In cas group,the relative value of TGF-β1 in the uterine isthmus decidua 0.68(0.45,1.11)was lower than that in the uterine cavity decidua 1.12(0.82,1.37),with statistical significance(P < 0.05).In del group,the relative value of TGF-β1 in the isthmus decidual tissues 0.63(0.50,0.93)was significantly lower than that in the uterine cavity 1.13(0.85,1.29)(P < 0.05).1.2 Comparison of TGF-β1 expression in decidual tissues at isthmus or scar of three groups.The relative value were significantly different between three groups(χ~2=30.248,P<0.001).Pairwise comparison showed that the relative value of TGF-β 1 in the scar decidua of CSP group 1.33(0.97,1.78) was significantly higher than that in the uterine isthmus decidua of cas group 0.68(0.45,1.11)(P < 0.05)and that in del group 0.63(0.50,0.93)(P < 0.05).There was little significant difference in the relative value of TGF-β 1 in the uterine isthmus deciduas of cas group and that in del group(P >0.05).1.3 comparison of expression of TGF-β 1 in uterine cavity decidua of the three groups.There was no significant difference in the relative value of TGF-β 1 in uterine cavity decidua of the three groups(χ~2=3.596,P > 0.05).2 Comparison of TGF-β RⅡ expression:2.1 TGF-β RⅡ expression quantity in uterine isthmus,or scar decidual tissue of each group compared with that in uterine cavity decidual: In CSP group,the relative value of TGF-β RⅡ in the scar decidua 0.75(0.54,1.02)was lower than that in uterine cavity decidua 0.90(0.70,1.10),with statistical significance(P < 0.05).In cas group,there was little significant difference in the relative value of TGF-β RⅡ in the uterine isthmus decidua 1.06(089,1.21)compared with the uterine cavity decidua 1.00(0.86,1.44)(P > 0.05).In del group,the relative value of TGF-β R Ⅱin the isthmus decidual tissues1.01(0.81,1.25)was not significantly differerent from that in the uterine cavity decidua 0.96(0.77,1.19)(P >0.05).2.2 Comparison of TGF-β RⅡ expression in decidual tissues at isthmus or scar of three groups.The relative value were significantly different between three groups(χ~2=16.396,P < 0.001).Pairwise comparison showed that the relative value of TGF-β R Ⅱin the scar decidua of CSP group 0.75(0.54,1.02)was significantly lower than that in the uterine isthmus decidua of cas group 1.06(0.89,1.21)(P < 0.05)and that in del group 1.01(0.81,1.25)(P < 0.05).There was little significant difference in the relative value of TGF-β R Ⅱ in the uterine isthmus decidua of cas group and that in del group(P >0.05).2.3 Comparison of expression of TGF-β R Ⅱin uterine cavity decidua of the three groups.There was no significant difference in the relative value of TGF-β R Ⅱin uterine cavity decidua of the three groups(χ~2=3.210,P=0.201).3 Comparison of TGF-β R expression:Ⅰ 3.1 TGF-β R Ⅰexpression quantity in uterine isthmus,or scar decidual tissue of each group compared with that in uterine cavity decidual: In CSP group,the relative value of TGF-β RⅠ in the scar decidua 0.75(0.60,0.89)was lower than that in uterine cavity decidua 0.93(0.80,1.14),with statistical significance(P < 0.05).In cas group,there was little significant difference in the relative value of TGF-β RⅠ in the uterine isthmus decidua 1.05(0.87,1.16)compared with the uterine cavity decidua 1.09(0.94,1.23)(P >0.05).In del group,the relative value of TGF-β R Ⅰin the isthmus decidual tissues 1.03(0.91,1.17)was not significantly differerent from that in the uterine cavity decidua 1.01(0.82,1.27)(P > 0.05).3.2 Comparison of TGF-β RⅠ expression in decidual tissues at isthmus or scar of three groups.The relative value of TGF-β R Ⅰ were significantly different between three groups(χ~2=18.175,P<0.001).Pairwise comparison showed that the relative value of TGF-β R Ⅰin the scar decidua of CSP group 0.75(0.60,0.89)was significantly lower than that in the uterine isthmus decidua of cas group 1.05(0.87,1.16)(P<0.05)and that in del group 1.03(0.91,1.17)(P< 0.05).There was little significant difference in the relative value of TGF-β R Ⅰin the uterine isthmus decidua of cas group and that in del group(P >0.05).3.3 Comparison of expression of TGF-β R Ⅰin uterine cavity decidua of the three groups.There was little significant difference in the relative value of TGF-β RⅠ in uterine cavity decidua of the three groups(χ~2 =3.867,P = 0.145).4 Comparison of CTGF expression: 4.1 CTGF expression quantity in uterine isthmus,or scar decidual tissue of each group compared with that in uterine cavity decidual: In CSP group,the relative value of CTGF in the scar decidua and uterine cavity decidua were 0.97±0.27 and 1.02±0.29,respectively,with no statistically significant difference(P>0.05).In cas group,there was little significant difference in the relative value of CTGF in the uterine isthmus decidua 1.02±0.30 compared with the uterine cavity decidua 1.03±0.30(P>0.05).In del group,the relative value of CTGF in the isthmus decidual tissues 1.14±0.25 was not significantly differerent from that in the uterine cavity decidua 1.04±0.27(P >0.05).4.2 Comparison of CTGF expression in decidual tissues at isthmus or scar of three groups.There was no significant difference in the relative value of CTGF between the groups(F=2.907,P=0.06).4.3 Comparison of expression of CTGF in uterine cavity decidua of the three groups.There was no significant difference in the relative value of CTGF between the groups(F=0.044,P=0.957).Conclusions: 1.The expression of TGF-β 1 in the scar decidua of CSP group was significantly higher than that in the uterine isthmus decidua of cas group and that in del group.Besides,it was higher than that in its own uterine cavity decidua,suggesting that TGF-β 1 had a high expression in the CSP scar.2.The expression of TGF-β R Ⅱ and TGF-βR Ⅰ in the scar decidua of CSP group were significantly lower than that in the uterine isthmus decidua of cas group and that in del group.Besides,it was lower than that in its own uterine cavity decidua,suggesting that TGF-β R Ⅱ and TGF-β R Ⅰexpressed low in the CSP scar.3.There was no difference in the expression of CTGF in decidual tissues.4.It was speculated that TGF-β 1 and its receptors may play imp-ortant roles in the pathogenesis of CSP.