Clinical Characteristics Of 80 Chinese Han Patients With Recurrent Hydatidiform Moles And Pathogenicity Of Associated Genes

BackgroundRecurrent hydatidiform moles refer to patients with at least two molar pregnancies.NLRP7 and KHDC3L have a clear correlation with it.It's difficult for patients to become pregnant,of which spontaneous abortion,stillbirth,hydatidiform mole and gestational trophoblastic tumor are common.Patients with previous history of hydatidiform mole are more likely to have subsequent hydatidiform mole than the"normal" population.The incidence of subsequent molar pregnancy ranges from 0.7 to 2.6%after one hydatidiform mole.The age less than 15 years and more than 45 years are two high-risk ages,patients with recurrent hydatidiform moles are usually at elderly age due to multiple failure pregnancies.10%-25%of patients withhydatidiform moles have to accept chemotherapy because of gestational trophoblastic tumor.In addition to the side effects caused by chemotherapy,another major problem in patients with recurrent hydatidiform moles is infertility,especially the presence of gene NLRP7 and KHDC3L mutation.PurposeTo explore the clinical characteristics of recurrent hydatidiform moles and the pathogenicity of gene NLRP7 and KHDC3L,based on retrospective analysisof 80 Chinese Han patients.MethodEighty Chinese patients with recurrent hydatidiform moles patients from 2003 to 2016 in Zhejiang University Medical College First Affiliated Hospital and Women's Hospital School of Medicine Zhejiang University outpatient were included in this study.Statistics of its initial age,subsequent hydatidiform moles age,the time interval of hydatidiform moles,histopathological type of hydatidiform mole,the incidence of gestational trophoblastic tumor and the reproductive history were collected.NLRP7 and KHDC3L mutation analysis were performed in all patients.Results1.The initial age of recurrent hydatidiform moles was between 26-30 years,the interval time was 13 to 24 months,and the histopathological type of hydatidiform mole was predominantly complete hydatidiform mole.Only 17 of the eighty patients with recurrent hydatidiform moles had normal reproductive outcomes,of which three patients were successfully pregnancy by intracytoplasmic sperm injection.There are totally 188 hydatidiform moles in 80 patients,24 hydatidiform moles of which were changed to gestational trophoblastic tumor with a total malignant rate of 12.77%.2.We identified 19 mutations in 21 of the patients.16 of the patients had at least one defective allele and only 5 of the patients had one defective allele.Whether it was a single site mutation or a double site mutation,the location was mainly concentrated in the LRR region.ConclusionThere was no enough evidence to suggest a difference in the mean age between patients with one molar pregnancy and patients with recurrent hydatidiform moles.Complete hydatidiform mole is more invasive than partial hydatidiform mole,which accounts for the reason why complete hydatidiform mole is more easily change into gestational trophoblastic tumor.Poor reproductive outcomes were often seen in patients with recurrent hydatidiform moles,especially with defective NLRP7 and KHDC3L alleles.Artificial reproductive technology is meaningful in infertility but not all.