The Changes Of TGF-?1 And CTGF In The Decidua Of Patients With Cesarean Scar Pregnancy

Objective:In this study,we studied the clinical specimens to investigate the changes of transforming growth factor-?1(TGF-?1)and connective tissue growth factor(CTGF)in decidua of patients with cesarean scar pregnancy(CSP),and to investigate the correlation between the two factors.To explore the biological mechanism of gestational sac implantation at the scar site,to reveal the pathogenesis of CSP,in order to provide clues and evidences for the prevention and targeted therapy of CSP.Methods:The study was carried out in the department of Obstetrics and Gynec-ology,Second Hospital of Hebei Medical University between January 2018 to December 2018.Collecting the decidua of CSP(scar decidua and uterine cavity decidua)at the end of pregnancy 31 cases.Another 32 cases of uterine decidua(scar decidua and uterine cavity decidua)were collected from the early pregnancy of normal intrauterine pregnancy with a history of cesarean section,and 32 cases of uterine decidual tissue(uterine isthmus decidua and uterine cavity decidua)during abortion in the early pregnancy without cesarean section.TGF-?1 and CTGF in paraffin sections of uterine decidua from different parts of the three groups were detected by immunohistochemistry,and the percentage of positive cells and the intensity of staining were scored by the semi-quantitative method.Results:1 Comparison of TGF-?1 expression in decidual tissue of three groups:1.1 The expression of TGF-?1 in scar or isthmic decidua of each group was compared with that of uterine cavity deciduaThe expression of TGF-?1 in the scar decidua of CSP group 4(3,4)was significantly higher than that in the uterine cavity decidua group3(3,3) (P<0.05).The expression of TGF-?1 in the scar decidua in the intrauterine early pregnancy group after cesarean section3(2,3.5)was not significantly different from that in the uterine cavity2(2,3)(P>0.05).There was no significant difference in the expression of TGF-?1 in the uterine isthmus decidua of the normal early pregnancy group3(2,3)compared with the expression of decidua in the uterine cavity 2(1,3)(P>0.05).1.2 Comparison of TGF-?1 expression in three groups of scar or isthmic deciduaThe difference was statistically significant in the expression of TGF-?1in the scar or uterine isthmus decidua between the three groups(?~2=16.291,P<0.001).Compared with the two groups,the expression of CSP scar4(3,4)was significantly higher than that of scar decidua in the intrauterine early pregnancy group after cesarean section3(2,3.5)(P<0.05)and the expression of decidua in the normal early pregnancy group 3(2,3)(P<0.05).There was no significant difference in the expression of TGF-?1in scar decidua of the intrauterine early pregnancy group3(2,3.5)after cesarean section with that of the normal early pregnancy group 3(2,3)(P>0.05).1.3 Comparison of TGF-?1 expression in uterine cavity decidua of three groupsThere were statistically significant differences in the expression of TGF-?1 in the uterine cavity decidua of the three groups(?~2=7.597,P<0.05).The expression of uterine cavity decidua in CSP 3(3,3)was significantly higher than that of the normal early pregnancy group2(1,3)(P<0.05).There was no significant difference in the expression of decidual in the intrauterine early pregnancy group after cesarean section2(2,3)(P>0.05).The expression of uterine cavity in the intrauterine early pregnancy group after cesarean section2(2,3)was not significantly different from that in the normal early pregnancy group2(1,3)(P>0.05).2 Comparison of CTGF expression in decidua in the three groups2.1 Comparison of CTGF expression in scars or isthmus decidua and uterine cavity decidua of each groupThere was no significant difference in the expression of CTGF between the scar decidua3(3,4)and the uterine cavity decidua3(2,4)at the CSP(P>0.05).The expression of CTGF in the scar decidua3(2,4)of the intrauterine early pregnancy group after cesarean section was not significantly differerent from that in the uterine cavity decidua2.5(2,3)(P>0.05).There was no significant difference in the expression of CTGF in the isthmus decidua of the normal early pregnancy group3(2,4)compared with the uterine cavity decidua2.5(2,3)(P>0.05).2.2 Comparison of CTGF expressionof scar or isthmus decidua in the three groupsThere was no significant difference in CTGF expression between the three groups at the scar or isthmus decidua(P>0.05).2.3 Comparison of CTGF expression in uterine cavity decidua of three groupsThere was no significant difference in the expression of CTGF in the decidua at the uterine cavity in the three groups(P>0.05).3 The correlation between expression of TGF-?1and CTGF in three groupsThere was no correlation between the expression of TGF-?1and CTGF In the three groups.Conclusions:The expression of TGF-?1 in the decidua at the cesarean section was higher than that in the early pregnancy group and the normal early pregnancy group.The expression of CTGF in three groups was similar.It is speculated that TGF-?1 may play a important role in the pathogenesis of CSP.