Maternal Serum İskemik Modifiye Albümin Düzeyleri ile Missed Abortus Arasındaki İlişki: Bir Vaka-Kontrol Çalışması

Öz

Erken gebelik kaybı çok faktörlü bir durum olup, missed abortus gelişiminde rol alan biyolojik mekanizmalar tam olarak açıklanamamıştır. Bu çalışmanın amacı, missed abortus olgularında maternal serum iskemik modifiye albümin ve albüminle düzeltilmiş iskemik modifiye albümin düzeylerini değerlendirmek ve bu parametrelerin plasental fonksiyon bozukluğunu yansıtma potansiyelini araştırmaktır. Bu prospektif olgu–kontrol çalışmasına 6–14 gebelik haftaları arasında olan kadınlar dahil edilmiştir. Missed abortus tanısı alan kadınlar çalışma grubunu, sağlıklı gebeliği olanlar kontrol grubunu oluşturmuştur. Maternal serum iskemik modifiye albümin ve düzeltilmiş iskemik modifiye albümin düzeyleri ölçülmüştür. Toplam 184 katılımcı çalışmaya alınmış olup, bunların 74’ü missed abortus ve 110’u kontrol grubunda yer almıştır. Missed abortus grubunda iskemik modifiye albümin düzeyleri anlamlı olarak daha yüksekti (97.3 ng/mL [17.6–591.6] ve 60.1 ng/mL [4–483], p=0.003), albümin ile düzeltilmiş iskemik modifiye albümin düzeyleri de benzer şekilde vaka grubunda daha yüksek bulundu (101.5 ng/mL [17.6–777.6] ve 63.6 ng/mL [2.6–579.7], p=0.006). ROC analizinde eğri altında kalan alan iskemik modifiye albümin için 0.63 (GA: 0.55–0.70), düzeltilmiş iskemik modifiye albümin için 0.62 (GA: 0.54–0.70) olarak hesaplandı. Kesme değerleri sırasıyla 63.5 ng/mL (duyarlılık %75, özgüllük %58) ve 75.8 ng/mL (duyarlılık %66, özgüllük %59) olarak bulundu. Bu sonuçlar, yüksek IMA düzeylerinin missed abortus olgularında oksidatif dengesizlik ve plasental yetmezlikle ilişkili olabileceğini düşündürmektedir. Tanısal performans sınırlı olsa da IMA, diğer klinik göstergelerle birlikte değerlendirildiğinde yardımcı bir biyobelirteç olarak kullanılabilir. Bulguların doğrulanması için geniş örneklemli ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Biyobelirteç
• İskemik Modifiye Albümin
• Missed Abortus
• Oksidatif Stres
• Plasental Disfonksiyon

Etik Beyan

Marmara Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu (09.2020.44 / 06.03.2020).

Association Between Maternal Serum Ischemia-Modified Albumin Levels and Missed Abortion: A Case-Control Study

Öz

Early pregnancy loss is a multifactorial condition, and the biological pathways contributing to missed abortion are not fully understood. This study aimed to investigate maternal serum ischemia-modified albumin and albumin-adjusted ischemia-modified albumin concentrations in missed abortion and assess their potential relevance as markers of placental dysfunction. This prospective case–control study included pregnant women between 6 and 14 weeks of gestation. Women diagnosed with missed abortion formed the study group, and healthy pregnancies served as controls. Maternal serum ischemia-modified albumin and adjusted ischemia-modified albumin concentrations were measured. A total of 184 participants were enrolled, consisting of 74 cases and 110 controls. Serum ischemia-modified albumin concentrations were significantly higher in women with missed abortion (97.3 ng/mL [17.6–591.6] vs. 60.1 ng/mL [4–483], p=0.003), and the same trend was observed for albumin-adjusted ischemia-modified albumin (101.5 ng/mL [17.6–777.6] vs. 63.6 ng/mL [2.6–579.7], p=0.006). Receiver operating characteristic analysis yielded an area under the curve of 0.63 (95% CI: 0.55–0.70) for ischemia-modified albumin and 0.62 (95% CI: 0.54–0.70) for adjusted ischemia-modified albumin. The corresponding cut-off values were 63.5 ng/mL (sensitivity 75%, specificity 58%) and 75.8 ng/mL (sensitivity 66%, specificity 59%). These findings indicate that elevated ischemia-modified albumin levels may reflect oxidative imbalance and impaired placentation in missed abortion. While diagnostic performance was modest, the biomarker may still provide value when used alongside other clinical tools. Further prospective studies are needed to confirm these results and define its clinical applicability.

Anahtar Kelimeler

• Biomarker
• Ischemia Modified Albumin
• Missed Abortion
• Oxidative Stress
• Placental Dysfunction

Etik Beyan

Clinical Research Ethics Committee of Marmara University Faculty of Medicine (09.2020.44/06.03.2020)

Kaynakça

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