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Effect of mifepristone on the expression of tumor necrosis factor-α and transforming growth factor-β in decidua of early pregnancy

Jing ZHANG ; Enju XIA ; Jianguo ZHANG

Chinese Journal of Obstetrics and Gynecology.2001;36(1):27-29.

Objective　To investigate the effect of mifepristone on the expression of tumor necrosis factor-α（TNF-α） and transforming growth factor-β（TGF-β）in decidua of early pregnancy. Methods　Thirty artificial abortion women as control and thirty drug abortion women were enrolled for study. The expressions of TNF-α and TGF-β in decidua were measured with immunohistochemical method. Results　There was no significant difference of TNF-α positive expression rates between drug abortion group (73.33%) and artificial abortion group (70.00%，P>0.05). TGF-β expression rate of drug abortion group was similar to that of artificial abortion group. The highly-positive (+　+ and +　+　+) TNF-α expression rate in drug abortion group was significantly higher than that in artificial abortion group (P<0.05). TGF-β expression degree in decidua of drug abortion group was significantly lower than that of artificial abortion group (P<0.05). The ratio of TNF-α/TGF-β in drug abortion group is higher than that in artificial abortion group. Conclusion　TGF-β has great effect on regulating the embryo development of early pregnancy. The change of TNF-α may be the reason of abortion. Mifepristone may interfere with embryo growth by inhibiting the activity of TGF-β or by stimulating the secretion of TNF-α.

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Screening for G1528C mutation in mitochondrial trifunctional protein gene in pregnant women with severe preeclampsia and new born infant

Rong WANG ; Zi YANG ; Jinming ZHU ; Jialue WANG ; Huixia YANG ; Qi WANG ; Guirong ZHAI ; Zhi LI ; Mei YU

Chinese Journal of Obstetrics and Gynecology.2000;0(10):-.

Objective Severe preeclampsia, and hemolysis, elevated liver enzymes, and low platelet syndrome (HELLP) are serious complications of pregnancy, and evidence suggests a genetic basis for these conditions. A G1528C mutation in the alpha-subunit of the mitochondrial trifunctional protein (MTP) gene has been identified in association with these conditions. The aim of this study is to explore the carrier rate of the G1528C mutation in the MTP gene in pregnant women with severe preeclampsia, HELLP syndrome and in their newborns, as well as in a normal pregnant population, so as to determine its association with maternal liver disease among women in Beijing. Methods A multicenter, prospective, case control study was carried out. Polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) was used to screen the G1528C mutations in the MTP gene. One hundred and forty cord blood samples from cases with severe preeclampsia (n=130) and HELLP syndrome (n=10) were collected. Ninety maternal peripheral blood samples among them (84 from severe preeclampsia and 6 from HELLP syndrome) were also collected for screening the common disease-causing mutation in Caucasians. Five hundred and sixty cord blood samples and 90 maternal peripheral blood samples obtained from normal pregnant women served as controls. Results The G1528C mutations in the MTP gene were not found in samples from women with severe preeclampsia and their newborns, from women with HELLP syndrome and their new borns, as well as in samples from the normal pregnant women and their new borns. Conclusions The common disease-causing mutation of G1528C in MTP gene in Caucasians is probably not a common mutation in Chinese Han people in Beijing. Further study is needed to expand the sample size among HELLP syndrome and maternal liver diseases in Chinese population.

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Changes of menstruation patterns and adverse effects during the treatment of LNG-IUS for symptomatic adenomyosis

Lei LI ; Jinhua LENG ; Junji ZHANG ; Shuangzheng JIA ; Xiaoyan LI ; Jinghua SHI ; Yi DAI ; Jiaren ZHANG ; Ting LI ; Xiaoxuan XU ; Zhenzhen LIU ; Shanshan YOU ; Xiaoyan CHANG ; Jinghe LANG

Chinese Journal of Obstetrics and Gynecology.2016;51(9):657-662. doi:10.3760/cma.j.issn.0529-567x.2016.09.004

Objective To investigate the changes of mestruation patterns and adverse effects during the treatment of levonorgestrel-releasing intrauterine system (LNG-IUS) for symptomatic adenomyosis in a prospective cohort study. Methods From December, 2006 to December, 2014, patients of symptomatic adenomyosis diagnosed by transvaginal ultrasound in Peking Union Medical College Hospital were given LNG-IUS. Before and after placement of IUS, all patients′ parameters were recorded, including carrying status of IUS, symptoms and scores of dysmenorrhea, menstruation scores, biochemical indicators, physical parameters, menstruation patterns and adverse effects. Risk factors for changes of menstruation patterns and adverse effects, and their impact on treatment effects were analyzed. Results Totally 1 100 cases met inclusion criteria, with median age 36 years (range 20-44 years), median follow-up 35 months (range 1-108 months). During follow-up changes of menstruation patterns increased significantly with amenorrhea and shortened-menstruation being the most common manifestations. On 3, 6, 12, 24, 36, 48 and 60 months after the placement of LNG-IUS, 0, 5.8%(43/744), 6.9%(47/682), 10.1%(60/595), 17.3%(87/502), 27.2%(104/383) and 29.6%(82/277) patients achieved amenorrhea respectively (P<0.01). Total and subclassification of adverse effects decreased significantly (P<0.01). Within 12 months and >12 months after placement, abdominal pain and body weight increasing ≥5 kg/year were the most common adverse effects. Changes of menstruation patterns, total and subclassifications of adverse effects were neither dependent on patient parameters, treatment modes and treatment effects, nor could predict future LNG-IUS carrying status (all P>0.05). After taking out of LNG-IUS, most changes of menstruation and adverse effects disappeared. Conclusions During the treatment of LNG-IUS for symptomatic adenomyosis, changes of menstruation patterns increase gradually with amenorrhea and shortened-menstruation being the most common manifestations, while adverse effects decrease significantly. Changes of menstruation patterns or adverse effects neither have any risk factor nor have impact on treatment effects.

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Clinical study of high intensity focused ultrasound ablation combined with GnRH-a and LNG-IUS for the treatment of adenomyosis

Mingzhu YE ; Xinliang DENG ; Xiaogang ZHU ; Min XUE

Chinese Journal of Obstetrics and Gynecology.2016;51(9):643-649. doi:10.3760/cma.j.issn.0529-567x.2016.09.002

Objective To investigate the clinical effect of dysmenorrhea in patients with adenomyosis treated by high intensity focused ultrasound (HIFU) ablation combined with gonadotropin-releasing hormone agonist (GnRH-a) and levonorgestrel-releasing intrauterine system (LNG-IUS). Methods From April 2012 to December 2015, 477 cases of adenomyosis patients with dysmenorrhea were treated by HIFU in the Third Xiangya Hospital. Among them, some patients were treated with HIFU alone, some of them were treated with HIFU combined with GnRH-a and (or) LNG-IUS, thus were classified as H group, H+G group, H+M group and H+G+M group. The improvements of clinical results were compared among the four groups and the influencing factors of HIFU treatment for adenomyosis were also analyzed. Results During the follow-up period, the overall effective rates of the treatment decreased with time, 3 months 89.4% (345/386), 12 months 84.0%(221/263), 24 months 74.2%(98/132), and the overall recurrence rate was 12.9%(39/303). The significant difference in the curative at 3 months [H group 83.7%(170/203), H+M group 95.0%(95/100), H+G group 100.0%(43/43), H+G+M group 96.8%(30/31)], 12 months [H group 79.4%(123/155), H+M group 93.2%(69/74), H+G group 11/12, H+G+M group 15/17], and 24 months [H group 68.0%(51/75), H+M group 96.4% (27/28), H+G group 6/12, H+G+M group 15/15] after HIFU treatment and recurrence rate [H group 19.0%(29/153), H+M group 3.3%(3/90), H+G group 19.4%(6/31), H+G+M group 4.5%(1/22)] were observed among the four groups (P<0.05). Pairwise comparison further showed that, in 3 months after the treatment, the effect of H group was significantly lower than those of H+M group and H+G group (P=0.003, P=0.005);in 12 months after the treatment, the effect of H group was significantly lower than that of H+M group (P=0.006);while in 24 months after treatment, the effect of H group was significantly lower than that of H+G+M group (P=0.005), and the effect of H+G group was lower than that of H+G+M group (P=0.001); and the recurrence rate of H group was significantly higher than that of H+M group (P<0.008). In patients of group H, the effect of HIFU was related to uterine size, the effect of patients with large uterine volume was significantly higher than that of small volume of uterine of patients (P=0.017, OR=2.739, 95%CI:1.200-6.251); with increasing of age, the improvement of dysmenorrhea had a increasing trend (P<0.05). Conclusions HIFU combined with GnRH-a and (or) LNG-IUS could improve the treatment effect in relief of dysmenorrhea. Based on our results, individual treatment protocol should be selected for different patients.

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Application of temporary balloon occlusion of the abdominal aorta in the treatment of complete placenta previa complicated with placenta accreta

Shihong CUI ; Yunxiao ZHI ; Kai ZHANG ; Lindong ZHANG ; Linna SHEN ; Yanan GAO

Chinese Journal of Obstetrics and Gynecology.2016;51(9):672-676. doi:10.3760/cma.j.issn.0529-567x.2016.09.007

Objective To investigate the value of temporary balloon occlusion of the abdominal aorta in the treatment of complete placenta previa with placenta accreta. Methods From January 2015 to February 2016, 24 cases of complete placenta previa with placenta accreta were treated with temporary balloon occlusion of the abdominal aorta (the study group) before cesarean, and 24 cases of complete placenta previa with placenta accreta did not receive balloon occlusion (the control group). The operation time, intraoperative blood loss, intraoperative blood transfusion volume, the perioperative hemoglobin level, the hysterectomy rate and the related complications were compared retrospectively.Also, the hospitalization time, the blood coagulation parameters after operation, including activated partial thromboplastin time (APTT), fibrinogen (FIB), D-Dimer and reperfusion injury parameters including creatine phosphokinase (CK), creatine phosphokinase isoenzyme (CK-MB), lactate dehydrogenase (LDH) and serum creatinine were compared between the 2 groups. Results The blood loss [750 ml (400-2 000 ml) vs 2 000 ml (1 500-2 375 ml);Z=-3.214, P=0.001] and blood transfusion volume [200 ml (0-800 ml) vs 800 ml (0-1 200 ml);173, P=0.030] in the study group were lower than in the control group. The hemoglobin difference between before and after operation in the study group was lower than the control group [(12.8±13.4) g/L vs (22.9±20.1) g/L;t=-2.041, P=0.047]. In the study group, there were still bleeding in 13 cases after releasing the balloon, 5 of them received uterine artery embolization, 5 cases received uterine artery ligation, and 3 cases received uterine packing. One case had venous thrombosis in the right lower limb. Two cases (8%,2/24) in the control group had hysterectomy, while none in the study group, there was no statistical significance (P=0.489). Conclusions Temporary balloon occlusion of the abdominal aorta can effectively reduce blood loss and blood transfusion in the treatment of complete placenta previa with placenta accreta, but there is still the risk of continuing bleeding after releasing the balloon. Other methods of hemostasis might be needed.

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Study on the dynamic changes of D-dimer during pregnancy and early puerperium

Dong XU ; Shuping CAI ; Jingwei XU ; Cheng LIANG ; Jing HE

Chinese Journal of Obstetrics and Gynecology.2016;51(9):666-671. doi:10.3760/cma.j.issn.0529-567x.2016.09.006

Objective To explore the dynamic changes of D-dimers during pregnancy and early puerperium (within 3 days postpartum). Methods A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women′s Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy (≤12 gestation weeks), middle pregnancy (12-28 gestation weeks), late pregnancy (>28 gestation weeks), 1 postpartum (within 48 hours postpartum) and 2 postpartum (48-72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student′s t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration≤0.5 mg/L was used as the normal range. Results (1) D-dimers concentrations during pregnancy were higher than the non-pregnant women (P<0.01), but there was no statistical difference between early pregnancy and late pregnancy (P=0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group (P<0.01). But in the 2 postpartum group, it was lower than early pregnancy, late pregnancy and 1 postpartum groups. (2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48-72 hours after vaginal delivery, ≤48 hours after cesarean section, 48-72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89-19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal range. In 3 cases, all after cesarean section, with lower extremity vein thrombosis within 48 hours postpartum, the D-dimers concentrations, 9.77, 8.65 and 6.89 mg/L respectively, were in the 95%CI of the study population after cesarean section. Conclusions D-dimers concentration of 0.5 mg/L is not suitable for venous thromboembolism screening during pregnancy. D-dimers concentration in pregnancy and early puerprium is higher than non-pregnancy. It increases in the very early period postpartum and decreases with time. D-dimers should not be a routine screening test to exclude thromboembolic disease in pregnant women without high risk factors and clinical manifestation of thromboembolic disease.

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Zhifeng HUO ; Chunlin CHEN ; Ping LIU ; Ben MA ; Hui DUAN ; Bingyang JIANG ; Yixin TANG ; Yujing XU ; Jianghong ZHU

Chinese Journal of Obstetrics and Gynecology.2016;51(9):650-656. doi:10.3760/cma.j.issn.0529-567x.2016.09.003

Objective To investigate the related factors on effects of uterine artery embolization (UAE) in the treatment of dysmenorrhea in patients with adenomyosis, and to construct and validate the efficacy prediction model. Methods A total of 127 cases of adenomyosis patients with symptoms of dysmenorrhea in Guangzhou No.1 People′s Hospital and Nanfang Hospital of Southern Medical University from June 1999 to December 2009 were reviewed. The evaluation standard was to improve the degree of dysmenorrhea, the related factors of efficacy were analysed. Combined with artificial neural network theory, the effect prediction model was constructed, and the effectiveness of the model was evaluated using receiver operating characteristic (ROC) curve, and the effectiveness of the cut-off point was calculated. The model was validated by 68 cases of patients with adenomyosis in the Nanfang Hospital from January 2010 to November 2014. Results (1) In 127 cases of dysmenorrhea patients, UAE treatment was effective in 98 cases, effective rate was 77.2% (98/127). (2) Age was an independent predictor of effective UAE treatment (HR=1.129, P=0.026);in the range of this study, the greater the age, the higher the UAE treatment efficiency. (3) The developing situation of ovary branches of uterine artery was an independent predictor of effective UAE treatment (HR=0.460, P=0.020), the efficiency of patients whose intraoperative bilateral uterine artery ovarian branch did not develop was 89.7%(35/39), the efficiency of patients whose unilateral uterine artery ovarian branch was developing was 84.1% (37/44) and the efficiency of patients whose bilateral uterine artery ovarian branch were developing was 59.1% (26/44). (4) Blood supply of adenomyosisis was an independent predictor of effective UAE treatment (HR=0.313, P=0.001). Type Ⅰ (bilateral predominated) patients, efficiency was 93.5%(43/46);typeⅡ(bilateral balanced) patients, efficiency was 78.0%(39/50);type Ⅲ (unilateral predominated) patients, efficiency was 51.6% (16/31). (5) UAE for the treatment of adenomyosis efficacy of artificial neural network prediction model was constructed, the model′s area under the ROC curve was 0.808, the optimal cut-off point was 0.669 13. Actual verification of the model, sensitivity was 96.5%, specificity was 81.8%, positive predictive value was 96.5%and negative predictive value was 81.8%, the total accuracy was 94.1%. Conclusions (1) Age, the developing situation of ovary branches and blood supply of adenomyosis are the independent predictors of effective UAE treatment. (2) The artificial neural network prediction model is satisfied with the accuracy and the accuracy of prediction.

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Study of effects of micheliolide on ovarian cancer cell lines and its mechanism

Zheng QI ; Yinghui LI ; Yahui DING ; Qing JI ; Ming YANG ; Yingdai GAO

Chinese Journal of Obstetrics and Gynecology.2016;51(9):688-692. doi:10.3760/cma.j.issn.0529-567x.2016.09.010

Objective To study the roles of micheliolide on ovarian cancer cells. Methods Firstly, human ovarian cancer cell lines HeyA8, SKOV3 and A2780/DDP were treated with different concentration of micheliolide (0.25, 0.5, 1, 2.5, 5, 10, 20, 50 μmol/L) for 72 hours, then methyl thiazolyl tetrazolium (MTT) assay was used wo detect the growth of the human ovarian cancer cell lines and the stongest inhibited cell line were selected for the following test. Secondly, after HeyA8 cell line was treated with different concentration (5, 10, 20μmol/L) of micheliolide for 24 hours, the HeyA8 cell apoptosis was measured byflow cytometry. Thirdly, the expression of RelA mRNA in HeyA8 cell was detected through real-time PCR, the expressions of nuclear factor κB(NF-κB)signal pathway related protein RelA and the activited cysteinyl aspartate specific proteinase (caspase-9) were detected by western blot analysis. Results (1) The growth of HeyA8, SKOV3 and A2780/DDP cells were all significantly inhibited after being treated with different concentration of micheliolide for 72 hours and the roles of inhibition were all concentration dependant (P<0.05). The half maximal inhibitory concentration (IC50) of HeyA8, SKOV3 and A2780/DDP were (9.8±2.2), (12.0±2.1) and (12.8±1.8)μmol/L, respectively. We chose HeyA8 cell to do the following expreriments because of its best inhibited effect. (2) After HeyA8 cell was treated with micheliolide of different concentrations, as the concentration increased (20 and 0μmol/L, for example), the apoptosis rate of HeyA8 cell raised from (7.2±1.0)%to (17.4±1.1)%, the percentage of survived cells reduce from (92.8 ± 1.3)% to (82.6 ± 1.4)%,and the relative mRNA level of RelA decreased from 1.00 ± 0.13 to 0.18 ± 0.00 (P<0.01); furthermore, the expression of RelA protein was weaken and the activited caspase-9 protein expression was increased gradually. Conclusions Micheliolide plays a significantly inhibited role in HeyA8, SKOV3 and A2780/DDP cells. The inhibited role of micheliolide inovarian cancer cells might through inhibiting nuclear factor-kappa B (NF-кB) signaling pathway, and inducing the expression of activited caspase-9 protein to promoting apoptosis of HeyA8 cell.

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Analysis of clinical and pathological characteristics of high-risk HPV-negative carcinoma of the uterine cervix

Zhimin LI ; Liqin ZENG ; Xiuhong PENG ; Lingzhi MAO ; Xiaoli SUN ; Yuhua LI ; Xiping LUO

Chinese Journal of Obstetrics and Gynecology.2016;51(9):683-687. doi:10.3760/cma.j.issn.0529-567x.2016.09.009

Objective To study the clinical and pathological characteristics of HPV-negative cervical cancer patients. Methods Retrospective analysis of 785 cervical cancer patients in Guangdong Women and Children Hospital from Jan. 2005 to Oct. 2015. By detecting high-risk HPV infection by flow-through hybridization genechip technique. Results (1) Among 785 cases of cervical cancer, 71 cases were negative for HPV infection tested by genechip technique, accounting for 9.0%(71/785), and the relative light units/cut off (RLU/CO) ratios of these 71 cases were less than 1 by hybird captureⅡ(HC-Ⅱ) methods. The results showed that the positive coincident rate of genechip technique detecting result with HC-Ⅱmethod was 100.0%(71/71). (2) There was no difference between 43 (60.6%) cases from 41-55 years old of 71 cases of HPV-negative patients and 392 (54.9%) cases from 41-55 years old of 714 cases of HPV infection patients (χ2=15.63, P=0.571). Among 71 cases of HPV-negative patients, 32 cases of patients with doing TCT, 6 (18.8%) cases for normal, 10 (31.2%) cases for atypical squamous cells of undetermined significance (ASCUS), 3 (9.4%) cases for atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), 3(9.4%) cases for low-grade squamous intraepithelial lesions (LSIL), 8 (25.0%) cases for hight-grade squamous intraepithelial lesions (HSIL), 2 (6.2%) cases for squamous cell carcinoma (SCC). And there were 391 cases of patients with doing thin-prep cytologic test (TCT) of 714 HPV infection patients, 60 (15.3%) cases for normal, 61 (15.6%) cases for ASCUS, 28 (7.2%) cases for ASC-H, 29 (7.4%) cases for LSIL, 164 (41.9%) cases for HSIL, 49 (12.5%) cases for SCC. There was no difference of TCT between HPV infection and HPV-negative patients (P>0.05). Among 70 cases from 71 patients with negative for HPV infection, there were 8(11.4%) cases in stage Ⅰa, 26 (37.1%) cases in stage Ⅰb1, 12 (17.1%) cases in stageⅠb2, 11 (15.7%) cases in stageⅡa, 10 (14.3%) cases in stageⅡb, 3 (4.3%) cases in stageⅢ-Ⅳ. There were 118(16.6%) cases in stageⅠa, 261 (36.8%) cases in stageⅠb1, 72 (10.1%) cases in stageⅠb2, 152 (21.4%) cases in stageⅡa, 87 (12.3%) cases in stageⅡb, 20(2.8%) cases in stageⅢ-Ⅳin 710 cases of HPV infection patients, in which there were no difference of clinical stage between HPV infection and HPV-negative patients (P>0.05). Among 69 cases from 71 patients HPV-negative infection, there were 51 (73.9%) cases for squamous carcinoma, 13 (18.8%) cases for adenocarcinoma, 5(7.2%) cases for adenosquamous carcinoma;and 593 (87.2%) cases for squamous carcinoma, 38 (5.6%) cases for adenocarcinoma, 39 (5.7%) cases for adenosquamous carcinoma, 10 (1.5%) case for others were in 680 patients of HPV infection, in which there was significant difference of adenocarcinoma between HPV infection and HPV-negative patients (χ2=11.96, P=0.001). Conclusions Flow-through hybridization genechip technique is the method of high sensitivity to detect high-risk type HPV, as like HC-Ⅱ method. HPV-negative of cervical cancer occurs mainly in 41-55 years old. Adenocarcinoma incidence is significantly higher in HPV-negative cases than those patients with infection of HPV positive.

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Expression and significance of EPCR in plasma and placenta of patients with early onset severe preeclampsia

Jinming ZHU ; Miao HE ; Lei HUANG ; Yuli SU ; Lei LI ; Min LI

Chinese Journal of Obstetrics and Gynecology.2016;51(9):678-682. doi:10.3760/cma.j.issn.0529-567x.2016.09.008

Objective To investigate the expression of endothelial protein C receptor (EPCR) and its roles in plasma and placenta of patients with early onset severe preeclampsia. Methods Sixty cases of severe preeclampsia women who delivered in Xuzhou Maternity and Child Health Care Hospital from March 2014 to February 2016, were recruited, which included 30 cases with early onset severe preeclampsia (early onset group, gestational week <34 weeks ) and 30 patients with late onset severe preeclampsia (late onset group, gestational week ≥34 weeks). Thirty cases of healthy late pregnant women at the same period (gestational week≥34 weeks) were selected as control group. Immunohistochemistry SP method was applied to detect the expression of in EPCR placenta. Reverse transcription (RT)-PCR was used to detect the expression of EPCR mRNA in placenta. ELISA method was used to detect the levels of soluble EPCR (sEPCR)level in plasma of the pregnant women of the three groups. Results The expression of EPCR in placenta mainly distributed in the membrane and cytoplasm of placental syncytiotrophoblasts and vascular endothelial cells, a few in the cell nucleus. The expression of EPCR in early onset group(57%, 17/30)was significantly lower than that in late onset group (93%, 28/30; χ2=25.165,P=0.001). The expression of EPCR in late onset group had no significant difference from that in control group (97%, 29/30;χ2=0.540,P=0.910). The expression of EPCR mRNA in placenta of early onset group(0.40±0.07)was significantly lower than that in late onset group(0.91±0.06;t=-30.044,P=0.001), while there was no statistical difference of the expression of EPCR mRNA between the late onset group and the control group (0.92±0.07;t=-0.631, P=0.538). Plasma sEPCR level in early onset group, late onset group and control group were (231 ± 11), (124±6)and(121±4)μg/L respectively, which is higher in early onset group than that in late onset group (t=48.080,P=0.001). There was no statistical difference of plasma sEPCR level between the late onset group and the control group(t=2.534,P=0.100). Conclusions The pathogenesis of early onset and late onset severe preeclampsia may be different. Decreased expression of EPCR in placenta may be associated with the pathogenesis of early onset severe preeclampsia.

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