Objective  To investigate the expression and clinical significance of serum tumor necrosis factor-related apoptosis-inducing ligand receptor 2 (TRAIL-R2) and interleukin-35 (IL-35) in placenta accreta spectrum (PAS).

Methods  Retrospectively select PAS patients treated at Changsha Maternal and Child Health Hospital from April 2021 to April 2024 as the observation group, and other healthy pregnant women were selected as control group. The clinical data of the subjects were collected and the serum levels of TRAIL-R2 and IL-35 were measured. Correlation analysis was used to explore the correlation between serum TRAIL-R2, IL-35 levels and PAS. Multivariate Logistic regression analysis was performed to screen the independent risk factors of PAS, and the receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the diagnostic efficacy of serum TRAIL-R2 and IL-35 levels alone and in combination for PAS.

Results  A total of 160 subjects were included, 100 cases in the observation group, including 63 cases in the placenta accreta group, 37 cases in the placenta adhesion group, and 60 cases in the control group.. The serum TRAIL-R2 of the observation group was lower than that of the control group, and the serum IL-35 of the observation group was higher than that of the control group (P<0.001). The serum TRAIL-R2 in the placenta accreta group was lower than that in the placenta adhesion group, and the serum IL-35 in the placenta accreta group was higher than that in placenta adhesion group (P<0.001). Correlation test showed that serum TRAIL-R2 (Eta coefficient=0.513), and serum IL-35 (Eta coefficient=0.485) were highly correlated with PAS. Logistic regression analysis showed that pregnancy number >2, cesarean section history, higher placenta score, lower serum TRAIL-R2 and higher serum IL-35 were independent risk factors for PAS (P<0.01). ROC results showed that the AUC of serum TRAIL-R2 combined with IL-35 in the diagnosis of PAS was 0.887 (sensitivity 0.950, specificity 0.710), and the diagnostic efficacy of the combination was significantly better than that of single diagnosis (P<0.05).

Conclusion  Abnormal decrease of serum TRAIL-R2 level and abnormal increase of IL-35 level are independent risk factors for the occurrence of PAS, and their combined detection has high value for the early diagnosis of PAS.

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