抗磷脂抗体与体外受精—胚胎移植结局的关系

Relationship between the implantation in IVF-ET and antiphospholipid antibodies.

目的探讨IVF-ET反复失败与抗磷脂抗体(anti-phospholip id antibod ies,APA),包括抗心磷脂抗体(anti-card iolip in antibod ies,ACA)和狼疮抗凝抗体(lupus anticoagu lant antibod ies,LA)的关系。方法188例种植失败和种植后妊娠丢失的患者225个周期(研究组)和75例同期接受IVF-ET治疗受孕的患者89个周期(对照组),分别采用酶联免疫吸附法和活性部分凝血酶原时间法,测定静脉血清中的APA。其中,研究组分为种植后妊娠丢失组(26周期)、一次种植失败组(126周期)和反复种植失败组(73周期)。结果研究组中APA、ACA、LA的阳性百分比均高于对照组,与对照组相比,差异均有显著性(P<0.01)。种植后妊娠丢失组和反复种植失败组此3项指标的阳性百分比分别与对照组比较,差异有显著性(P<0.01),一次种植失败组与对照组相比,差异无显著性(P>0.05)。结论APA与IVF-ET种植失败有关,尤其是种植后妊娠丢失和多次种植失败。因此,应对预进行体外受精—胚胎移植患者常规筛查APA,以利于尽早干预治疗以期提高IVF临床妊娠率,降低妊娠丢失率。

Objective： To investigate the relationship between women with history of repeated pregnancy loss and sero - positive anti- phospholipid antibodies （APA）, including anti- cardiolipin antibodies （ACA） and lupus anticoagulant antibodies （LA） in in -vitro fertilization and embryo transfer （IVF- ET） . Methods： Levels of serum APA, including ACA and LA were determined by enzyme linked immuno - absorbent assay and activated partial thromboplastin time method respectively in 188 patients with history of repeated pregnancy loss （study group） and 100 normal non -pregnant women （control group） . The study group was further divided into three subgroups： chemical pregnancy loss （ n = 26）, once implantation failure （ n = 126）, and repetat implantation failure （ n = 73） . Results. The positive rates of APA, ACA, LA in the study group were significantly higher than those in controls group （ P 〈 0. 05 - 0. 001 ） . The above significance was also true in both subgroups of biochemical pregnancy loss and recurrent implantation failure but not in once implantation failure. Conclusion： Levels of serum APA were associated with repeated failure, especially recurrent biochemical pregnancy abortion and recurrent implantation failure in IVF - ET. Therefore, routine screening of serum APA in patients with history of fetal wastage for the sake of early diagnosis and treatment, in turn it might increase pregnancy rate of IVF - ET.