不同亚型抗心磷脂抗体和抗β2糖蛋白1抗体与体外受精结局的关系

Relationship between different subtypes of anticardiolipin antibody,anti-β2 glycoprotein 1 antibody and IVF outcome

目的探讨不同免疫亚型抗心磷脂抗体(ACA)和抗β2糖蛋白1抗体(anti-β2GP-1)对流产以及体外受精结局的影响。方法回顾性分析2016年6月至2017年12月在我院本部生殖与遗传中心就诊、因"不明原因不孕"行体外受精治疗的563对夫妇(共623个周期)的临床资料。按周期类型分为冻融胚胎移植周期组和鲜胚移植周期组;按结局分为妊娠失败组、流产组与活产组,分析组间3种ACA与anti-β2GP-1的差别,以及两种抗体不同免疫亚型与鲜胚移植周期优质胚胎率、临床妊娠率、流产率、活产率等参数的相关性。结果冻融周期流产患者的ACA IgM、IgG及anti-β2GP-1IgG数值均显著高于其余两组患者(P<0.05);鲜胚移植周期流产患者ACA IgG及anti-β2GP-1IgG均显著性升高(P<0.05);ACA IgA与鲜胚移植周期过程中的使用Gn持续天数呈负相关(P<0.05),而ACA IgG与获卵数呈显著负相关(P<0.05);多因素Logistics回归分析发现ACA IgM、IgG及anti-β2GP-1IgG的升高与流产率有统计学关联(P<0.05)。结论两种抗体的IgM与IgG与流产率显著相关,但其阈值与治疗方案的确定仍需要更多的实验论证。

Objective:To investigate the effects of different immunological subtypes of anticardiolipin antibodies and anti-β2 glycoprotein 1 antibody on abortion and the IVF outcome.Methods:The clinical data of 563 couples(623 cycles)who underwent IVF treatment due to“unexplained infertility”in our department from June 2016 to December 2017 were retrospectively analyzed.According to the type of cycle,the cycles were divided into frozen-thawed cycle group and fresh cycle group.According to the outcome,they were divided into pregnancy failure group,abortion group and live birth group.The differences between the three immunotypes of anti-cardiolipin antibody and anti-β2 glycoprotein 1 antibody were analyzed.The correlation between the different immunotypes of the two antibodies and the quality of the fresh cycle embryo,clinical pregnancy rate,abortion rate,live birth rate and other parameters were statistically analyzed.Results:The values of ACA IgM,IgG and anti-β-GP1 IgG of patients with abortion in frozen-thawed cycle group were significantly higher than those in the other two groups(P<0.05).ACA IgG and anti-β-GP1 IgG were significantly increased in abortion group of fresh cycle(P<0.05).There was a negative correlation between ACA IgA and days of Gn used in the fresh cycle(P<0.05),while ACA IgG was significantly negatively correlated with the number of oocytes retrieved(P<0.05).Multivariate logistic regression analysis showed that ACA IgM,IgG and anti-β-GP1 IgG were significantly correlated with the abortion rate(P<0.05).Conclusions:The IgM and IgG subtypes of the two antibodies are significantly correlated with abortion rate.However,the threshold and treatment protocol still need more experimental demonstration.