抗磷脂抗体联合抗β2糖蛋白Ⅰ抗体对妊娠结局的指导作用

The significance of combined detection of antiphospholipid antibodies in predicting pregnancy outcome

目的观察联合检测妊娠不良结局抗磷脂抗体(antiphospholipid antilxoies,APA)单抗体IgA/G/M阳性率与抗磷脂抗体IgA/G/M阳性率和抗β2糖蛋白Ⅰ抗体IgA/G/M联合阳性率与正常妊娠检测结果的差异,回顾妊娠不良结局抗磷脂抗体单抗体IgA/G/M阳性率与抗磷脂抗体IgA/G/M阳性率和抗β2糖蛋白Ⅰ抗体IgA/G/M联合阳性率的差异,比较抗磷脂抗体单抗体IgA/G/M阳性率与联合检测抗磷脂抗体IgA/G/M阳性率和抗β2糖蛋白Ⅰ抗体IgA/G/M同时阳性率对孕妇妊娠结局影响的差异,探讨抗磷脂抗体联合检测指标对预测妊娠结局的价值。方法回顾2011年2月至2014年1月不良妊娠结局的58例产妇和正常产妇578例抗磷脂抗体单抗体IgA/G/M阳性率和抗磷脂抗体IgA/G/M阳性率和抗β2糖蛋白Ⅰ抗体IgA/G/M联合阳性率,分析其联合阳性率与单阳性率的差异;同时选取2014年1月至2017年12月就诊的孕妇为研究对象,采用酶联免疫吸附法测定血清抗心磷脂抗体,将抗磷脂抗体单IgA/G/M阳性孕妇85例作为对照组,同时将联合检测抗磷脂抗体IgA/G/M阳性和抗β2糖蛋白Ⅰ抗体IgA/G/M同时阳性孕妇86例作为观察组,分析2组孕妇的妊娠结局。结果回顾病例中,妊娠不良结局的产妇抗磷脂抗体IgA/G/M阳性率和抗β2糖蛋白Ⅰ抗体IgA/G/M联合阳性率显著高于正常产妇,差异有统计学意义(P<0.05);观察组发生习惯性流产、早产、死胎、妊娠期高血压的比例高于对照组,差异有统计学意义(P<0.05);观察组D-二聚体水平高于对照组,差异有统计学意义(P<0.05)。结论联合检测血清抗磷脂抗体IgA/G/M和抗β2糖蛋白Ⅰ抗体IgA/G/M阳性率比血清抗磷脂抗体单IgA/G/M阳性率对妊娠结局的预测更具有临床价值,妊娠女性进行常规筛查时,为保证预测结果的准确性,应该选择联合检测血清抗磷脂抗体IgA/G/M和抗β2糖蛋白Ⅰ抗体IgA/G/M。

Objective To investigate the differences between the positive rates of anti phospholipid antibody(Antiphospholipid antilxoies, APA) single antibody IgA/G/M and the positive rate of anti phospholipid antibody IgA/G/M positive rate as well as anti beta 2 glycoprotein I antibody IgA/G/M, and to explore the significance of combined detection of antiphospholipid antibodies in predicting pregnancy outcome.Methods A total of 58 parturients with adverse pregnancy outcomes were enrolled as research group, and 578 normal parturients were enrolled as normal control group. The positive rate of IgA/G/M positive antiphospholipid antibody and the positive rate of antiphospholipid antibody IgA/G/M as well as anti beta 2 glycoprotein Ⅰ antibody IgA/G/M were observed and compared between the two groups. At the same time, the pregnant women who visited our hospital from January 2014 to December 2017 were selected as the research objects, and the serum levels of antiphospholipid antibody were detected by enzyme linked immunosorbent assay,and the 85 pregnant women with positive IgA/G/M antiphospholipid antibody were enrolled as control group,and the other 86 pregnant women with positive anti phospholipid antibody IgA/G/M and positive anti beta 2 glycoprotein Ⅰ antibody IgA/G/M were enrolled as observation group, the pregnancy outcomes were observed and compared between the two groups.Results The positive rates of anti phosphatidylcholine antibody IgA/G/M and anti beta 2 glycoprotein Ⅰ antibody IgA/G/M in the parturients with poor pregnancy outcome were significantly higher than those in normal parturients(P<0.05). The proportion of habitual abortion, preterm birth, stillbirth and pregnancy hypertension in observation group were significantly higher than those in control group(P<0.05).Moreover the D-dimer levels in observation group were significantly higher than those in control group(P<0.05).Conclusion The combined detection of the positive rate of serum anti phospholipid antibody IgA/G/M and anti beta 2 glycoprotein Ⅰ antibody IgA/G/M is more valuable in predicting the pregnancy outcome than that of detection of positive rate of serum antiphospholipid antibody single IgA/G/M.In order to ensure the accuracy of the prediction results, the combined detection of serum anti phospholipid antibody IgA/G/M and anti beta 2 glycoprotein Ⅰ antibody IgA/G/M should be selected.