湖州地区复发性流产患者中易栓症相关指标筛查的意义

Significance of thrombophilia related markers for screening in women with recurrent spontaneous abortion

目的分析湖州地区复发性流产(RSA)患者中易栓症相关指标筛查结果,探讨其检测对预测RSA的意义。方法以2019年11月至2021年8月湖州市妇幼保健院生殖中心的RSA患者67例为观察组,同期正常妊娠孕妇137例作为对照组。对两组孕妇凝血功能指标和狼疮抗凝物(LA)、抗心磷脂抗体(ACA)及抗β2糖蛋白Ⅰ抗体(β2-GPⅠ)等指标进行检测,分析不同指标水平与RSA的关系,评价单一检测或联合检测对诊断RSA的筛查价值。结果观察组Fib、D-二聚体、狼疮抗凝物比值(LAR)、ACA(IgM)及β2-GPⅠ(IgM和IgA)水平均明显高于对照组,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,D-二聚体和LAR对诊断RSA的AUC为0.858和0.861。联合LAR、ACA(IgM)、Fib、D-二聚体4个指标诊断RSA的AUC可达0.923,灵敏度为0.821,特异度为0.942。结论湖州地区RSA孕妇中易栓症相关指标水平均有显著升高,联合易栓症相关指标和凝血功能相关指标可以有效筛查RSA风险。有必要加强孕妇筛查,及早发现流产高风险孕妇,避免不良妊娠结局再次发生。

Objective To analyze the screening results of thrombophilia related markers in pregnant women with recurrent spontaneous abortion(RSA)in Huzhou area,and to explore the diagnostic value of these biomarkers for RSA.Methods From November 2019 to August 2021,67 pregnant women with RSA at the reproductive center of Huzhou Maternal&Child Health Care Hospital were recruited as the observation group,and 137 pregnant women with normal pregnancy in the same period as the control group.The indexes of coagulation function,lupus anticoagulant(LA),anticardiolipin antibodies(ACA)and anti-β2 glycoproteinⅠantibodies(β2-GPⅠ)were detected,the correlation between different marker levels and RSA of pregnant women was analyzed,and the diagnostic value of RSA alone or in combination was evaluated by receiver operating characteristic curve(ROC).Results The levels of Fbgrinogen(Fib),D-dimer,lupus anticoagulant ratio(LAR),ACA(IgM)andβ2-GPⅠ(IgM and IgA)were significantly higher in observation group than those in the control group(P<0.05).ROC analysis showed that the areas under the curve(AUC)of D-dimer and LAR for the detection of RSA could reach 0.858 and 0.861.Combined with LAR,ACA(IgM),Fib and D-dimer,the AUC can reach 0.923,the diagnostic sensitivity is 0.821,and the specificity is 0.942.Conclusion The levels of thrombophilia related markers in patients with RSA increased among pregnant women in the Huzhou area.The combination of thrombophilia related markers and some coagulation function indicators can effectively screen the risk of abortion.It is necessary to strengthen the screening of thrombophilia related markers in pregnant women,find women with high risk of abortion in time,and avoid recurrence of adverse pregnancy outcomes.