自身免疫性抗体在妊娠丢失中的临床分析

Clinical analysis of autoimmune antibodies in pregnancy loss

目的分析自身免疫性抗体在不同妊娠丢失次数中的变化,为早期妊娠丢失的预防及诊断提供科学依据和临床参考。方法回顾性分析兰州大学第二医院生殖医学科187例妊娠丢失患者的临床资料,根据妊娠丢失次数分为A组(妊娠丢失1次)50例、B组(妊娠丢失2次)87例、C组(妊娠丢失≥3次)50例。比较3组患者的组织非特异性自身抗体和组织特异性自身抗体的差异。结果3组抗核抗体(ANA)、ANA谱阳性率,抗心磷脂抗体(ACA)免疫球蛋白(Ig)G(ACA-IgG)、ACA-IgA、ACA-IgM、抗β2糖蛋白1抗体(β2-GP1)IgG、β2-GP1IgA、β2-GP1IgM、抗甲状腺过氧化物酶抗体(TPO-Ab)水平,狼疮抗凝物初筛试验1(LA1)、狼疮抗凝物确定试验2(LA2)时间及LA1/LA2比较,差异均无统计学意义(P>0.05);C组抗精子抗体(ASAb)阳性率明显高于A组,2组比较差异有统计学意义(P<0.05);C组抗卵巢抗体(AoAb)、抗子宫内膜抗体(EMAb)、抗透明带抗体(AzpAb)、抗人绒毛膜促性腺抗体(AhCGAb)阳性率明显高于A组和B组,差异均有统计学意义(P<0.05);C组抗甲状腺球蛋白抗体(anti-TGAb)水平明显高于A组,2组比较差异有统计学意义(P<0.05)。结论妊娠丢失3次及3次以上患者的生殖免疫性抗体的阳性率显著高于妊娠丢失1次及2次的患者,需要引起临床医生格外重视;抗磷脂抗体(APA)是妊娠丢失的关键致病因素,但其阳性率不随妊娠丢失次数的增加而升高。故对于有妊娠丢失病史的患者,在备孕及早孕期间进行自身免疫性抗体的早期检测和及时干预具有重要的临床价值。

Objective To analyze the changes of autoimmune antibodies in different times of pregnancy loss, and to provide scientific basis and clinical reference value for the prevention and diagnosis of early pregnancy loss.Methods The clinical data of 187 patients with pregnancy loss in the Department of Reproductive Medicine of the Second Hospital of Lanzhou University were retrospectively analyzed. 50 cases were divided into group A(1 pregnancy loss),87 cases in group B(2 pregnancy losses) and 50 cases in group C(≥3 pregnancy losses) according to the number of pregnancy losses. The differences in tissue non-specific autoantibodies and tissue-specific autoantibodies were compared between the three groups of patients.Results There were no significant differences in anti-nuclear antibody(ANA) and ANA spectrum positivity rates, anticardiolipin antibody(ACA) immunoglobulin(Ig)G(ACA-IgG),ACA-IgA,ACA-IgM,anti-β2 glycoprotein 1 antibody(β2-GP1) IgG,β2-GP1 IgA,β2-GP1 IgM,anti-thyroid peroxidase antibody(TPO-Ab) levels, the time of lupus anticoagulant primary screening test 1(LA1),lupus anticoagulant determination test 2(LA2) and LA1/LA2 among the three groups(P<0.05).The positive rate of antisperm antibody(ASAb) in group C was significantly higher than that in group A,and the difference between the two groups was statistically significant(P<0.05).The positive rates of anti-ovarian antibody(AoAb),anti-endomet-rium antibody(EMAb),anti-zona pellucida antibody(AzpAb) and anti-human chorionic gonadotropin antibody(AhCGAb) in group C were significantly higher than those in group A and group B(P<0.05),and all the differences were statistically significant(P<0.05).The level of anti-thyroglobulin antibody(anti-TGAb) in group C was significantly higher than that in group A,and the difference between the two groups was statistically significant(P<0.05).Conclusion The positive rate of reproductive immune antibodies in patients with three or more times of pregnancy loss is significantly higher than that in patients with one or two times of pregnancy loss.Clinicians should pay special attention to the detection of reproductive immune antibodies as soon as possible to clarify the cause of pregnancy loss, and timely immunomodulator treatment to avoid the recurrence of adverse pregnancy outcomes.Anti-phospholi-pid antibody(APA) are the key pathogenic factor of pregnancy loss, but the positive rate of APA does not increase with the increase of the number of pregnancy loss.Therefore, early detection and timely intervention for patients with a history of pregnancy loss during pregnancy preparation and early pregnancy have important clinical value.