抗磷脂抗体阳性的先兆流产孕妇子宫动脉阻力与血清抗磷脂抗体及妊娠结局的相关性分析

Correlation analysis of uterine artery resistance,serum antiphospholipid antibody and pregnancy outcome in pregnant women with antiphospholipid antibody-positive threatened abortion

目的分析抗磷脂抗体(APL)阳性的先兆流产孕妇子宫动脉阻力与血清APL及妊娠结局的相关性。方法选择2020年2月—2021年12月温州医科大学附属第三医院的127例先兆流产孕妇为研究对象,所有孕妇均接受APL检测,分为APL阳性组与APL阴性组。对比两组孕妇的子宫动脉阻力、血清APL水平,采用Pearson相关性分析法分析子宫动脉阻力与血清APL水平的相关性。随访至孕妇分娩,统计APL阳性先兆流产孕妇的妊娠结局,并分为成功组与失败组,对比两组临床资料与子宫动脉阻力,采用多因素logistic回归分析法分析APL阳性先兆流产孕妇妊娠结局的危险因素,并绘制受试者工作特征(ROC)曲线,分析子宫动脉阻力预测妊娠结局的价值。结果127例先兆流产孕妇中,APL阳性47例,占37.01%。APL阳性组子宫动脉阻力指数(RI)为(0.89±0.16),高于APL阴性组的(0.76±0.11),差异有统计学意义(t=5.414,P<0.05)。子宫动脉RI与血清APL阳性呈正相关(r=0.397,P<0.05)。APL阳性组妊娠成功率(68.09%)低于APL阴性组(91.25%),差异有统计学意义(χ^(2)=11.093,P<0.05)。失败组黄体功能不全发生率(80.00%)、子宫动脉RI(1.01±0.13)高于成功组(40.62%、0.83±0.12),血清孕酮[(56.14±5.36)nmol/L]、雌二醇水平[(1652.52±289.43)pmol/L]低于成功组[(69.21±6.72)nmol/L、(2069.54±309.62)pmol/L],差异均有统计学意义(χ^(2)=6.359,t=4.669、5.085、4.391,均P<0.05)。logistic回归分析结果显示:黄体功能不全(OR=5.846,95%CI:1.373~24.887)、子宫动脉RI(OR=77.102,95%CI:9.285~615.260)是APL阳性先兆流产孕妇妊娠结局的危险因素(均P<0.05),血清孕酮(OR=0.718,95%CI:0.588~0.876)、雌二醇水平(OR=0.996,95%CI:0.993~0.998)是保护因素(均P<0.05)。ROC曲线结果显示:子宫动脉RI对APL阳性先兆流产孕妇妊娠结局具有一定预测价值,曲线下面积为0.869(95%CI:0.766~0.972)。结论APL阳性先兆流产孕妇子宫动脉阻力升高,妊娠结局与黄体功能不全、子宫动脉RI、血清孕酮、雌二醇水平有关。

Objective To analyze the correlations of uterine artery resistance,serum antiphospholipid antibody and pregnancy outcome in pregnant women with antiphospholipid antibody(APL)-positive threatened abortion.Methods From February 2020 to December 2021,127 pregnant women with threatened abortion were selected from the Third Affiliated Hospital of Wenzhou Medical University as study object,APL test was performed,then the cases were divided into APL positive group and APL negative group.Uterine artery resistance and serum APL levels in the two groups were compared,Pearson correlation analysis method was used to analyze the correlation between uterine artery resistance and serum APL level.The pregnant women were followed up until the delivery,the pregnant outcomes of APL-positive pregnant women were analyzed,and the cases were divided into success group and failure group,the clinical data and uterine artery resistance in the two groups were compared,multivariate logistic regression analysis was used to analyze the risk factors of pregnancy outcome of APL-positive pregnant women,receiver operating characteristic(ROC)was drawn to analyze the value of uterine artery resistance in predicting pregnancy outcome.Results Among 127 pregnant women with threatened abortion,47 cases were APL positive,accounting for 37.01%.Uterine artery resistance index(RI)in APL-positive group was(0.89±0.16),which was higher than that in APL-negative group(0.76±0.11),there was statistically significant difference(t=5.414,P<0.05).Uterine artery RI was positively correlated with serum APL positivity(r=0.397,P<0.05).The rate of pregnancy success in APL-positive group(68.09%)was lower than that in APLnegative group(91.25%),there was statistically significant difference(χ^(2)=11.093,P<0.05).The incidence rate of luteal insufficiency and uterine artery RI in failure group were 80.00%and(1.01±0.13),respectively,which were higher than those in success group(40.62%,0.83±0.12),the levels of serum progesterone and estradiol in failure group were(56.14±5.36)nmol/L and(1652.52±289.43)pmol/L,respectively,which were lower than those in success group[(69.21±6.72)nmol/L,(2069.54±309.62)pmol/L],there were statistically significant differences(χ^(2)=6.359,t=4.669,5.085,4.391,all P<0.05).Logistic regression analysis showed that luteal insufficiency(OR=5.846,95%CI:1.373-24.887)and uterine artery RI(OR=77.102,95%CI:9.285-615.260)were risk factors of pregnancy outcome of pregnant women with APL-positive threatened abortion(P<0.05),serum progesterone(OR=0.718,95%CI:0.588-0.876)and estradiol levels(OR=0.996,95%CI:0.993-0.998)were protective factors(P<0.05).ROC curve showed that uterine artery RI had a certain predictive value for pregnancy outcome of pregnant women with APL-positive threatened abortion,the area under ROC curve was 0.869(95%CI:0.766-0.972).Conclusion Uterine artery resistance of pregnant women with APL-positive threatened abortion increases,the pregnancy outcome is related to luteal insufficiency,uterine artery RI,serum progesterone,and estradiol levels.