不明原因复发性流产中aPS/PT IgM/IgG、anti-MCV、α-fodrin的表达及药物干预的妊娠结局分析

Expression of aPS/PT IgM/IgG,anti-MCV,α-fodrin in unexplained recurrent spontaneous abortion and the analysis of pregnancy outcome by drug intervention

目的检测不明原因复发性流产(URSA)患者血清抗磷脂酰丝氨酸凝血酶原复合物(aPS/PT)、抗突变瓜氨酸波形蛋白抗体(anti-MCV)、α-胞衬蛋白抗体(α-fodrin)的表达情况,探究其与URSA的关系。并探讨羟氯喹在抗体表达阳性患者中的应用疗效。方法回顾性选取2018年11月至2022年4月郑州大学附属郑州中心医院收治的596例URSA患者作为研究组,以同期在本院体检的无不良孕产史且已正常生育的健康女性80名为对照组。采用酶联免疫吸附试验法检测两组血清aPS/PT IgG/IgM、anti-MCV及α-fodrin表达水平,并比较两组血清aPS/PT IgG/IgM、anti-MCV及α-fodrin的表达情况。对研究组aPS/PT IgM/IgG、anti-MCV、α-fodrin血清学检测阳性的111例患者进行药物干预。随访14例失访,余下97例患者中,85例自愿接受药物干预,12例拒绝药物治疗,根据其意愿分为治疗A组(n=42),治疗B组(n=43)及未治疗组(n=12)。比较治疗A组、治疗B组与未治疗组的妊娠成功率。结果研究组aPS/PT IgM、aPS/PT IgG、anti-MCV及α-fodrin表达率分别为7.38%、0.50%、7.21%、5.03%,对照组分别为0、0、0、0.12%,研究组血清aPS/PT IgM、anti-MCV表达率均显著高于对照组,差异均有统计学意义(P<0.05);两组aPS/PT IgG、α-fodrin比较,差异均无统计学意义(P>0.05)。治疗A组、治疗B组妊娠率分别为66.67%、88.37%,明显高于未治疗组(25.00%),治疗B组患者妊娠成功率明显高于治疗A组,差异均有统计学意义(P<0.05)。结论URSA患者中aPS/PT IgM及anti-MCV二者异常高表达是URSA发生的危险因素。对于aPS/PT IgG/IgM、anti-MCV、α-fodrin阳性的URSA患者,羟氯喹联合低剂量阿司匹林及低分子肝素治疗可明显改善妊娠结局。

Objective To detect the expression of serum anti-phosphatidylserine-prothrombin complex(aPS/PT),anti-mutated citrullinated vimentin(anti-MCV),and alpha-fodrin antibodies in patients with unexplained recurrent spontaneous abortion(URSA)and explore their relationship with URSA.The effectiveness of hydroxychloroquine application in patients with positive antibody expression was also investigated.Methods A total of 596 patients with URSA admitted to Zhengzhou Central Hospital of Zhengzhou University from November 2018 to April 2022 were retrospectively selected as the study group,and 80 healthy women without adverse pregnancy history and normal fertility during the same period in our hospital physical examination were selected as the control group.The expression levels of serum aPS/PT IgG/IgM,anti-MCV,andα-fodrin were detected using enzyme-linked immunosorbent assay between the two groups,and the expression of serum aPS/PT IgG/IgM,anti-MCV andα-fodrin were compared between the two groups.Among the URSA patients,111 patients had positive serological tests for aPS/PT IgM/IgG,anti-MCV,andα-fodrin.Among them,14 patients were lost to follow-up,the remaining 97 patients,85 patients voluntarily received drug intervention and 12 patients refused drug treatment.According to their wishes,they were divided into the treatment group A(n=42),the treatment group B(n=43)and the untreated group(n=12).And the pregnancy success rate of the treatment group A,the treatment group B and the untreated group was compared.Results The expression rates of aPS/PT IgM,aPS/PT IgG,anti-MCV andα-fodrin in the study group were 7.38%,0.50%,7.21%and 5.03%,respectively,and those in the control group were 0,0,0 and 0.12%,respectively.The expression rates of serum aPS/PT IgM and anti-MCV in the study group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05);there were no statistically significant differences in aPS/PT IgG andα-fodrin between the two groups(P>0.05).The pregnancy rates of the treatment group A and the treatment group B were 66.67%and 88.37%,respectively,which were significantly higher than those of the untreated group(25.00%).The pregnancy success rate of the treatment group B was significantly higher than that of the treatment group A,and the differences were statistically significant(P<0.05).Conclusion The abnormally high expression of aPS/PT IgM and anti-MCV in URSA patients is a risk factor for URSA.Hydroxychloroquine combined with low-dose aspirin and low molecular weight heparin can significantly improve the pregnancy outcome of URSA patients with aPS/PT IgG/IgM,anti-MCV andα-fodrin positive.