多囊卵巢综合征患者发生复发性流产的危险因素及抗子宫内膜抗体和抗心磷脂抗体对复发性流产的预测价值

Risk factors for recurrent abortion in patients with polycystic ovary syndrome and the predictive value of anti-endometrial antibody and anti-cardiolipin antibody for recurrent abortion

目的 分析多囊卵巢综合征(PCOS)患者发生复发性流产的危险因素及抗子宫内膜抗体(EMAB)、抗心磷脂抗体(ACA)对复发性流产的预测价值。方法 选取2020年5月—2022年5月杭州市富阳区第二人民医院PCOS合并复发性流产的患者50例为复发性流产组,PCOS未发生复发性流产的患者72例为非复发性流产组。对PCOS患者发生复发性流产的相关变量进行单因素、多因素logistic回归分析。分析血清EMAB、ACA对复发性流产的预测价值。结果 多因素logistic回归分析显示:年龄≥35岁、体质量指数(BMI)≥25 kg/m^(2)、子宫内膜厚度<5 mm、基础黄体生成素(LH)水平异常、基础睾酮(T)水平异常、存在妊娠期合并症、存在流产史、存在胰岛素抵抗、EMAB≥0.35 ng/L、ACA≥3.50 U/ml是PCOS患者发生复发性流产的主要危险因素(均P<0.05)。非复发性流产组EMAB、ACA水平分别为(0.21±0.10)ng/L、(1.12±0.75)U/ml;复发性流产组EMAB、ACA水平分别为(0.52±0.24)ng/L、(6.46±4.70)U/ml。与非复发性流产组相比,复发性流产组EMAB、ACA水平均升高(t=9.815,14.417,均P<0.05)。EMAB、ACA联合检测预测复发性流产的效能显著高于EMAB、ACA单一检测(均P<0.05)。结论 年龄≥35岁、BMI≥25 kg/m^(2)、子宫内膜厚度<5 mm、基础LH水平异常、基础T水平异常、存在妊娠期合并症、存在流产史、存在胰岛素抵抗、EMAB≥0.35 ng/L、ACA≥3.50 U/ml是PCOS患者发生复发性流产的主要危险因素。分析患者的EMAB、ACA水平,能预测复发性流产的发生风险,从而更好地制定针对性治疗措施,降低复发性流产发生风险,改善患者妊娠结局。

Objective To analyze the risk factors of recurrent abortion in patients with polycystic ovary syndrome(PCOS) and the predictive value of anti-endometrial antibody(EMAB) and anti-cardiolipin antibody(ACA) for recurrent abortion.Methods The medical records of 50 patients with PCOS and recurrent abortion in the Second People's Hospital of Fuyang District,Hangzhou from May 2020 to May 2022 were selected as recurrent abortion group,72 patients with PCOS were selected as non-recurrent abortion group.Univariate analysis and multivariate logistic regression analysis were performed on the variables associated with recurrent abortion in patients with PCOS.The predictive value of serum EMAB and ACA for recurrent abortion was analyzed.Results Multivariate logistic regression analysis showed that equal or more than 35 years,body mass index(BMI) equal or greater than 25 kg/m~2,endometrial thickness less than 5 mm,abnormal basic luteinizing hormone(LH) level,abnormal basic testosterone(T) level,presence of pregnancy complications,history of abortion,insulin resistance,and EMAB equal or greater than 0.35 ng/L,ACA equal or greater than 3.50 U/ml were the main risk factors for recurrent abortion in patients with PCOS(P<0.05).The levels of EMAB and ACA in non-recurrent abortion group were(0.21±0.10) ng/L and(1.12±0.75) U/ml,respectively.The levels of EMAB and ACA in recurrent abortion group were(0.52±0.24) ng/L and(6.46±4.70) U/ml,respectively.Compared with non-recurrent abortion group,the levels of EMAB and ACA in recurrent abortion group were higher(t=9.815,14.417,P<0.05).The efficiency of EMAB combined with ACA in predicting recurrent abortion was significantly higher than those of single detection of EMAB and ACA(P<0.05).Conclusion Equal or more than 35 years,body mass index(BMI) equal or greater than 25 kg/m~2,endometrial thickness less than 5 mm,abnormal basic luteinizing hormone(LH) level,abnormal basic testosterone(T) level,presence of pregnancy complications,history of abortion,insulin resistance,and EMAB equal or greater than 0.35 ng/L,ACA equal or greater than 3.50 U/ml are the main risk factors for recurrent abortion in patients with PCOS.Analysis of EMAB and ACA levels can predict the risk of recurrent abortion,make corresponding treatment measures,reduce the risk of recurrent abortion,and improve pregnancy outcome.