抗核抗体与低分子肝素治疗不明原因复发性流产子宫胎盘血流指数的关系  

The Relationship Between Anti-nuclear Antibody and Effect of Low Molecular Weight Heparin on Uterine Placental Blood Flow Index in Unexplained Recurrent Spontaneous Abortion

作　　者：鲁红艳 王雪影[1] 王小兰[1] LU Hongyan;WANG Xueying;WANG Xiaolan(Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院围产医学部,北京100026

出　　处：《标记免疫分析与临床》2024年第5期789-793,共5页Labeled Immunoassays and Clinical Medicine

基　　金：北京妇产医院/北京妇幼保健院中青年学科骨干培养专项(编号:FCYY201903)。

摘　　要：目的探讨抗核抗体(ANA)与低分子肝素(LMWH)治疗不明原因复发性流产(URSA)孕妇子宫胎盘血流指数的关系。方法2020年1月至2022年12月期间,共纳入80例URSA孕妇,其中40例接受LMWH治疗,另外40例未接受LMWH治疗,2组ANA阴性(-)和ANA阳性(+)各20例。借助虚拟器官计算机辅助分析技术进行2D多普勒测量子宫动脉搏动指数(PI)和3D超声测定血管化指数(VI)、血流指数(FI)和血管化血流指数(VFI),并对所有女性进行血清ANA测定。结果未接受LMWH治疗和接受LMWH治疗的ANA(-)URSA孕妇分娩孕周、新生儿结局比较,差异具有统计学意义(P<0.05)。无论ANA状态如何,未接受LMWH治疗和接受LMWH治疗的URSA孕妇间PI、VFI、FI值差异均无统计学意义(P>0.05)。而接受LMWH治疗的ANA(-)URSA孕妇VI值显著高于未接受LMWH治疗的ANA(-)URSA孕妇(20.02±6.06 vs 11.60±3.04,P<0.001)。仅考虑ANA(-)URSA患者,VI用于区分接受和未接受LMWH治疗孕妇的ROC曲线下面积为0.889(标准误=0.053,P<0.001,95%置信区间=0.785~0.993),VI临界值为16.05,灵敏度为75.0%,特异性为100.0%。结论LMWH可能对于恢复ANA(-)状态下URSA女性VI的生理血流供应具有潜在的有益作用,但是仍需要更进一步的研究来解释彼此之间的关系。Objective To investigate the relationship between anti-nuclear antibody(ANA)and effect of low molecular weight heparin(LMWH)on uterine placental blood flow index in unexplained spontaneous abortion(URSA).Methods From January,2020 to December,2022,80 pregnant women with URSA were enrolled in the study.40 of these subjects received LMWH and another 40 did not receive LMWH.There were 20 cases of ANA negative(-)and ANA positive(+)in each group.With the aid of virtual organ computer-aided analysis technology,uterine artery pulse Index(PI)was measured by 2D Doppler and vascularization index(VI).Blood flow index(FI)and vascularization blood flow index(VFI)were determined by 3D ultrasound,and serum ANA was measured in all women.Results Between ANA(-)URSA pregnant women who did not receive LMWH treatment and those who received LMWH treatment,there were statistically significant differences in gestational weeks and neonatal outcomes(P<0.05).Regardless of ANA status,there were no differences in PI,VFI and FI values between URSA pregnant women who were not treated with LMWH and those who were treated with LMWH(P>0.05).The VI value of ANA(-)URSA women who received LMWH was significantly higher than that of ANA(-)URSA women who did not receive LMWH(20.02±6.06 vs 11.60±3.04,P<0.001).For ANA(-)patients,AUC for VI differentiation between pregnant women who received LMWH and those who did not received LMWH was 0.889(standard error=0.053,P<0.001,95%CI 0.785-0.993).When the VI threshold was 16.05,the sensitivity was 75.0%and the specificity was 100.0%.Conclusion LMWH could have a potential positive effect on restoring the physiological blood supply of URSA female VI in ANA(-)state,while further studies are needed to identify and explain the relationship between them.

关 键 词：不明原因复发性流产 抗核抗体 虚拟器官计算机辅助分析 胎盘血流 低分子肝素 

分 类 号：R714.21[医药卫生—妇产科学]