孕早期血清补体C3、C4水平与系统性红斑狼疮孕妇不良妊娠结局的关系  

Relationship between serum complement C3 and C4 levels in early pregnancy and adverse pregnancy outcome in pregnant women with systemic lupus erythematosus

作　　者：赵菲[1] 齐彩静 张婷[1] 马晓真 ZHAO Fei;QI Caijing;ZHANG Ting;MA Xiaozhen(Department of Gynecology and Obstetrics,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an,Shaanxi 710061,China;Department of Physiology,College of Basic Medicine,Shaanxi University of Chinese Medicine,Xianyang,Shaanxi 712046,China)

机构地区：[1]西安交通大学第一附属医院妇产科,陕西西安710061 [2]陕西中医药大学基础医学院生理教研室,陕西咸阳712046

出　　处：《中国优生与遗传杂志》2024年第12期2531-2537,共7页Chinese Journal of Birth Health & Heredity

基　　金：陕西省教育厅重点科学研究计划项目(22IS004)。

摘　　要：目的探讨孕早期血清补体C3、C4水平与系统性红斑狼疮(SLE)孕妇不良妊娠结局的关系。方法在2019年1月至2023年11月进行了一项回顾性队列研究,纳入了来自西安交通大学第一附属医院妇产科的100例SLE孕妇作为研究对象。浊度免疫测定试验对所有患者测定血清补体C3、C4水平。比较不良妊娠结局和良好妊娠结局患者血清补体C3、C4水平差异,并通过Logistic模型分析影响SLE孕妇妊娠结局的临床因素。结果共计有48例(48.0%)患者发生不良妊娠结局。在不良妊娠结局患者中血清补体C3和C4水平显著低于良好妊娠结局患者(P<0.001);这种降低趋势主要表现在发生早产和未发生早产以及小于胎龄儿(small for gestational age infant,SGA)和非SGA患者中。经多因素Logistic模型分析,血清补体C3水平降低、不使用AZA和子痫前期是影响SLE患者不良妊娠结局的独立危险因素(P<0.05)。经受试者操作特征(ROC)曲线分析,血清补体C3、C4预测不良妊娠结局的曲线下面积(AUC)为0.832、0.757(P<0.001)。以血清补体C3、C4的正常值下限75 mg/dL、9 mg/dL进行分组,组间间隔为10 mg/dL和1 mg/dL;随着血清补体C3、C4水平的下降,不良妊娠结局的发生率增加,尤其在以血清补体C3分组的患者中。Spearman相关性分析显示孕早期血清补体C3(r=–0.342,P<0.001)、C4(r=–0.387,P<0.001)水平与SLE疾病活动度评分呈显著负相关性。结论孕早期血清补体(尤其是补体C3)水平降低是影响SLE孕妇不良妊娠结局的重要危险因素,因此孕早期补体C3、C4水平降低的患者可能更容易发生不良妊娠结局,但是该结果需要在更大的患者群体中进一步证实。Objective To investigate the relationship between serum complement C3 and C4 levels in early pregnancy and adverse pregnancy outcomes in pregnant women with systemic lupus erythematosus(SLE).Methods A retrospective cohort study was conducted from January 2019 to December 2023,including 100 pregnant women with SLE from the Department of Gynecology and Obstetrics of the First Affiliated Hospital of Xi’an Jiaotong University.Turbidimetric immunoassay test was performed to determine serum complement C3 and C4 levels in all patients.Differences in serum complement C3 and C4 levels were compared between patients with poor and good pregnancy outcomes,and clinical factors affecting pregnancy outcomes in pregnant women with SLE were analyzed by Logistic modeling.Results A total of 48(48.0%)patients had adverse pregnancy outcomes.Serum complement C3 and C4 levels were significantly lower in patients with adverse pregnancy outcomes than in patients with good pregnancy outcomes(P<0.001).This trend toward lower levels was predominantly seen in patients who experienced preterm labor and those who did not,as well as in patients with and without small for gestational age infant(SGA).Reduced serum complement C3 levels,non-use of AZA and preeclampsia were independent risk factors for adverse pregnancy outcomes in patients with SLE,as analyzed by multifactorial logistic modeling(P<0.05).According to receiver operating characteristic(ROC)curve analysis,the area under the curve(AUC)of serum complement C3 and C4 in predicting adverse pregnancy outcomes were 0.832 and 0.757(P<0.001).Grouped at the lower limit of normal for serum complement C3 and C4 of 75 mg/dL and 9 mg/dL,with intergroup intervals of 10 mg/dL and 1 mg/dL.The incidence of adverse pregnancy outcomes increased with decreasing serum complement C3 and C4 levels,especially in patients grouped by serum complement C3.Spearman correlation analysis showed that early pregnancy serum complement C3(r=–0.342,P<0.001),C4(r=–0.387,P<0.001)levels were significantly and negativel

关 键 词：系统性红斑狼疮 不良妊娠结局 早产 补体C3 补体C4 

分 类 号：R71[医药卫生—妇产科学]