自身免疫型复发性流产预后不良的相关风险因素探讨  

Risk factors of poor prognosis of autoimmune recurrent spontaneous abortion

作　　者：李建斌 韩婷 吴锐[1] LI JianBin;HAN Ting;WU Rui(Department of Rheumatology and Immunology,the First Affiliated Hospital of Nanchang University,Nanchang,Jiangxi 330006,China;Department of Rheumatology and Immunology,Nanchang First Hospital,Nanchang,Jiangxi 330006,China)

机构地区：[1]南昌大学第一附属医院风湿免疫科,江西南昌330006 [2]南昌市第一医院风湿免疫科,江西南昌330006

出　　处：《中国医学工程》2025年第4期78-81,共4页China Medical Engineering

摘　　要：目的探讨自身免疫型复发性流产(RSA)孕妇妊娠不良结局的相关性风险因素。方法回顾性纳入2018年5月至2021年5月南昌大学第一附属医院风湿免疫科就诊的具有自身抗体且伴RSA 3次以上的145例患者,记录相关信息,包括一般人口学特征、妊娠及流产史、25-羟基维生素D[25(OH)D]水平、抗心磷脂抗体、抗β2糖蛋白1抗体、狼疮抗凝物(LA),抗核抗体(ANA),以及免疫治疗用药情况[糖皮质激素(GC)、硫酸羟氯喹(HCQ)、环孢素(CsA)、他克莫司(FK506)],分析各项指标与妊娠丢失的相关性。结果妊娠成功患者48例,妊娠丢失患者97例,两组在流产次数、抗磷脂抗体(APL)阳性、使用GC、25(OH)D水平差异有统计学意义(P<0.05);多因素Logistic回归分析发现流产次数≥3次、APL阳性为不良妊娠结局的危险因素,25(OH)D充足、使用GC治疗是保护因素(P<0.05)。结论流产次数≥3次、APL阳性会增加自身免疫型RSA患者不良妊娠结局的风险,保持充足的维生素D水平及合理使用GC可增加RSA活胎率。【Objective】To explore the risk factors of adverse pregnancy outcome in patients with autoimmune recurrent spontaneous abortion(RSA).【Methods】From May 2018 to May 2021,145 patients with autoantibodies and recurrent pregnancy loss were enrolled in the Department of Rheumatology and Immunology,the First Affiliated Hospital of Nanchang University.The relevant information was recorded,including general demographic characteristics,history of pregnancy and abortion,25(OH)D level,anticardiolipin antibody,anti-β_(2) glycoprotein I antibody,lupus anticoagulant(LA),antinuclear antibody(ANA).The use of immunotherapy(GC,HCQ,CsA,FK506),and the correlation between each index and pregnancy loss was analyzed.【Results】There were 48 cases of successful pregnancy and 97 cases of pregnancy loss,there were significant differences in the frequency of abortion,APL,hormone use and 25(OH)D level between the two groups(P<0.05).Multivariate logistic regression analysis showed that miscarriage times≥3 times and positive antiphospholipid antibodies were risk factors for adverse pregnancy outcome,while adequate 25(OH)D and hormone therapy were protective factors(P<0.05).【Conclusion】The frequency of abortion≥3 times and positive antiphospholipid antibody can increase the risk of adverse pregnancy outcome in patients with RSA.Adequate vitamin D level and rational use of GC can increase the live pregnancy rate of RSA.

关 键 词：复发性流产 自身抗体 预后不良 风险因素 

分 类 号：R714.21[医药卫生—妇产科学]