封闭抗体和抗心磷脂抗体与复发性流产的相关性研究

摘要

目的 探讨封闭抗体和抗心磷脂抗体与复发性流产的相关性,寻找复发性流产的病因.方法 选取2014年6月至2016年6月三亚市妇幼保健院收治的120例有复发性流产史妇女为观察组,120例健康经产妇为对照组.采用ELISA法检测两组受检者的封闭抗体和抗心磷脂抗体,采用χ2检验比较两组受检者中抗体的表达率;采用诊断试验评价的灵敏度、特异度和受试者工作曲线(ROC)方法,定量反映两种抗体表达对育龄期妇女复发性流产的预测情况.结果 观察组妇女的血清封闭抗体阴性率为85.8%,明显高于对照组的30.0%,差异有显著统计学意义(P<0.01);观察组妇女的血清抗心磷脂抗体阳性率为19.2%,高于对照组的4.2%,差异亦有显著统计学意义(P<0.01);观察组的血清封闭抗体阴性+抗心磷脂抗体阳性为11例,占9.17%,高于对照组的0.83%,差异有显著统计学意义(P<0.01);经诊断试验评价,血清封闭抗体阴性、抗心磷脂抗体阳性或两者联合对育龄期妇女复发性流产预测的灵敏度(85.8%、19.2%、9.2%)、特异度(70.0%、95.8%、99.2%)和ROC曲线下面积(0.779、0.575、0.542)有明显差异.结论 育龄期妇女的血清封闭抗体缺失或抗心磷脂抗体增高与复发性流产密切相关,尤其是前者.在临床中应重视免疫抗体的检测及治疗,减轻育龄期妇女因反复流产带来的心理、身体伤害及社会医疗负担.%Objective To investigate the relationship between blocking antibodies and anti-cardiolipin anti-body in recurrent spontaneous abortion, and find the causes of recurrent spontaneous abortion. Methods From June 2014 to June 2016, 120 women with recurrent spontaneous abortion history were selected as the study group, and 120 healthy non-pregnant parous women were recruited as the control group, who were given blocking antibody detection and anti-cardiolipin antibody detection by ELISA method. The negative rate of blocking antibodies and positive rate of anti-cardiolipin antibody were compared by the chi-square test, and sensitivity, specificity and receiver operator charac-teristic curve (ROC) were used to calculate and compare the prediction ability of the two antibodies for recurrent sponta-neous abortion. Results Blocking antibody negative rate of the study group were significantly higher than that in the control group (85.8%vs 30.0%, P<0.001). Anti-cardiolipin antibody positive rate of the study group were significantly higher than that in the control group (19.2%vs 4.2%, P<0.001). The rate of blocking antibody negative and anticardiolip-in antibody positive in the study group was 9.17%(11 cases), which was significantly higher than 0.83%in the control group (P=0.003). According to diagnostic test evaluating, the sensitivity (85.8%vs 19.2%vs 9.2%), specificity (70.0%vs 95.8%vs 99.2%) and area under the curve (0.779 vs 0.575 vs 0.542) showed significant difference among blocking anti-bodies negative, anti-cardiolipin antibody positive, and the combination of the two. Conclusion Blocking antibody neg-ative and anticardiolipin antibody positive in women are closely related to the recurrent spontaneous abortion, especially the former. We should strengthen the detection and treatment in clinic, so as to reduce the psychological and physical damage, and social medical burden of women of childbearing age due to repeated abortion.