孕期血清抗磷脂抗体水平变化及临床意义

Changes in Serum Antiphospholipid Antibody Levels during Pregnancy and Their Clinical Significance

摘要: 目的：通过检测全孕期健康女性血清抗心磷脂(aCL)及抗β2糖蛋白1抗体(aβ2GPI)水平，建立郑州市健康孕期抗体的参考区间，分析孕期抗体变化的特点及临床意义。方法：纳入2023.5~2023.10于郑大二附院建档围保的134名健康孕期女性检测aCL和aβ2GPI-IgA/IgM/IgG血清水平，使用非参数法计算各百分位值，同期纳入78例孕前检测抗磷脂抗体阳性的孕妇，收集其孕后抗体水平及治疗用药和妊娠结局。结果：1) 正常妊娠妇女剔除离群值后，aCL和aβ2GPI-IgA/IgM/IgG的P₉₉值分别为：4.78 RU/mL、29.18 RU/mL、3.33 RU/mL、4.88 RU/mL、11.44 RU/mL、<2 RU/mL，与243例非孕期健康育龄期女性相比，孕期健康育龄期女性aCL-IgM和aβ2GPI-IgM水平显著降低(P < 0.05)，不同孕期抗体水平间无统计学差异。2) 孕前抗体阳性孕妇，孕后各型抗体水平随孕周增加逐渐降低，孕前、孕后抗体水平间比较具有显著的统计学差异(P < 0.01)；26例恢复正常孕期范围后停用免疫抑制剂，停药与未停药者20周后持续妊娠率及活产率均为100%；以每项正常抗磷脂抗体95%截断值上限为1，计算孕前阳性的抗磷脂抗体的最大倍数，ROC计算最大倍数的最佳截断值为2.725，AUC = 0.91；Logistic回归分析显示最大倍数、年龄、不良孕产次均为不良妊娠结局的独立影响因素(P < 0.01)。结论：健康孕期女性的aCL-IgM和aβ2GPI-IgM水平显著降低，抗体阳性者孕后其水平显著降低，孕前APLs升高2.725倍与不良妊娠结局相关。

Abstract: Objective: By detecting serum levels of anticardiolipin (aCL) and anti-β-2-glycoprotein I antibody (aβ2GPI) in healthy women throughout pregnancy, establish a reference interval for healthy pregnancy antibodies in Zhengzhou city, and analyze the characteristics and clinical significance of changes in pregnancy antibodies. Method: Serum levels of aCL and aβ2GPI-IgA/IgM/IgG were tested in 134 healthy pregnant women who were included in the perioperative period of the Second Affiliated Hospital of Zhengzhou University from March 3, 2023 to October 2023. Non parametric methods were used to calculate the percentile values. During the same period, 78 pregnant women who tested positive for antiphospholipid antibodies before pregnancy were included, and their post pregnancy antibody levels, treatment medication, and pregnancy outcomes were collected. Result: 1) After excluding outliers in normal pregnant women, The P99 of aCL and aβ2GPI-IgA were 4.78 RU/mL, 29.18 RU/mL, 3.33 RU/mL, 4.88 RU/mL, 11.44 RU/mL, and <2 RU/mL, respectively. Compared with 243 non pregnant healthy reproductive age women, aCL-IgM and aβ2GPI-IgM significantly decreased (P < 0.05), and there was no statistically significant difference in antibody levels between different pregnancy periods. 2) Pregnant women with positive antibodies before pregnancy have gradually decreased levels of various types of antibodies with increasing gestational age. There is a significant statistical difference in antibody levels between pre pregnancy and post pregnancy (P < 0.01); after returning to normal pregnancy range, 26 cases stopped using immunosuppressive agents. The sustained pregnancy rate and live birth rate after 20 weeks were 100% for those who stopped and those who did not; the upper limit of the 95% cutoff value for each normal antiphospholipid antibody is 1. Calculate the maximum multiple of positive antiphospholipid antibodies before pregnancy, and the optimal cutoff value for ROC calculation of the maximum multiple is 2.725, with AUC = 0.91; logistic regression analysis showed that maximum multiple, age, and number of adverse pregnancies were independent influencing factors for adverse pregnancy outcomes (P < 0.01). Conclusion: aCL-IgM and aβ2GPI-IgM in healthy pregnant women were significantly reduced, and those who were antibody positive had a significant decrease in their levels after pregnancy. An increase of 2.725 times in pre pregnancy APLs was associated with adverse pregnancy outcomes.