抗β2糖蛋白Ⅰ抗体和复发性自然流产的关系

发布时间：2018-03-05 09:09

本文选题：复发性自然流产　切入点：抗β2糖蛋白Ⅰ抗体　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的复发性自然流产(recurrent spontaneous abortion,RSA)是育龄期妇女的常见疾病,对于其发病原因及治疗的探索一直是临床研究的热点。抗磷脂综合征(antiphospholipid syndrome,APS)已经明确证实和复发性自然流产密切相关。其中抗p2糖蛋白Ⅰ抗体作为抗磷脂综合征的重要诊断标准,在复发性流产的诊断和治疗的作用日渐突出。但是抗β2糖蛋白Ⅰ抗体的在正常育龄期妇女测量值水平尚不清楚,同时对于复发性流产的人抗β2糖蛋白Ⅰ抗体小于20RU/mL时我们是否该采取抗凝治疗措施,以及采取治疗措施后对其预后有多大帮助尚不清楚。本研究通过对比正常育龄期女性和复发性自然流产患者的抗β2糖蛋白Ⅰ抗体的不同水平的分布,同时对门诊复发性自然流产病人抗β2糖蛋白Ⅰ抗体15-20RU/mL之间的患者采取治疗措施与否对于预后的影响,同时对处于临界值上下两组人群采取治疗措施病人预后的比较,以期探索抗β2糖蛋白Ⅰ抗体对复发性自然流产的治疗指导作用。方法本研究回顾性研究就诊日期在2012.01.01-2012.12.31之间的于山东大学附属山东省立医院门诊治疗的复发性自然流产的224名患者临床和实验室数据,同时对这些患者电话随访了解治疗结局。其中抗心磷脂抗体阴性的患者有210人,定义为A组。将A组患者根据抗β2糖蛋白Ⅰ抗体不同水平分为三组：A1组小于15RU/mL、A2组15RU/mL-20RU/mL之间的和A3组大于20RU/mL。同时收集40名正常育龄期女性的相关病史和实验室数据作为正常对照B组。 1.分析A、B两组人群中抗p2糖蛋白Ⅰ抗体检测值的分布并比较有无差异。 2.分析抗β2糖蛋白Ⅰ抗体三种抗体水平IgM、IgG、IgA和复发性自然流产相关性。 3.比较A组人群中抗β2糖蛋白抗体处于不同水平时是否接受抗凝治疗对预后的的影响。 4.应用统计学软件SPSS21.0对数据结果进行分析, P0.05为差异具有统计学意义。结果 1.A组和B组人群中抗β2糖蛋白Ⅰ抗体小于15RU/mL、5RU/mL-20RU/mL之间的和大于20RU/mL的分别为：110人、52人、48人；34人、2人、4人。复发性流产组和正常对照组抗β2糖蛋白Ⅰ抗体分布差异有统计学意义。 2.抗β2糖蛋白Ⅰ抗体阳性的48人,全部伴有IgM阳性,IgA阳性者6人,IgG阳性者1人。 3.(1)A组人群中抗β2糖蛋白Ⅰ抗体15RU/mL-20RU/mL,即A2组患者接受抗凝治疗以及妊娠成功人数分别为：21人和14人。A2组未接受抗凝治疗以及妊娠成功人数分别为：31和6人。A2组中接受抗凝治疗组和非治疗组预后差异具有统计学意义。 (2)A组人群中抗β2糖蛋白Ⅰ抗体大于20RU/mL,即A3组患者接受抗凝治疗和妊娠成功者分别为：30和22人。对比A2组接受抗凝治疗的患者,预后无明显差异。 4.对于A2+A3组患者接受抗凝治疗以及妊娠成功人数分别为51和36人；未接受抗凝治疗以及妊娠成功人数分别为49和9人。接受抗凝治疗的患者和未接受抗凝治疗的患者预后差异有统计学意义。结论 1.复发性流产组女性体内的抗β2糖蛋白Ⅰ抗体水平和正人群存在显著差异,当抗体水平大于15RU/mL时差异明显。 2.复发性流产病人主要与抗β2糖蛋白Ⅰ抗体中的IgM相关。 3.对于抗β2糖蛋白Ⅰ抗体处于阳性临界值以下(15-20RU/mL之间)的复发性流产的病人采取抗凝治疗后期妊娠结局明显好于未接受抗凝治疗的病人。 4.对于抗β2糖蛋白Ⅰ抗体处于阳性临界值以下(15-20RU/mL之间)的复发性流产的病人采取抗凝治疗后期妊娠结局和抗β2糖蛋白Ⅰ抗体阳性的病人治疗后的妊娠结局无明显差异。
[Abstract]:objective
Recurrent spontaneous abortion (recurrent spontaneous, abortion, RSA) is a common disease of women of childbearing age, to explore its pathogenesis and treatment has been a hot topic in clinical research. The antiphospholipid syndrome (antiphospholipid syndrome APS) has been confirmed and recurrent spontaneous abortion is closely related. The anti P2 antibody as an important diagnostic glycoprotein the standard of antiphospholipid syndrome in the diagnosis and treatment of recurrent spontaneous abortion have become increasingly prominent role. But the anti beta 2 glycoprotein antibodies in normal women of childbearing age measurement level is not clear, at the same time for recurrent abortion anti beta 2 glycoprotein antibody is less than 20RU/mL whether we should take anticoagulation measures. And after treatment on the prognosis of help is unclear. This study by anti beta patients compared with normal women of childbearing age and recurrent spontaneous abortion 2 sugar The distribution of different levels of antibody protein, while outpatient recurrent spontaneous abortion patients between 2 anti beta glycoprotein antibody 15-20RU/mL patients to take treatment and not for prognosis, while in the critical value under the two groups compared the prognosis of patients take measures, in order to explore the anti beta 2 glycoprotein antibody for the treatment of recurrent spontaneous abortion guide.
Method
This study reviewed 224 patients with clinical and laboratory data of the date between 2012.01.01-2012.12.31 in the treatment of Shandong University affiliated Shangdong Province-owned Hospital outpatient recurrent spontaneous abortion, and telephone follow-up for these patients understand the treatment outcome. The anti cardiolipin antibody negative patients 210 were defined as group A, A group according to. Anti beta 2 glycoprotein antibody levels were divided into three groups: A1 group was less than 15RU/mL, the related history and laboratory data between A2 group and 15RU/mL-20RU/mL A3 group than 20RU/mL. and 40 normal women of childbearing age as normal control group B.
1. the distribution of anti P2 glycoprotein I antibody in A and B two groups was analyzed and there were no differences.
2. the correlation of IgM, IgG, IgA, and recurrent spontaneous abortion was analyzed for the anti beta 2 glycoprotein I antibody level of three antibodies.
3. to compare the effect of anticoagulant therapy on the prognosis of the A group at different levels of anti beta 2 glycoprotein antibody at different levels.
4. statistics software SPSS21.0 is used to analyze the results of the data, and P0.05 has statistical significance for the difference.
Result
In group 1.A and group B, the anti beta 2 glycoprotein I antibody was less than 15RU/mL, 5RU/mL-20RU/mL and 20RU/mL were 110, 52, 48, 34, 2, 4, respectively. There was a significant difference in the distribution of anti beta 2 glycoprotein I antibody between recurrent abortion group and normal control group.
2. anti beta 2 glycoprotein I antibody positive 48, all accompanied by IgM positive, 6 IgA positive, and 1 IgG positive.
3. (1) A group anti beta 2 glycoprotein antibody 15RU/mL-20RU/mL, A2 group of patients receiving anticoagulant therapy and the number of successful pregnancy were 21 and 14 in group.A2 did not receive anticoagulant therapy and the number of successful pregnancy were 31 and 6 in the.A2 group received significant anticoagulant therapy group and non the treatment group differences in prognosis.
(2) the anti beta 2 glycoprotein I antibody in group A is more than 20RU/mL, that is, A3 group receiving anticoagulant therapy and pregnancy success is 30 and 22 respectively. Compared with A2 group, there is no significant difference in prognosis between patients receiving anticoagulation therapy and those with anticoagulation therapy.
4., for A2+A3 group, the number of patients receiving anticoagulation therapy and pregnancy success was 51 and 36, respectively. The number of patients who did not receive anticoagulation therapy and pregnancy success were 49 and 9, respectively. There was a significant difference in prognosis between patients receiving anticoagulation therapy and those who did not receive anticoagulation therapy.
conclusion
1. there were significant differences in the level of anti beta 2 glycoprotein I antibody and the positive population in the female recurrent abortion group, and the difference was obvious when the antibody level was greater than 15RU/mL.
2. the patients with recurrent abortion are mainly associated with IgM in the anti beta 2 glycoprotein I antibody.
3., for patients with recurrent abortion with anti beta 2 glycoprotein I antibody below the positive threshold value (15-20RU/mL), anticoagulant therapy is better than late anticoagulation therapy.
4., there was no significant difference in the pregnancy outcome of patients with recurrent spontaneous abortion below the positive threshold value (15-20RU/mL) between anticoagulant therapy and those who had positive anti beta 2 glycoprotein I antibody after treatment with anti beta 2 glycoprotein I antibody.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.21

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