血清双酚A及anti-β2GPI抗体联合检测预测宫内妊娠结局的临床价值-东南大学学报医学版

血清双酚A及anti-β2GPI抗体联合检测预测宫内妊娠结局的临床价值

单位：南通大学附属医院妇产科, 江苏南通 226001

分类号：R714.2

出版年·卷·期（页码）：2019·38·第一期（136-140）

摘要：

目的：明确血清双酚A（BPA）水平及抗β2糖蛋白I抗体（anti-β2GPI抗体，抗β2-GPI抗体）表达与不良妊娠结局的关系，探索联合诊断预测模型的有效性。方法：回顾性分析80名先兆流产或先兆早产孕妇血清BPA水平及anti-β2GPI抗体表达情况，分析其与不良妊娠结局的相关性，通过ROC曲线分析联合孕妇血清BPA及anti-β2GPI抗体预测妊娠结局的效果及优势。结果：出现不良妊娠结局者33名，正常结局孕妇为47名，分别归类为不良妊娠结局组与对照组；两组孕妇年龄、流产史均无显著差异，不良妊娠结局组孕妇其血清抗β2-GPI抗体阳性者较对照组增多（P=0.000），血清BPA水平（14.16±5.08）ng·ml^-1较对照组（9.01±4.28）ng·ml^-1增高（P=0.000）。以血清抗β2-GPI抗体阳性、血清BPA浓度>9.33 ng·ml^-1为不良妊娠结局的独立预测指标，ROC曲线下面积（AUC）分别为0.713与0.799；以血清抗β2-GPI抗体阳性且BPA浓度>9.33 ng·ml^-1为不良妊娠结局的联合预测指标，ROC曲线下面积为0.842，诊断灵敏度、特异度、准确度、阳性预计值及阴性预计值分别为68.9%、85.7%、76.3%、93.9%、63.8%。结论：血清BPA水平增高或anti-β2GPI抗体阳性与不良妊娠结局具有相关性，联合血清BPA及anti-β2GPI抗体表达对不良妊娠结局进行预测，具有理想的诊断效果，如能应用至临床诊断中，可早期制定有针对性的治疗方案，通过特异性的治疗降低不良妊娠结局的发生率。

Objective:To clarify the relationship between serum bisphenol A (BPA) level, the expression of anti-beta 2 glycoprotein I antibody (anti-beta 2GPI antibody) and adverse pregnancy outcomes, and explore the validity of the combined diagnostic and predictive model. Methods:The serum levels of BPA and anti-β2GPI antibody in 80 pregnant women with threatened abortion or threatened preterm labor were retrospectively analyzed. The correlation between anti-β2GPI and anti-β2GPI antibodies was analyzed. The pregnancy outcome was predicted by ROC curve analysis combined with serum BPA and anti-β2GPI antibodies effects and advantages. Results:Thirty-three female got the adverse result, otherwise, 47 got the normal outcomes. Therefore, they were classified as adverse pregnancy outcome group and control group. The average age, history of abortion between the two groups were not significantly different. anti-β2GPI antibody positive expression increased compared with the control group (P=0.000) in adverse pregnancy outcome group, so did the level of BPA level (14.16±5.08) ng·ml^-1compared with the control group (9.01±4.28) ng·ml^-1 (P=0.000). anti-β2GPI antibody positive expression and increased BPA were the independent predictor of adverse pregnancy outcomes, ROC area under curve (AUC) were 0.713 and 0.799, respectively, Youden index were 0.427 and 0.465 respectively. When using the anti-beta 2GPI antibody positive expression and BPA lever above 9.33 ng·ml^-1 as combined predictors of adverse pregnancy outcomes, the ROC area under curve was 0.842, the diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 68.9%, 85.7%, 76.3%, 93.9%, 63.8%, respectively. The Youden index was 0.444. Conclusion:There was a positive correlation between anti-β2GPI antibody positive expression, increased BPA level and adverse pregnancy outcomes. The diagnostic prediction value seems better when using serum BPA level above 9.33 ng·ml^-1 combined with anti-beta 2GPI antibody positive expression looks better, therefore the combination detection of expression of serum BPA and anti-β2 GPI antibodies can predict the outcome of adverse pregnancy, which can be used to make early targeted treatment plan, thus the incidence of adverse pregnancy outcomes can be reduced.

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