>
网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
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
作者:倪惠华  李娟  叶青 
单位:南通大学附属医院 妇产科, 江苏 南通 226001
关键词:不良妊娠结局 双酚A 抗β2糖蛋白I抗体 联合诊断预测 
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.

参考文献:

[1] PERET Z,VROOMAN L,RICKE W A,et al.Bisphenol A and reproductive health:Update of experimental and human evidence,2007-2013[J].Environ Health Perspect,2014,122(8):775-786.
[2] 张晖,孔繁翔,王世和.环境雌激素联合作用的分析与预测[J].东南大学学报:自然科学版,2008,38(3):488-492.
[3] HUNT P A,KOEHLER K E,SUSIARJO M,et al.Bisphenol A exposure causes meiotic aneuploidy in the female mouse[J].Curr Biol,2003,13(7):546.
[4] ANDREOLI L,NALLI C,BORGHI M O,et al.Fine specificity of anti-β2glycoprotein I antibodies in systemic autoimmune diseases is mostly directed against domain 1[J].Reumatismo,2011,63(2):91-6.
[5] AGOSTINIS C,DURIGUTTO P,SBLATTERO D,et al.A non-complement-fixing antibody to β2 glycoprotein I as a novel therapy for antiphospholipid syndrome[J].Blood,2014,123(22):3478-3487.
[6] 黄晓洁,杨俊波,李琳.妊娠结局与不良情绪的相关性研究[J].东南大学学报:医学版,2015,34(2):226-230.
[7] 张红媛,王谢桐.抗β2-糖蛋白I抗体和复发性流产的关系[J].中华产科急救杂志:电子版,2014,(2):46-49.
[8] 黄莉,张莉,李洪艳,等.孕产妇不良妊娠结局危险因素的巢式病例对照研究[J].中国现代医学杂志,2015,25(9):106-109.
[9] KASSEBAUM J N,BARBER M R,BHUTTA Z,et al.Global,regional,and national levels and causes of maternal mortality during 1990-2013:A systematic analysis for the global burden of disease study 2013[J].Lancet,2014,384(9947):980-1004.
[10] 王劲进,柒铭铭,赖慧敏.抗心磷脂抗体和抗β2糖蛋白与早期妊娠丢失关系的探讨[J].湖南师范大学学报:医学版,2014,11(2):56-58.
[11] 李凤中,陈波,黄永建.抗心磷脂抗体检测在孕妇不良妊娠结局中的临床意义[J].实验与检验医学,2014,32(1):68-70.
[12] 胡乔飞,李坚.脂蛋白(a)及某些抗凝因子与反复自然流产的相关性研究[J].生殖与避孕,2008,28(2):116-120.
[13] MERONI P L,BORGHI M O,RASCHI E,et al.Pathogenesis of antiphospholipid syndrome:understanding the antibodies[J].Nat Rev Rheumatol,2011,7(6):330-339.
[14] PENGO V,BANZATO A,DENAS G,et al.Correct laboratory approach to APS diagnosis and monitoring[J].Autoimmun Rev,2013,12(8):832-834.
[15] RIBEIRO S L,PEREIRA H L,SILVA N P,et al.Anti-β2-glycoprotein I antibodies are highly prevalent in a large number of Brazilian leprosy patients[J].Acta Reumatol Port,2011,36(1):30-37.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 250591 位访问者


copyright ©《东南大学学报(医学版)》编辑部
联系电话:025-87232481 83272483
电子邮件:
bjb@pub.seu.edu.cn

苏ICP备09058364