天津医药

天津医药 ›› 2025, Vol. 53 ›› Issue (8): 831-835.doi: 10.11958/20242359

• 临床研究 • 上一篇    下一篇

血清自身抗体变化对不明原因复发性流产患者妊娠结局的影响及预测模型构建

王婷1(), 王丹2,△(), 李瑛1   

  1. 1 宝鸡第三医院妇产科（邮编721000）
    2 宝鸡第三医院检验科（邮编721000）
  • 收稿日期:2024-12-25 修回日期:2025-05-27 出版日期:2025-08-15 发布日期:2025-08-12
  • 通讯作者: △E-mail：dananw@qq.com
  • 作者简介:王婷（1985），女，主治医师，主要从事妇科内分泌及卵巢肿瘤方面研究。E-mail：tingting160020@163.com
  • 基金资助:
    陕西省科学技术研究发展计划(2021K17-11)

The influence of changes in serum autoantibodies on pregnancy outcome of patients with unexplained recurrent spontaneous abortion and construction of a predictive model

WANG Ting1(), WANG Dan2,△(), LI Ying1   

  1. 1 Department of Obstetrics and Gynecology, the Third Hospital of Baoji, Baoji 721000, China
    2 Department of Laboratory Medicine, the Third Hospital of Baoji, Baoji 721000, China
  • Received:2024-12-25 Revised:2025-05-27 Published:2025-08-15 Online:2025-08-12
  • Contact: △E-mail：dananw@qq.com

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摘要：

目的 探讨血清自身抗体变化与不明原因复发性流产（URSA）患者妊娠结局的相关性，并构建预测模型。方法 回顾性收集147例URSA患者的临床资料，根据妊娠结局分为妊娠成功组（108例）和妊娠失败组（39例）。比较2组血清自身抗体（抗磷脂抗体、抗甲状腺抗体、抗核抗体、抗子宫内膜抗体、抗卵巢抗体）水平，凝血功能和激素水平差异。采用Logistic回归分析URSA患者妊娠结局的影响因素，并构建列线图模型预测URSA患者不良妊娠结局的风险。结果 妊娠失败组年龄、既往流产次数、抗磷脂抗体、抗甲状腺抗体、抗核抗体、抗子宫内膜抗体、抗卵巢抗体阳性率，纤维蛋白原升高比例、D-二聚体升高比例，促卵泡生成素（FSH）、黄体生成素（LH）、催乳素（PRL）水平均高于妊娠成功组（P<0.05），而雌二醇（E2）、孕酮（P）、睾酮（T）水平低于妊娠成功组（P<0.05）。多因素Logistic回归分析结果显示，高龄、既往流产次数增加、抗磷脂抗体阳性、抗子宫内膜抗体阳性、FSH水平升高和E2水平降低是URSA患者妊娠失败的独立危险因素。基于上述指标构建的列线图模型显示出良好的预测能力，其受试者工作特征曲线下面积为0.795（95%CI：0.697~0.893）。结论 血清抗磷脂抗体、抗子宫内膜抗体可影响URSA患者的妊娠结局，构建的预测模型有很好的临床应用价值。

关键词: 自身抗体, 流产, 习惯性, 妊娠结局, 抗体, 抗磷脂, 抗子宫内膜抗体

Abstract:

Objective To explore the correlation between changes in serum autoantibodies and pregnancy outcome in patients with unexplained recurrent spontaneous abortion (URSA) and to establish a predictive model. Methods The clinical data of 147 patients with URSA were retrospectively collected. Based on pregnancy outcome, patients were divided into the successful pregnancy group (108 cases) and the failed pregnancy group (39 cases). Serum levels of autoantibodies (including antiphospholipid antibodies, antithyroid antibodies, antinuclear antibodies, anti-endometrial antibodies and anti-ovarian antibodies), coagulation function and hormone levels were compared between the two groups. Logistic regression analysis was used to examine the correlation between changes in serum autoantibodies and pregnancy outcome in URSA patients. A nomogram model was constructed to predict the risk of adverse pregnancy outcomes in URSA patients. Results The age, number of previous miscarriages, positive rates of antiphospholipid antibodies, antithyroid antibodies, antinuclear antibodies, anti-endometrial antibodies, anti-ovarian antibodies, as well as the elevated proportions of fibrinogen and D-dimer, and levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) were significantly higher in the failed pregnancy group than those in the successful pregnancy group (P<0.05). In contrast, the levels of estradiol (E2), progesterone (P) and testosterone (T) were significantly lower in the failed pregnancy group compared to the successful pregnancy group (P<0.05). Multivariate Logistic regression analysis indicated that age, previous miscarriage count, positive antiphospholipid antibodies, positive anti-endometrial antibodies, elevated FSH levels and reduced E2 levels were independent risk factors for pregnancy failure in URSA patients. The nomogram model constructed based on these indicators demonstrated good predictive ability, with an AUC of 0.795 (95%CI: 0.697-0.893). Conclusion Serum antiphospholipid antibodies and anti-endometrial antibodies can affect pregnancy outcome in URSA patients, and the constructed prediction model has significant clinical application value.

Key words: autoantibodies, abortion, habitual, pregnancy outcome, antibodies, antiphospholipid, anti-endometrial antibodies

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