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

doi:10.11958/20242359

Abstract

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

CLC Number:

R714.2

Figures/Tables 5

References 18

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组别		n			年龄/岁			BMI/ （kg/m2）		既往流产次数/次			抗磷脂抗体阳性
妊娠成功组		108			30.8±4.5			23.2±3.0		3（2，4）			38（35.2）
妊娠失败组		39			33.2±5.1			24.1±3.3		4（3，4）			22（56.4）
t、Z或χ2					2.816^＊＊			1.550		2.316^＊＊			5.334^＊
组别		抗甲状腺抗体阳性			抗核抗体阳性			抗子宫内膜抗体阳性		抗卵巢抗体阳性			D-D 升高
妊娠成功组		29（26.9）			13（12.0）			20（18.5）		17（15.7）			11（10.2）
妊娠失败组		17（43.6）			11（28.2）			15（38.5）		13（33.3）			10（25.6）
χ2		3.734^＊			5.483^＊			5.231^＊		4.430^＊			5.590^＊
组别	Fib 升高			PT 延长		APTT 延长			FSH/ （U/L）		LH/（U/L）			E2/（pmol/L）
妊娠成功组	9（8.3）			6（5.6）		8（7.4）			6.5±2.1		4.8±1.6			251.4±78.2
妊娠失败组	8（20.5）			6（15.4）		7（17.9）			7.8±2.8		6.2±2.3			202.6±69.4
t或χ2	4.156^＊			3.695		3.475			3.019^＊		4.141^＊＊			3.440^＊＊
组别			P/ （nmol/L）				T/ （nmol/L）					PRL/ （U/L）
妊娠成功组			40.7±11.1				1.562±0.523					394.3±122.9
妊娠失败组			30.2±9.9				1.320±0.626					474.9±159.0
t			5.197^＊＊				2.341^＊					3.234^＊＊

组别		n			年龄/岁			BMI/ （kg/m2）		既往流产次数/次			抗磷脂抗体阳性
妊娠成功组		108			30.8±4.5			23.2±3.0		3（2，4）			38（35.2）
妊娠失败组		39			33.2±5.1			24.1±3.3		4（3，4）			22（56.4）
t、Z或χ2					2.816^＊＊			1.550		2.316^＊＊			5.334^＊
组别		抗甲状腺抗体阳性			抗核抗体阳性			抗子宫内膜抗体阳性		抗卵巢抗体阳性			D-D 升高
妊娠成功组		29（26.9）			13（12.0）			20（18.5）		17（15.7）			11（10.2）
妊娠失败组		17（43.6）			11（28.2）			15（38.5）		13（33.3）			10（25.6）
χ2		3.734^＊			5.483^＊			5.231^＊		4.430^＊			5.590^＊
组别	Fib 升高			PT 延长		APTT 延长			FSH/ （U/L）		LH/（U/L）			E2/（pmol/L）
妊娠成功组	9（8.3）			6（5.6）		8（7.4）			6.5±2.1		4.8±1.6			251.4±78.2
妊娠失败组	8（20.5）			6（15.4）		7（17.9）			7.8±2.8		6.2±2.3			202.6±69.4
t或χ2	4.156^＊			3.695		3.475			3.019^＊		4.141^＊＊			3.440^＊＊
组别			P/ （nmol/L）				T/ （nmol/L）					PRL/ （U/L）
妊娠成功组			40.7±11.1				1.562±0.523					394.3±122.9
妊娠失败组			30.2±9.9				1.320±0.626					474.9±159.0
t			5.197^＊＊				2.341^＊					3.234^＊＊

变量	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.234	0.097	5.871	0.015	1.264（1.051~1.519）
既往流产次数	0.418	0.163	6.583	0.010	1.519（1.116~2.071）
抗磷脂抗体	1.327	0.451	8.672	0.003	3.770（1.582~8.985）
抗子宫内膜抗体	1.283	0.511	6.324	0.012	3.608（1.289~10.087）
FSH	0.317	0.141	5.042	0.025	1.373（1.046~1.807）
E2	-0.038	0.014	7.581	0.006	0.963（0.937~0.990）
常数项	1.365	0.697	3.835	0.050	3.916

变量	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.234	0.097	5.871	0.015	1.264（1.051~1.519）
既往流产次数	0.418	0.163	6.583	0.010	1.519（1.116~2.071）
抗磷脂抗体	1.327	0.451	8.672	0.003	3.770（1.582~8.985）
抗子宫内膜抗体	1.283	0.511	6.324	0.012	3.608（1.289~10.087）
FSH	0.317	0.141	5.042	0.025	1.373（1.046~1.807）
E2	-0.038	0.014	7.581	0.006	0.963（0.937~0.990）
常数项	1.365	0.697	3.835	0.050	3.916