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目的探讨β2糖蛋白I(β2GPI)相关抗磷脂抗体对于妊娠丢失免疫因素病因的诊断价值。方法通过酶联免疫吸附试验检测59名妊娠丢失患者(实验组)及29名正常妊娠分娩者(对照组)的血清中抗心磷脂抗体(aCL)、β2GPI依赖性aCL、β2-GPI依赖性抗磷脂酰丝氨酸抗体(aPS)及β2GPI非依赖性aCL的IgG水平。结果(1)自然流产史组β2GPI依赖性aPS的阳性率高于对照组(P<0.05),死胎史组β2GPI依赖性aCL和aCL的阳性率均高于对照组(P<0.05);(2)不同自然流产次数组β2GPI依赖性aPS阳性率均高于对照组(P<0.05);(3)各种抗体对于诊断妊娠丢失的敏感性及特异性比较aCL的敏感性最高,为45.3%;β2GPI依赖性aPS和β2GPI依赖性aCL的特异性均为100.0%;(4)各种aPL交叉阳性情况β2GPI依赖性aPS与β2GPI依赖性aCL的交叉阳性率最高,为33.3%,β2GPI依赖性aPS与β2GPI非依赖性aCL交叉阳性率最低,为7.7%。结论β2GPI依赖性aPS与自然流产有关,β2GPI依赖性aCL和aCL与死胎有关,联合检测能增加妊娠丢失患者免疫因素病因诊断的敏感性。β2GPI依赖性aPS及β2GPI依赖性aCL的特异性最高,是诊断妊娠丢失较准确的指标。β2GPI依赖性aPS出现于一次自然流产史组,有统计学意义,其阳性率与流产次数无关。
Objective To investigate the diagnostic value of β2GPI related antiphospholipid antibodies in the etiology of lost immune factors in pregnancy. Methods Serum levels of anticardiolipin antibodies (aCL), β2GPI-dependent aCL, β2-GPI-dependent anti-cancer antibodies in 59 patients with pregnancy loss (experimental group) and 29 normal pregnant women (control group) were measured by enzyme linked immunosorbent assay Phosphatidylserine antibodies (aPS) and β2GPI-independent aCL IgG levels. Results (1) The positive rate of β2GPI-dependent aPS in spontaneous abortion group was higher than that in control group (P <0.05). The positive rates of β2GPI-dependent aCL and aCL in stillbirth history group were higher than those in control group (P <0.05) (3) The sensitivities and specificities of various antibodies to diagnosis of pregnancy loss were the highest (45.3%) compared with those of aCL. (3) The positive rates of β2GPI-dependent aPS in spontaneous abortion group were higher than those in control group (P <0.05) The specificity of β2GPI-dependent aPS and β2GPI-dependent aCL were all 100.0%. (4) The cross-positive rates of β2GPI-dependent aPS and β2GPI-dependent aCL were 33.3% The positive rate of β2GPI-independent aCL was the lowest, 7.7%. Conclusions β2GPI-dependent aPS is associated with spontaneous abortion. Β2GPI-dependent aCL and aCL are associated with stillbirth. Combined detection may increase the sensitivity of the etiological diagnosis of immunosuppression in patients with pregnancy loss. β2GPI-dependent aPS and β2GPI-dependent aCL the highest specificity, is a more accurate diagnosis of pregnancy loss indicators. β2GPI-dependent aPS occurred in a history of spontaneous abortion group, with statistical significance, the positive rate has nothing to do with the number of abortions.