抗凝血素抗体与自身免疫性自然流产的关系及其诊断价值

论著 抗凝血素抗体与自身免疫性自然流产的关系及其诊断价值

陈伟梅1 朱付凡2 皮丕湘2 王新2

(1.湖南省邵阳市中心医院妇产科,湖南 邵阳 422000;

2.中南大学湘雅二医院妇产科,湖南 长沙 410011)

[摘要]目的!探讨抗凝血素抗体(anti pro thrombin antibodies aPT)与自身免疫性自然流产关系及其诊

断价值。方法!通过病例对照研究的方法,用酶联免疫吸附实验(EL ISA)检测60名有自然流产的患者(研

究组)及20名正常妇女(对照组)的血清中抗凝血素抗体(aP T)Ig G、IgM水平,同时与抗心磷脂抗体A CA的

检测相比较。结果!∀研究组aPT IgG和Ig M浓度分别为6.71# 2.11U/ml和5.30# 1.71U/ml;对照组

aPT Ig G和Ig M浓度分别为4.48#1.42U/ml和4.00#1.11U/ml,研究组aPT IgG和IgM浓度水平均显

著高于对照组(P<0.01)。∃研究组aPT阳性率为35.00%,对照组为5.00%,两组比较差异有统计学意义

(P=0.021,P<0.05),研究组A CA阳性率为65.00%,对照组为15.00%,两组比较差异有显著性(P<0.

01)。aPT阳性率、敏感度、准确度及误诊率(假阳性率)均低于ACA,而aPT特异度、漏诊率(假阴性率)高于

ACA。结论!∀aPT与自身免疫性自然流产有关。∃aPT可在自身免疫性自然流产及A PS诊断过程中作

为辅助诊断指标,但a PT的敏感度低,漏诊率高,故它的临床应用价值有待于进一步研究。

[关键词] 流产,自发性/诊断; 抗体

Diagnostic Value of Anti prothrombin Antibody in Autoimmune Spontaneous Abortion

CH E N W ei mei1, ZH U F u f an2, PI Pi x iang2,et al(1.Dep ar tment of Gy ne,Shaoy ang City

Centr al H os p ital,Shaoy ang422000,China;2.Dep ar tment of Gy ne,Second X iangy a,,Central S outh

Univer sity,changsha410011,China)

[Abstract]Objective!T o investig ate the relationship betw een anti pr othro mbin(aP T)antibodies and au

to immune spontaneous abor tion,and the diag no st ic v alue of aPT to auto immune spo ntaneous abo rtio n.

M ethods!A do pt case contr ol studies.T he serum samples w ere measured by enzy me linked immuno so rbent

assay(EL ISA)for immuno globulin G and immunog lo bulin M antibodies against aP T,w hich w ere obtained

from60patients with spontaneous abor tio n and20contr ols,meanw hile compared with the lev el of anticar dio

lipin antibody(A CA).R esult s!∀aPT IgG and aP T IgM titers of60patients w ith spontaneous abor tion wer e

6.71#2.11u/ml and5.30#1.52u/ml respectively;and the t iters of20co nt rols w itho ut spo nt aneous abo rtion

wer e4.48#1.42u/ml and4.00#1.11u/ml r espectively.T he aP T IgG/Ig M titers of the study g ro up wer e

significantly hig her than the co nt rol g ro up(P<0.01).∃T he positive rates o f aP T in the study g ro up and con

t rols wer e35.00%and5.00%r espectively,and t he incidence o f the st udy g roup w as hig her than that o f contr ol

gr oup(P=0.021,<0.05),both w ith significant differences.T he posit ive rates o f A CA in the study g roup

and contro ls wer e65.00%and15.00%,and the incidence o f the study gr oup was higher than that of contr ol

gr oup(P<0.01),bot h w ith sig nificant diff er ences.aP T's positive r ate,sensitivity,accur acy and fa lse posi

t ive rat e o f aPT wer e low er than those of A CA,but aP T's specificity and false negative r ate wer e hig her than

ACA's.Conclusio n!∀aPT is asso ciated w ith autoimmune spontaneous abo rtio n.∃T he detectio n o f aPT can

help diag nose autoimmune spontaneo us abo rtion and A PS.But aPT's sensitiv ity is lo w and false negative rate is

high,t hus the value of clinical usage of t he aP T should be further studied.

[Key words] abor tion,spontaneous/DI; antibo dies

[中图分类号] R714.21 [文献标识码] A [文章编号] 1671 7171(2007)09 1555 03

自然流产是指妊娠不足28周、体重不足1000 g而非人工发生终止者,其发生率高达10%~ 15%[1],43%[2],严重影响人类生育繁衍和妇女身心健康。近年来,免疫功能异常性自然流产越来越受到重视,尤其是抗磷脂抗体(APL)引起的自然流产更是研究