新型抗磷脂抗体与不良妊娠结局的关系

IF 5.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Obstetrics and gynecology Pub Date : 2025-01-01 Epub Date: 2024-09-19 DOI:10.1097/AOG.0000000000005729
Kimberly A Moyle, D Ware Branch, Lisa K Peterson, Marta M Guerra, Amanda A Allshouse, Ashley E Benson, Jane E Salmon
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Levels of aD1 and antiphosphatidylserine-prothrombin were quantified with the QUANTA Flash and QUANTA Lite systems, respectively, in sera collected at less than 18 weeks of gestation. Adverse pregnancy outcome was defined as delivery at before 34 weeks of gestation for preeclampsia or placental insufficiency or fetal death after 12 weeks of gestation. Receiver operating characteristic (ROC) analysis assessed the diagnostic properties of aD1 and antiphosphatidylserine-prothrombin for adverse pregnancy outcomes. Bivariate comparisons were made between each biomarker. Multivariable regression modeling of adverse pregnancy outcomes was performed, and backward selection determined variables for a final model for adverse pregnancy outcomes. Logistic regression of lupus anticoagulant quantified the association with aD1 and antiphosphatidylserine-prothrombin. 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Backward selection identified lupus anticoagulant, aD1, and antiphosphatidylserine-prothrombin IgG for final adverse pregnancy outcome modeling: lupus anticoagulant odds ratio (OR) 7.0 (95% CI, 3.4-14.4), aD1 OR 12.1 (95% CI, 3.64-40.2), and antiphosphatidylserine-prothrombin IgG OR 11.4 (95% CI, 5.2-25.2). Both aD1 and antiphosphatidylserine-prothrombin IgG remained significant when lupus anticoagulant was removed from the model. Both aD1 and antiphosphatidylserine-prothrombin IgG performed the best in ruling in adverse pregnancy outcomes. With a likelihood ratio less than 0.1, aD1 or antiphosphatidylserine-prothrombin IgG performed well for ruling out adverse pregnancy outcomes. Both aD1 and antiphosphatidylserine-prothrombin IgG were associated with lupus anticoagulant positivity: OR 27.9 (95% CI, 12.1-64.0) if both were positive. 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引用次数: 0

摘要

目的:探讨抗β2糖蛋白- i结构域1 (aD1)和抗磷脂酰丝氨酸-凝血酶原抗体对高危人群不良妊娠结局的预测价值,并探讨aD1、抗磷脂酰丝氨酸-凝血酶原、狼疮抗凝剂及其他抗磷脂抗体(aPL)之间的关系。方法:数据来自一项前瞻性队列研究,该研究包括妊娠aPL患者、系统性红斑狼疮(SLE)患者(n=59)、无SLE患者(n=106)或无aPL的SLE患者(n=100) (PROMISSE[系统性红斑狼疮和抗磷脂综合征妊娠结局的预测因素]研究;NCT00198068)。使用QUANTA Flash和QUANTA Lite系统分别定量测定妊娠18周以下血清中aD1和抗磷脂酰丝氨酸-凝血酶原的水平。不良妊娠结局定义为妊娠34周前分娩的先兆子痫或胎盘功能不全或妊娠12周后胎儿死亡。受试者工作特征(ROC)分析评估了aD1和抗磷脂酰丝氨酸-凝血酶原对不良妊娠结局的诊断特性。在每个生物标志物之间进行双变量比较。对不良妊娠结局进行多变量回归建模,并通过逆向选择确定最终不良妊娠结局模型的变量。狼疮抗凝剂的Logistic回归量化了与aD1和抗磷脂酰丝氨酸-凝血酶原的关系。不良妊娠结局的发生率由狼疮抗凝血药aD1和抗磷脂酰丝氨酸-凝血酶原免疫球蛋白G (IgG)的综合结果描述。结果:265例患者中,45例(17.0%)出现不良妊娠结局。ROC分析aD1的曲线下面积为0.734 (95% CI, 0.664-0.805),抗磷脂酰丝氨酸-凝血酶原IgG的曲线下面积为0.83 (95% CI, 0.751-0.899),抗磷脂酰丝氨酸-凝血酶原免疫球蛋白M (IgM)的曲线下面积为0.612 (95% CI, 0.520-0.703)。与不良妊娠结局相关的标志物是aD1 (p)。结论:在aPL妊娠个体中,无论是否伴有SLE, aD1和抗磷脂酰丝氨酸-凝血酶原IgG是不良妊娠结局的重要独立预测因子,且与狼疮抗凝剂密切相关。联合使用可识别严重产科并发症风险最大的患者。
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Association Between Novel Antiphospholipid Antibodies and Adverse Pregnancy Outcomes.

Objective: To investigate the value of anti-β2 glycoprotein-I domain 1 (aD1) and antiphosphatidylserine-prothrombin antibodies for predicting adverse pregnancy outcomes in an at-risk population and to describe the relationship among aD1, antiphosphatidylserine-prothrombin, lupus anticoagulant, and other antiphospholipid antibodies (aPL).

Methods: Data were obtained from a prospective cohort of pregnant patients with aPL, with systemic lupus erythematosus (SLE) (n=59) or without SLE (n=106), or SLE without aPL (n=100) (PROMISSE [Predictors of Pregnancy Outcome in Systemic Lupus Erythematosus and Antiphospholipid Syndrome] study; NCT00198068). Levels of aD1 and antiphosphatidylserine-prothrombin were quantified with the QUANTA Flash and QUANTA Lite systems, respectively, in sera collected at less than 18 weeks of gestation. Adverse pregnancy outcome was defined as delivery at before 34 weeks of gestation for preeclampsia or placental insufficiency or fetal death after 12 weeks of gestation. Receiver operating characteristic (ROC) analysis assessed the diagnostic properties of aD1 and antiphosphatidylserine-prothrombin for adverse pregnancy outcomes. Bivariate comparisons were made between each biomarker. Multivariable regression modeling of adverse pregnancy outcomes was performed, and backward selection determined variables for a final model for adverse pregnancy outcomes. Logistic regression of lupus anticoagulant quantified the association with aD1 and antiphosphatidylserine-prothrombin. The rate of adverse pregnancy outcomes was described by combined results of lupus anticoagulant, aD1, and antiphosphatidylserine-prothrombin immunoglobulin G (IgG).

Results: Of 265 individuals, 45 (17.0%) experienced adverse pregnancy outcomes. Area under the curve from ROC analysis for aD1 was 0.734 (95% CI, 0.664-0.805), for antiphosphatidylserine-prothrombin IgG was 0.83 (95% CI, 0.751-0.899), and for antiphosphatidylserine-prothrombin immunoglobulin M (IgM) was 0.612 (95% CI, 0.520-0.703). Markers associated with adverse pregnancy outcomes were aD1 (P<.001), anticardiolipin IgG (P<.001), β2-glycoprotein I IgG (P=.003), antiphosphatidylserine-prothrombin IgG (P<.001), antiphosphatidylserine-prothrombin IgM (P=.03), and lupus anticoagulant (P<.001). Backward selection identified lupus anticoagulant, aD1, and antiphosphatidylserine-prothrombin IgG for final adverse pregnancy outcome modeling: lupus anticoagulant odds ratio (OR) 7.0 (95% CI, 3.4-14.4), aD1 OR 12.1 (95% CI, 3.64-40.2), and antiphosphatidylserine-prothrombin IgG OR 11.4 (95% CI, 5.2-25.2). Both aD1 and antiphosphatidylserine-prothrombin IgG remained significant when lupus anticoagulant was removed from the model. Both aD1 and antiphosphatidylserine-prothrombin IgG performed the best in ruling in adverse pregnancy outcomes. With a likelihood ratio less than 0.1, aD1 or antiphosphatidylserine-prothrombin IgG performed well for ruling out adverse pregnancy outcomes. Both aD1 and antiphosphatidylserine-prothrombin IgG were associated with lupus anticoagulant positivity: OR 27.9 (95% CI, 12.1-64.0) if both were positive. Adverse pregnancy outcomes were highest in those with positive lupus anticoagulant, aD1, and antiphosphatidylserine-prothrombin IgG (47.6%).

Conclusion: In pregnant individuals with aPL, with or without SLE, aD1 and antiphosphatidylserine-prothrombin IgG are significant independent predictors of adverse pregnancy outcomes and are strongly associated with lupus anticoagulant. Combined use may identify patients at greatest risk for severe obstetric complications.

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来源期刊
Obstetrics and gynecology
Obstetrics and gynecology 医学-妇产科学
CiteScore
11.10
自引率
4.20%
发文量
867
审稿时长
1 months
期刊介绍: "Obstetrics & Gynecology," affectionately known as "The Green Journal," is the official publication of the American College of Obstetricians and Gynecologists (ACOG). Since its inception in 1953, the journal has been dedicated to advancing the clinical practice of obstetrics and gynecology, as well as related fields. The journal's mission is to promote excellence in these areas by publishing a diverse range of articles that cover translational and clinical topics. "Obstetrics & Gynecology" provides a platform for the dissemination of evidence-based research, clinical guidelines, and expert opinions that are essential for the continuous improvement of women's health care. The journal's content is designed to inform and educate obstetricians, gynecologists, and other healthcare professionals, ensuring that they stay abreast of the latest developments and best practices in their field.
期刊最新文献
ACOG Publications: February 2025. New Editors Selected for Obstetrics & Gynecology. Obstetric Racial Disparities in the Era of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) Trial and the Coronavirus Disease 2019 (COVID-19) Pandemic: Correction. Clinical Validation of a Prenatal Cell-Free DNA Screening Test for Fetal RHD in a Large U.S. Cohort. Online Screening and Virtual Patient Education for Hereditary Cancer Risk Assessment and Testing.
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