本文選題：復(fù)發(fā)性自然流產(chǎn)　切入點(diǎn)：抗β2糖蛋白Ⅰ抗體　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 復(fù)發(fā)性自然流產(chǎn)(recurrent spontaneous abortion,RSA)是育齡期婦女的常見疾病,對于其發(fā)病原因及治療的探索一直是臨床研究的熱點(diǎn)。抗磷脂綜合征(antiphospholipid syndrome,APS)已經(jīng)明確證實(shí)和復(fù)發(fā)性自然流產(chǎn)密切相關(guān)。其中抗p2糖蛋白Ⅰ抗體作為抗磷脂綜合征的重要診斷標(biāo)準(zhǔn),在復(fù)發(fā)性流產(chǎn)的診斷和治療的作用日漸突出。但是抗β2糖蛋白Ⅰ抗體的在正常育齡期婦女測量值水平尚不清楚,同時對于復(fù)發(fā)性流產(chǎn)的人抗β2糖蛋白Ⅰ抗體小于20RU/mL時我們是否該采取抗凝治療措施,以及采取治療措施后對其預(yù)后有多大幫助尚不清楚。本研究通過對比正常育齡期女性和復(fù)發(fā)性自然流產(chǎn)患者的抗β2糖蛋白Ⅰ抗體的不同水平的分布,同時對門診復(fù)發(fā)性自然流產(chǎn)病人抗β2糖蛋白Ⅰ抗體15-20RU/mL之間的患者采取治療措施與否對于預(yù)后的影響,同時對處于臨界值上下兩組人群采取治療措施病人預(yù)后的比較,以期探索抗β2糖蛋白Ⅰ抗體對復(fù)發(fā)性自然流產(chǎn)的治療指導(dǎo)作用。 方法 本研究回顧性研究就診日期在2012.01.01-2012.12.31之間的于山東大學(xué)附屬山東省立醫(yī)院門診治療的復(fù)發(fā)性自然流產(chǎn)的224名患者臨床和實(shí)驗(yàn)室數(shù)據(jù),同時對這些患者電話隨訪了解治療結(jié)局。其中抗心磷脂抗體陰性的患者有210人,定義為A組。將A組患者根據(jù)抗β2糖蛋白Ⅰ抗體不同水平分為三組：A1組小于15RU/mL、A2組15RU/mL-20RU/mL之間的和A3組大于20RU/mL。同時收集40名正常育齡期女性的相關(guān)病史和實(shí)驗(yàn)室數(shù)據(jù)作為正常對照B組。 1.分析A、B兩組人群中抗p2糖蛋白Ⅰ抗體檢測值的分布并比較有無差異。 2.分析抗β2糖蛋白Ⅰ抗體三種抗體水平IgM、IgG、IgA和復(fù)發(fā)性自然流產(chǎn)相關(guān)性。 3.比較A組人群中抗β2糖蛋白抗體處于不同水平時是否接受抗凝治療對預(yù)后的的影響。 4.應(yīng)用統(tǒng)計學(xué)軟件SPSS21.0對數(shù)據(jù)結(jié)果進(jìn)行分析, P0.05為差異具有統(tǒng)計學(xué)意義。 結(jié)果 1.A組和B組人群中抗β2糖蛋白Ⅰ抗體小于15RU/mL、5RU/mL-20RU/mL之間的和大于20RU/mL的分別為：110人、52人、48人；34人、2人、4人。復(fù)發(fā)性流產(chǎn)組和正常對照組抗β2糖蛋白Ⅰ抗體分布差異有統(tǒng)計學(xué)意義。 2.抗β2糖蛋白Ⅰ抗體陽性的48人,全部伴有IgM陽性,IgA陽性者6人,IgG陽性者1人。 3.(1)A組人群中抗β2糖蛋白Ⅰ抗體15RU/mL-20RU/mL,即A2組患者接受抗凝治療以及妊娠成功人數(shù)分別為：21人和14人。A2組未接受抗凝治療以及妊娠成功人數(shù)分別為：31和6人。A2組中接受抗凝治療組和非治療組預(yù)后差異具有統(tǒng)計學(xué)意義。 (2)A組人群中抗β2糖蛋白Ⅰ抗體大于20RU/mL,即A3組患者接受抗凝治療和妊娠成功者分別為：30和22人。對比A2組接受抗凝治療的患者,預(yù)后無明顯差異。 4.對于A2+A3組患者接受抗凝治療以及妊娠成功人數(shù)分別為51和36人；未接受抗凝治療以及妊娠成功人數(shù)分別為49和9人。接受抗凝治療的患者和未接受抗凝治療的患者預(yù)后差異有統(tǒng)計學(xué)意義。 結(jié)論 1.復(fù)發(fā)性流產(chǎn)組女性體內(nèi)的抗β2糖蛋白Ⅰ抗體水平和正人群存在顯著差異,當(dāng)抗體水平大于15RU/mL時差異明顯。 2.復(fù)發(fā)性流產(chǎn)病人主要與抗β2糖蛋白Ⅰ抗體中的IgM相關(guān)。 3.對于抗β2糖蛋白Ⅰ抗體處于陽性臨界值以下(15-20RU/mL之間)的復(fù)發(fā)性流產(chǎn)的病人采取抗凝治療后期妊娠結(jié)局明顯好于未接受抗凝治療的病人。 4.對于抗β2糖蛋白Ⅰ抗體處于陽性臨界值以下(15-20RU/mL之間)的復(fù)發(fā)性流產(chǎn)的病人采取抗凝治療后期妊娠結(jié)局和抗β2糖蛋白Ⅰ抗體陽性的病人治療后的妊娠結(jié)局無明顯差異。
[Abstract]:objective
Recurrent spontaneous abortion (recurrent spontaneous, abortion, RSA) is a common disease of women of childbearing age, to explore its pathogenesis and treatment has been a hot topic in clinical research. The antiphospholipid syndrome (antiphospholipid syndrome APS) has been confirmed and recurrent spontaneous abortion is closely related. The anti P2 antibody as an important diagnostic glycoprotein the standard of antiphospholipid syndrome in the diagnosis and treatment of recurrent spontaneous abortion have become increasingly prominent role. But the anti beta 2 glycoprotein antibodies in normal women of childbearing age measurement level is not clear, at the same time for recurrent abortion anti beta 2 glycoprotein antibody is less than 20RU/mL whether we should take anticoagulation measures. And after treatment on the prognosis of help is unclear. This study by anti beta patients compared with normal women of childbearing age and recurrent spontaneous abortion 2 sugar The distribution of different levels of antibody protein, while outpatient recurrent spontaneous abortion patients between 2 anti beta glycoprotein antibody 15-20RU/mL patients to take treatment and not for prognosis, while in the critical value under the two groups compared the prognosis of patients take measures, in order to explore the anti beta 2 glycoprotein antibody for the treatment of recurrent spontaneous abortion guide.
Method
This study reviewed 224 patients with clinical and laboratory data of the date between 2012.01.01-2012.12.31 in the treatment of Shandong University affiliated Shangdong Province-owned Hospital outpatient recurrent spontaneous abortion, and telephone follow-up for these patients understand the treatment outcome. The anti cardiolipin antibody negative patients 210 were defined as group A, A group according to. Anti beta 2 glycoprotein antibody levels were divided into three groups: A1 group was less than 15RU/mL, the related history and laboratory data between A2 group and 15RU/mL-20RU/mL A3 group than 20RU/mL. and 40 normal women of childbearing age as normal control group B.
1. the distribution of anti P2 glycoprotein I antibody in A and B two groups was analyzed and there were no differences.
2. the correlation of IgM, IgG, IgA, and recurrent spontaneous abortion was analyzed for the anti beta 2 glycoprotein I antibody level of three antibodies.
3. to compare the effect of anticoagulant therapy on the prognosis of the A group at different levels of anti beta 2 glycoprotein antibody at different levels.
4. statistics software SPSS21.0 is used to analyze the results of the data, and P0.05 has statistical significance for the difference.
Result
In group 1.A and group B, the anti beta 2 glycoprotein I antibody was less than 15RU/mL, 5RU/mL-20RU/mL and 20RU/mL were 110, 52, 48, 34, 2, 4, respectively. There was a significant difference in the distribution of anti beta 2 glycoprotein I antibody between recurrent abortion group and normal control group.
2. anti beta 2 glycoprotein I antibody positive 48, all accompanied by IgM positive, 6 IgA positive, and 1 IgG positive.
3. (1) A group anti beta 2 glycoprotein antibody 15RU/mL-20RU/mL, A2 group of patients receiving anticoagulant therapy and the number of successful pregnancy were 21 and 14 in group.A2 did not receive anticoagulant therapy and the number of successful pregnancy were 31 and 6 in the.A2 group received significant anticoagulant therapy group and non the treatment group differences in prognosis.
(2) the anti beta 2 glycoprotein I antibody in group A is more than 20RU/mL, that is, A3 group receiving anticoagulant therapy and pregnancy success is 30 and 22 respectively. Compared with A2 group, there is no significant difference in prognosis between patients receiving anticoagulation therapy and those with anticoagulation therapy.
4., for A2+A3 group, the number of patients receiving anticoagulation therapy and pregnancy success was 51 and 36, respectively. The number of patients who did not receive anticoagulation therapy and pregnancy success were 49 and 9, respectively. There was a significant difference in prognosis between patients receiving anticoagulation therapy and those who did not receive anticoagulation therapy.
conclusion
1. there were significant differences in the level of anti beta 2 glycoprotein I antibody and the positive population in the female recurrent abortion group, and the difference was obvious when the antibody level was greater than 15RU/mL.
2. the patients with recurrent abortion are mainly associated with IgM in the anti beta 2 glycoprotein I antibody.
3., for patients with recurrent abortion with anti beta 2 glycoprotein I antibody below the positive threshold value (15-20RU/mL), anticoagulant therapy is better than late anticoagulation therapy.
4., there was no significant difference in the pregnancy outcome of patients with recurrent spontaneous abortion below the positive threshold value (15-20RU/mL) between anticoagulant therapy and those who had positive anti beta 2 glycoprotein I antibody after treatment with anti beta 2 glycoprotein I antibody.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.21

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