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抗凝蛋白缺陷与反复妊娠丢失相关性研究
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Abstract:
目的：探讨中国反复妊娠丢失(Recurrent Pregnancy Loss, RPL)患者血浆抗凝蛋白缺陷的特征。方法：收集2019年~2021年期间在我院门诊就诊的1604例患者进行回顾性病例对照研究，其中RPL患者1407例，非RPL患者200例。抗凝蛋白指标包括：蛋白S、蛋白C、抗凝血酶III (Antithrombin III, AT-III)。使用SPSS17.0软件进行统计学分析(SPSS Inc, ChicagoIL, USA)。结果：在1407例RPL患者中，蛋白S缺陷最为常见，占21.32%，AT-III缺陷发生率为1%，蛋白C活性低下比例为0.64%。在200例非RPL患者中，仅10%的患者出现蛋白S活性降低，蛋白C和AT-III活性均正常。蛋白S活性低下在RPL组和非RPL组之间有统计学差异(P < 0.001)，蛋白C和ATIII在RPL组和非RPL组之间无统计学差异(P > 0.05)。且随着流产次数的增加，蛋白S活性低下的发生率显著增加(P < 0.01, P < 0.001)。有晚期流产史(妊娠≥12)的RPL患者蛋白S活性低下发生率明显高于有早期流产史(妊娠<12 w) (22.81% vs 16.88%, P < 0.05)的RPL患者。另外，约25%合并自身抗体阳性的RPL患者中出现蛋白S活性低下(P < 0.05)，继发性APS患者中蛋白S活性异常的发生率高达50% (P < 0.001)。结论：中国RPL患者发生血浆蛋白S缺陷的比例增高，尤其有晚期流产史和自身抗体呈阳性的RPL患者蛋白S缺陷发生比例更高。建议对有晚期流产史和自身抗体阳性的RPL患者进行蛋白S的检测和及早的治疗。
Aim: To investigate the characteristics of plasma anticoagulant protein deficiency in Chinese patients with recurrent pregnancy loss (RPL). Methods: A retrospective and case-control study was conducted of 1407 RPL patients and 200 women without a history of RPL in our Outpatient Clinic during 2019 to 2021 by the following factors: Protein S, protein C, antithrombin III (AT-III). The data were analyzed using SPSS 17.0 software (SPSS Inc, Chicago, IL, USA). Results: Of 1407 RPL patients, low protein S activity was the most prevalent (21.32%). ATIII was abnormal in 1% and Protein C was abnormal in 0.64%. 10% non-RPL patients were subjected to reduced activity of Protein S, whereas Protein C and AT-III were normal in all non-RPL cases. Protein S activity was significantly lower in RPL group than in non-RPL Group (P < 0.001). Protein C and ATIII had no significant difference between RPL Group and non-RPL Group (P > 0.05). With increasing abortions, the incidence of low protein S activity increased significantly (P < 0.01, P < 0.001), while no significant difference was found between RPL group and non-RPL group for deficiency of protein C and ATIII (P > 0.05). The incidence of low protein S activity was significantly higher in RPL patients with late abortion (≥12 weeks of gestation) than those with early abortion (<12 w) (22.81% vs 16.88%, P < 0.05). Approximately 25% of RPL individuals who are positive antibodies have reduced activities of protein S (P < 0.05). Moreover, the prevalence of low protein S activity goes up to 50% in RPL patients with APS and positive other antibodies (P < 0.001). Conclusion: Reduced Protein S activity occurs in Chinese women with RPL, especially for those with late abortion and positive for auto-antibodies. We suggest performing the tests of Protein S tests in RPL
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