背景:抗核抗体(ANA)在复发性妊娠丢失(RPL)发病机理中的潜在作用仍存在争议,尽管一些证据表明它们可能会影响妊娠结局,导致这些患者的流产率较高。一个假设的机制是通过在概念前阶段子宫血流的变化,通过改变RPL中的子宫内膜容受性。然而,可用的数据很少,在怀孕期间,关于它们在RPL胎盘灌注中的作用,关于其潜在的治疗方法,如低分子量肝素(LMWH)。这项研究的目的是回顾性地进一步调查二维(2D)和三维(3D)子宫和胎盘血流指数与存在或不存在ANA之间的相关性。用LMWH治疗或不治疗。
方法:二维多普勒测量子宫动脉搏动指数(PI)和三维超声测定血管化指数(VI),在LMWH治疗(n24)和未治疗的uRPL患者(n20)和相对对照组(n27)中,借助虚拟器官计算机辅助分析(VOCAL)技术进行了血流指数(FI)和血管化血流指数(VFI)。每组分为ANA+和ANA-亚组。在所有女性中进行ANA存在的血清测定。
结果:在PI方面没有发现差异,VFI和VI值,通过比较不同的群体。对于未接受LMWH治疗的RPL女性和接受治疗的女性,ANA患者的VI值存在差异(p=0.01),具有较低的VI值且与控件类似。通过仅考虑ANA治疗和未治疗的RPL患者,ROC曲线显示面积为0.80,在VI截断值为11,08时,灵敏度为85%,特异性为67%。
结论:LMWH可以在恢复uRPLANA状态下VI的生理血流供应方面发挥潜在的有益作用,建议在研究背景下将ANA和VI调查纳入RPL诊断算法,因为需要进一步的研究来澄清这一具有挑战性的假设,以便尝试改善ANA和胎盘血管形成异常对RPL妊娠结局的负面影响。
BACKGROUND: The potential role of antinuclear antibodies (ANA) in recurrent pregnancy loss (RPL) pathogenesis is still debated, although some evidences suggest that they could affect pregnancy outcome, leading to a higher miscarriage rate in these patients. A hypothesized mechanism is through changes in uterine flow in pre-conceptional stage, by modifying endometrial receptivity in RPL. However, scant data are available, in pregnancy, about their role in RPL placental perfusion, also in relation to its potential treatments, such as low molecular weight heparin (LMWH). The aim of this
study is to retrospectively further investigate the correlation between two-dimensional (2D) and three-dimensional (3D) uterine and placental flow indexes and the presence or the absence of ANA in women with unexplained RPL (uRPL), treated or not treated with LMWH.
METHODS: 2D Doppler measurement of pulsatility index (PI) of the uterine arteries and 3D ultrasonography determination of vascularization index (VI), flow index (FI) and vascularization flow index (VFI) was carried out with the aid of the virtual organ computer-aided analysis (
VOCAL) technique in LMWH treated (n 24) and not treated-uRPL patients (n 20) and in the relative control group (n 27), each group divided in ANA+ and ANA- subgroups. Serum assay for the presence of ANA was performed in all women.
RESULTS: No differences were found in PI, VFI and VI values, by comparing the different groups. A difference in VI values was found for ANA- patients between RPL women not treated with LMWH and the treated ones (p = 0,01), which have lower VI values and similar to controls. By considering only ANA- treated and not treated RPL patients, the ROC curve shows an area of 0,80 and at the VI cut-off of 11,08 a sensitivity of 85% and a specificity of 67%.
CONCLUSIONS: LMWH could exert a potential beneficial effect in restoring the physiological blood flow supply in terms of VI in uRPL ANA- status, suggesting to include ANA and VI investigations in the RPL diagnostic algorithm in a research context, since further studies are needed to clarify this challenging hypothesis in order to try to ameliorate ANA and abnormal placental vascularization negative influence on RPL pregnancy outcome .