■肿瘤坏死因子-α(TNF-α)水平升高与不良妊娠结局有关,特别是复发性妊娠丢失(RPL)。这些升高的水平可能与自身抗体的存在有关。尽管TNF-α抑制剂已显示出改善妊娠率的希望,需要进一步的研究来了解它们对RPL患者的影响和机制.
■本研究旨在探讨RPL患者中TNF-α水平升高与自身抗体之间的关联。以及评估TNF-α抑制对妊娠结局的影响。
■本研究共纳入249例RPL患者。血清TNF-α水平,自身抗体,测量和监测补体。在这些患者中,138例TNF-α检测呈阳性,而111检测为阴性。对这些患者的病历进行回顾性评估。此外,102例TNF-α水平升高的患者接受TNF-α抑制剂治疗,并对其妊娠结局进行评估.
■TNF-α阳性RPL患者的补体C1q水平较高,抗心磷脂(ACL)-IgA,ACL-IgM,ACL-IgG,甲状腺球蛋白抗体,和抗磷脂酰丝氨酸/凝血酶原IgM抗体,以及与TNF-α阴性患者相比,抗核抗体阳性率更高(23.19%vs.12.6%,P<0.05)。相反,TNF-α阳性患者的补体C3较低(t检验,P<0.05)。使用TNF-α抑制剂导致早期流产率降低(13.7%vs.44.4%,P<0.001)和足月分娩率的改善(52.0%vs.27.8%,P=0.012)。此外,在妊娠5周前使用TNF-α抑制剂的患者早期流产率较低(7.7%vs.24.3%,P=0.033)和更高的定期交付率(69.2%与48.6%,P=0.033)。
■TNF-α在RPL的发生发展中起作用,其表达与自身抗体和补体密切相关。TNF-α抑制剂增加TNF-α阳性RPL患者的足月分娩率,在怀孕5周之前使用它们可能更有益。
UNASSIGNED: Elevated levels of tumor necrosis factor-alpha (TNF-α) have been associated with adverse pregnancy outcomes, specifically recurrent pregnancy loss (RPL). These elevated levels may be associated with the presence of autoantibodies. Although TNF-α inhibitors have shown promise in improving pregnancy rates, further research is needed to comprehend their impact and mechanisms in RPL patients.
UNASSIGNED: This study aims to investigate the association between elevated TNF-α levels and autoantibodies in RPL patients, as well as evaluate the effect of TNF-α inhibition on pregnancy outcomes.
UNASSIGNED: A total of 249 RPL patients were included in this study. Serum levels of TNF-α, autoantibodies, and complement were measured and monitored. Among these patients, 138 tested positive for TNF-α, while 111 tested negative. The medical records of these patients were retrospectively evaluated. Additionally, 102 patients with elevated TNF-α levels were treated with TNF-α inhibitors, and their pregnancy outcomes were assessed.
UNASSIGNED: TNF-α-positive RPL patients had higher levels of complement C1q, anti-cardiolipin (ACL)-IgA, ACL-IgM ,ACL-IgG, thyroglobulin antibody, and Anti-phosphatidylserine/prothrombin IgM antibody, as well as a higher positive rate of antinuclear antibodies compared to TNF-α-negative patients (23.19% vs. 12.6%, P< 0.05). Conversely, complement C3 were lower in TNF-α-positive patients (t test, P< 0.05). The use of TNF-α inhibitors led to a reduction in the early abortion rate (13.7% vs. 44.4%, P< 0.001) and an improvement in term delivery rate (52.0% vs. 27.8%, P= 0.012). Furthermore, patients who used TNF-α inhibitors before 5 weeks of pregnancy had a lower early abortion rate (7.7% vs. 24.3%, P= 0.033) and a higher term delivery rate (69.2% vs. 48.6%, P= 0.033).
UNASSIGNED: TNF-α plays a role in the occurrence and development of RPL, and its expression is closely associated with autoantibodies and complements. TNF-α inhibitors increase the term delivery rate in TNF-α-positive RPL patients, and their use before 5 weeks of pregnancy may more beneficial.