Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Lupus. 2021 May;30(6):981-990. doi: 10.1177/09612033211001126. Epub 2021 Mar 12.
We investigated the validity of quad serum markers for the prediction of adverse pregnancy outcome (APO) in women with antiphospholipid antibody syndrome (APS).
We included 75 women with APS delivered at our institution. APO was defined as stillbirth, small for gestational age (SGA), severe preeclampsia, or preterm delivery. First, we compared clinical characteristics between patients with or without composite APO. Second, we compared the rate of APO according to abnormal level of quad serum markers. Lastly, receiver operating characteristic (ROC) curve analysis was performed.
APS mothers with APO showed higher median α-fetoprotein (AFP) and inhibin A compared with those without APO. They were also associated with higher rates of positive risk of Down syndrome and neural tube defect. Elevated AFP, human chorionic gonadotropin (hCG), and inhibin A level was associated with higher rates of stillbirth, SGA, preterm delivery, and composite APO. ROC curve for prediction of stillbirth revealed an area under the curve of 0.835 for AFP, 0.781 for hCG, and 0.932 for inhibin A. For composite APO, the area under the ROC curve was 0.692 for AFP and 0.810 for inhibin A.
Elevated AFP, hCG, and inhibin A in women with APS demonstrated a high predictive value for APO, especially stillbirth.
我们研究了抗磷脂抗体综合征（APS）女性中四项血清标志物预测不良妊娠结局（APO）的有效性。
我们纳入了在我院分娩的 75 名 APS 患者。APO 定义为死胎、小于胎龄儿（SGA）、重度子痫前期或早产。首先，我们比较了 APO 患者和非 APO 患者的临床特征。其次，我们比较了四项血清标志物异常水平患者的 APO 发生率。最后，进行了受试者工作特征（ROC）曲线分析。
APO 的 APS 母亲的中位甲胎蛋白（AFP）和抑制素 A 高于无 APO 的患者。它们还与唐氏综合征和神经管缺陷的阳性风险率升高相关。升高的 AFP、人绒毛膜促性腺激素（hCG）和抑制素 A 水平与死胎、SGA、早产和复合 APO 的发生率升高相关。预测死产的 ROC 曲线 AFP 的曲线下面积为 0.835，hCG 为 0.781，抑制素 A 为 0.932。对于复合 APO，AFP 的 ROC 曲线下面积为 0.692，抑制素 A 为 0.810。
APS 女性中 AFP、hCG 和抑制素 A 的升高对 APO 有很高的预测价值，尤其是死胎。
