TNF-α 阳性复发性流产患者：病因与处理。
TNF-α-positive patients with recurrent pregnancy loss: The etiology and management.
机构信息
Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Qilu Hospital of Shandong University, Jinan, China.
Department of Obstetrics and Gynecology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
出版信息
Technol Health Care. 2024;32(6):4581-4591. doi: 10.3233/THC-240757.
BACKGROUND
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.
OBJECTIVE
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
背景
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。虽然 TNF-α 抑制剂已显示出提高妊娠率的潜力，但仍需要进一步研究以了解其在 RPL 患者中的影响和机制。
目的
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系，并评估 TNF-α 抑制对妊娠结局的影响。
方法
共纳入 249 例 RPL 患者。测量和监测血清 TNF-α、自身抗体和补体水平。其中 138 例 TNF-α 阳性，111 例 TNF-α 阴性。回顾性评估这些患者的病历。此外，102 例 TNF-α 水平升高的患者接受 TNF-α 抑制剂治疗，并评估其妊娠结局。
结果
TNF-α 阳性 RPL 患者的补体 C1q、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 抗体水平更高，抗核抗体阳性率也更高（23.19%比 12.6%，P<0.05）。相反，TNF-α 阳性患者的补体 C3 水平较低（t 检验，P<0.05）。使用 TNF-α 抑制剂可降低早期流产率（13.7%比 44.4%，P<0.001）和提高足月分娩率（52.0%比 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%比 24.3%，P=0.033），足月分娩率较高（69.2%比 48.6%，P=0.033）。
结论
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 抑制剂可提高 TNF-α 阳性 RPL 患者的足月分娩率，且在妊娠 5 周前使用可能更有益。
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