Liu Manman, Zhang Hebo, Xu Shilian, Zhang Rui, Yuan Mengfan, Ren Bingnan, Zhang Wenjuan, Liu Zhaozhao, Guan Yichun
Department of Reproductive Medicine, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Int J Gynaecol Obstet. 2025 Jul;170(1):352-360. doi: 10.1002/ijgo.16183. Epub 2025 Jan 30.
To explore the correlation between antinuclear antibodies (ANAs) and pregnancy loss (PL), and to observe its impact on the pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) in recurrent PL (RPL) patients.
In this retrospective study, patients first seen at the hospital between January 2016 and December 2022 and who underwent two ANA tests within 4-6 weeks were included. After exclusion of confounding factors, patients were allocated to the non-pregnancy loss (non-PL), single-PL, or RPL group according to previous number of PLs, and the correlation between PL and ANAs was analyzed. The first embryo transfer (ET) after in vitro IVF/ICSI without immunological treatment was placed in the RPL group, and patients were classified into the ANA-negative or ANA-positive subgroup according to ANA titer. The effect of ANAs on pregnancy outcomes in the RPL patients after IVF/ICSI-ET was further analyze.
The results of multivariate unordered logistic regression showed that when the non-PL group was used as the reference, ANA positivity was an independent risk factor for RPL (P = 0.023) but not for single PL (P = 0.654). When the single-PL group was used as the reference, ANA positivity was an independent risk factor for RPL (P = 0.022). Multivariate logistic regression analysis revealed that the early PL rate of the ANA-positive subgroup was significantly higher than that of the ANA-negative subgroup (P = 0.009), and the total PL rate of the ANA-positive subgroup was significantly higher than that of the ANA-negative subgroup (P = 0.049).
The results showed that ANA positivity may be related to RPL occurrence, but there was no significant correlation between ANA positivity and single PL. ANA positivity is associated with PL occurrence in RPL patients after transfer, and the correlation is reflected mainly in the first trimester.
探讨抗核抗体（ANA）与妊娠丢失（PL）之间的相关性，并观察其对复发性妊娠丢失（RPL）患者体外受精/卵胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）妊娠结局的影响。
本回顾性研究纳入了2016年1月至2022年12月期间首次在本院就诊且在4-6周内进行了两次ANA检测的患者。排除混杂因素后，根据既往PL次数将患者分为非妊娠丢失（非PL）组、单次PL组或RPL组，并分析PL与ANA之间的相关性。将未进行免疫治疗的体外IVF/ICSI后首次胚胎移植（ET）纳入RPL组，并根据ANA滴度将患者分为ANA阴性或ANA阳性亚组。进一步分析ANA对RPL患者IVF/ICSI-ET后妊娠结局的影响。
多因素无序逻辑回归结果显示，以非PL组为参照时，ANA阳性是RPL的独立危险因素（P = 0.023），但不是单次PL的独立危险因素（P = 0.654）。以单次PL组为参照时，ANA阳性是RPL的独立危险因素（P = （0.022）。多因素逻辑回归分析显示，ANA阳性亚组的早期PL率显著高于ANA阴性亚组（P = 0.009），ANA阳性亚组的总PL率显著高于ANA阴性亚组（P = 0.049）。
结果表明，ANA阳性可能与RPL的发生有关，但ANA阳性与单次PL之间无显著相关性。ANA阳性与RPL患者移植后PL的发生有关，且这种相关性主要体现在孕早期。
