Wang Bo, Li Qian, Li Chunli, Li Shu
Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, China.
Medicine (Baltimore). 2025 Aug 1;104(31):e43604. doi: 10.1097/MD.0000000000043604.
The causes of recurrent spontaneous abortion (RSA) are highly complex. A comprehensive analysis of the risk factors for RSA will be beneficial for its diagnosis and treatment. Peripheral blood from RSA patients were collected to test the levels of autoantibodies, thyroid antibodies, anticoagulant proteins, and lupus-anticoagulants. Then, 3 major electronic databases (PubMed, China National Knowledge Infrastructure, and Cochrane Library) were searched to include all detection indicators related to RSA. First, we found that 6 autoantibodies were significantly elevated in RSA patients. Among these, antinuclear antibody (RSA: 32.99 ± 3.85; control group: 13.51 ± 3.30, P < .001, R = 0.612) showed the highest correlation with RSA. Additionally, the expression levels of anti-double-stranded DNA antibody-IgG antibody (R = 0.306) and anti-RA33 IgG antibody (R = 0.265) were also highly correlated with RSA. The protein S activity in RSA patients was significantly lower than in the control group. The ratios of lupus-anticoagulants, thyroid peroxidase antibodies, and thyroglobulin antibodies were significantly higher in RSA patients. Then, the meta-analysis revealed that the levels of antinuclear antibody, thyroid peroxidase antibody, anticardiolipid antibody, lupus anticoagulant, DFI, and BMI were significantly elevated in RSA patients, while the activity of protein S and protein C were decreased. Finally, there were no statistically significant differences in the expression levels of these indicators between patients with 2 and 3 miscarriage histories. Given the complexity of the causes of RSA, early multi-indicator combined testing for patients with a history of ≥2 miscarriages can effectively improve the accuracy of diagnosing RSA. This approach can optimize treatment plans and improve the prognosis for patients with RSA.
复发性自然流产(RSA)的病因高度复杂。对RSA的危险因素进行全面分析将有助于其诊断和治疗。收集RSA患者的外周血以检测自身抗体、甲状腺抗体、抗凝蛋白和狼疮抗凝物的水平。然后,检索3个主要电子数据库(PubMed、中国知网和Cochrane图书馆),纳入所有与RSA相关的检测指标。首先,我们发现RSA患者中有6种自身抗体显著升高。其中,抗核抗体(RSA:32.99±3.85;对照组:13.51±3.30,P<0.001,R=0.612)与RSA的相关性最高。此外,抗双链DNA抗体-IgG抗体(R=0.306)和抗RA33 IgG抗体(R=0.265)的表达水平也与RSA高度相关。RSA患者的蛋白S活性显著低于对照组。RSA患者中狼疮抗凝物、甲状腺过氧化物酶抗体和甲状腺球蛋白抗体的比例显著更高。然后,荟萃分析显示RSA患者的抗核抗体、甲状腺过氧化物酶抗体、抗心磷脂抗体、狼疮抗凝物、DFI和BMI水平显著升高,而蛋白S和蛋白C的活性降低。最后,有2次和3次流产史的患者之间这些指标的表达水平无统计学显著差异。鉴于RSA病因的复杂性,对有≥2次流产史的患者进行早期多指标联合检测可有效提高RSA的诊断准确性。这种方法可以优化治疗方案并改善RSA患者的预后。