Katano K, Aoki A, Sasa H, Ogasawara M, Matsuura E, Yagami Y
Department of Obstetrics and Gynecology, Nagoya City University Medical School, Japan.
Hum Reprod. 1996 Mar;11(3):509-12. doi: 10.1093/humrep/11.3.509.
Our aim was to elucidate prospectively whether beta 2-glycoprotein I-dependent anticardiolipin antibodies (beta 2GPI-dependent aCL; autoimmune type) can predict an adverse pregnancy outcome in healthy pregnant women and whether beta 2GPI-dependent aCL should be applied for routine screening of the pregnant population. A prospective cohort study was performed on 1600 healthy pregnant women from whom blood samples were obtained at about week 10 of gestation. We used a modified enzyme-linked immunosorbent assay with which to divide the subjects into three study groups: beta 2GPI-independent aCL positive, beta 2GPI-dependent aCL positive and aCL negative. Their subsequent pregnancy outcomes were ascertained and the three study groups were compared statistically for the following poor pregnancy outcomes: intrauterine fetal death (IUFD) after 12 gestational weeks, intrauterine growth retardation (IUGR) and pre-eclampsia. The total number of patients eligible for this study was 1125. The prevalence of beta 2GPI-dependent aCL positive was eight (0.7%), beta 2GPI-independent aCL positive was 17 (1.5%) and aCL negative was 1100 (97.8%). Beta 2-GPI-dependent aCL positivity was significantly associated with poor pregnancy outcome: 25.0% of beta 2GPI-dependent aCL-positive and 0.5% of aCL-negative patients experienced IUFD [relative risk 52.4; 95% confidence interval (CI), 12.7-216.3; P = 0.0009]; 37.5% of beta 2GPI-dependent aCL-positive and 2.9% of aCL-negative patients experienced IUGR (relative risk 18.4; 95% CI, 4.6-74.0; P = 0.001); and 50.0% of beta 2GPI-dependent aCL-positive and 4.0% aCL-negative patients experienced pre-eclampsia (relative risk 22.1; 95% CI, 5.7-85.7; P = 0.0002). In contrast, beta 2GPI-independent aCL did not show any significant association with such adverse pregnancy outcomes. beta 2GPI-dependent aCL are significantly highly associated with adverse pregnancy outcomes in healthy pregnant women and can be used for prediction purposes, whereas beta 2GPI-independent aCL cannot. Our results suggest that routine screening for beta 2GPI-dependent aCL should be introduced for the general pregnant population.
我们的目的是前瞻性地阐明β2-糖蛋白I依赖性抗心磷脂抗体（β2GPI依赖性aCL；自身免疫型）是否可预测健康孕妇的不良妊娠结局，以及β2GPI依赖性aCL是否应用于孕妇群体的常规筛查。对1600名健康孕妇进行了一项前瞻性队列研究，在妊娠约10周时采集她们的血样。我们使用改良的酶联免疫吸附测定法将受试者分为三个研究组：β2GPI非依赖性aCL阳性、β2GPI依赖性aCL阳性和aCL阴性。确定了她们随后的妊娠结局，并对三个研究组在以下不良妊娠结局方面进行统计学比较：妊娠12周后宫内胎儿死亡（IUFD）、宫内生长受限（IUGR）和先兆子痫。符合本研究条件的患者总数为1125例。β2GPI依赖性aCL阳性的患病率为8例（0.7%），β2GPI非依赖性aCL阳性为17例（1.5%），aCL阴性为1100例（97.8%）。β2-GPI依赖性aCL阳性与不良妊娠结局显著相关：β2GPI依赖性aCL阳性患者中有25.0%发生IUFD，而aCL阴性患者中为0.5%[相对风险52.4；95%置信区间（CI），12.7 - 216.3；P = 0.0009]；β2GPI依赖性aCL阳性患者中有37.5%发生IUGR，而aCL阴性患者中为2.9%（相对风险18.4；95%CI，4.6 - 74.0；P = 0.001）；β2GPI依赖性aCL阳性患者中有50.0%发生先兆子痫，而aCL阴性患者中为4.0%（相对风险22.1；95%CI，5.7 - 85.7；P = 0.0002）。相比之下，β2GPI非依赖性aCL与这些不良妊娠结局无任何显著关联。β2GPI依赖性aCL与健康孕妇的不良妊娠结局显著高度相关，可用于预测目的，而β2GPI非依赖性aCL则不能。我们的结果表明，应针对一般孕妇群体引入β2GPI依赖性aCL的常规筛查。
