Objective: To explore the clinical significance of anti-endothelial cell antibodies (AECA) in predicting early miscarriage.
Methods: A total of 122 pregnant women with no history of autoimmune diseases who underwent prenatal examination at Peking University People's Hospital from January 2020 to December 2022 were selected, and they were tested for AECA. Based on the history of early miscarriage (gestational age at miscarriage < 12 weeks), the participants were divided into an early miscarriage group and a control group. t-tests, non-parametric Wilcoxon tests, Chi-square tests, and Fisher's exact probability method were used to compare general information and laboratory indicators between the two groups. A multivariate Logistic regression model was used to analyze the factors associated with early miscarriage. The natural miscarriage rates were assessed through follow-up with pregnant women, and Kaplan-Meier survival analysis was employed to compare the natural miscarriage rates between AECA-positive and AECA-negative pregnant women.
Results: (1) A total of 122 pregnant women were enrolled, comprising 35 cases (28.7%) in the early miscarriage group, with an average age of (32.1±6.1) years, and 87 cases (71.3%) in the control group, with an average age of (30.7±5.1) years. The early miscarriage group had higher gravidity [3 (2, 4) vs. 1 (1, 2), Z=-6.402, P < 0.001] and a higher prevalence of hypertension (11.4% vs.1.1%, P=0.024). The positive rate of AECA in the early miscarriage group (34.3% vs. 8.0%, χ2=13.070, P < 0.001) and the proportion of elevated immunoglobulin G (17.1% vs. 4.6%, P=0.032) were significantly higher than that in the control group. (2) Multivariate logistic regression analysis showed that higher gravidity (OR=4.149, 95%CI: 2.287-7.529, P < 0.001), AECA positivity (OR= 4.288, 95% CI: 1.157-15.893, P=0.029), and elevated immunoglobulin G levels (OR =6.177, 95%CI: 1.156-33.015, P=0.033) were risk factors for early miscarriage. (3) The 122 pregnant women were categorized into two groups: the AECA-positive group (19 cases) and the AECA-negative group (103 cases). Survival analysis demonstrated that at the end of 12 weeks of gestation, the fetal survival rate in the AECA-positive group was significantly lower than that in the AECA-negative group (84.2% vs. 96.1%, P= 0.035).
Conclusion: Higher gravidity, AECA positivity, and elevated immunoglobulin G levels are significant risk factors for early miscarriage. The results demonstrate that AECA is a novel predicting test in early miscarriage.
目的: 探讨抗内皮细胞抗体(anti-endothelial cell antibodies, AECA)预测早期流产的临床意义。
方法: 选取2020年1月至2022年12月于北京大学人民医院进行产检并完善AECA的无自身免疫病史孕妇122例。根据早期流产史(流产时孕周＜12周)，将研究对象分为早期流产组和对照组，采用t检验、非参数Wilcoxon检验、Chi-square检验、Fisher确切概率法比较两组一般资料和实验室指标，多因素Logistic回归模型分析早期流产的相关因素。随访孕妇的自然流产情况，Kaplan-Meier生存分析比较AECA阳性和AECA阴性孕妇的自然流产率。
结果: (1) 共纳入122例孕妇，其中早期流产组35例(28.7%)，平均年龄(32.1±6.1)岁；对照组87例(71.3%)，平均年龄(30.7±5.1)岁。早期流产组有更多的妊娠次数[3 (2, 4) vs. 1 (1, 2), Z=-6.402, P < 0.001]和高血压合并症(11.4% vs.1.1%, P=0.024)。早期流产组AECA的阳性率(34.3% vs. 8.0%, χ2=13.070, P < 0.001)和免疫球蛋白G升高的比例(17.1% vs. 4.6%, P=0.032)显著高于对照组。(2)多因素Logistic回归分析结果显示，妊娠次数增加(OR=4.149, 95%CI: 2.287~7.529, P < 0.001)、AECA阳性(OR=4.288, 95%CI: 1.157~15.893, P=0.029)、免疫球蛋白G升高(OR=6.177, 95%CI: 1.156~33.015, P=0.033)是早期流产的危险因素。(3)将122例孕妇分为AECA阳性组(19例)和AECA阴性组(103例)，生存分析显示，孕12周时AECA阳性组的胎儿生存率显著低于AECA阴性组(84.2% vs. 96.1%, P=0.035)。
结论: 妊娠次数增加、AECA阳性及免疫球蛋白G升高是导致早期流产的显著危险因素；AECA的检测有助于预测早期流产，可以为改善妊娠结局提供依据。
Keywords: Anti-endothelial cell antibodies; Early miscarriage; Risk factors.