TNF-α阳性的复发性妊娠失败患者：病因和管理。

IF 1.4 4区医学 Q4 ENGINEERING, BIOMEDICAL

Technology and Health Care Pub Date : 2024-07-16 DOI:10.3233/THC-240757

Zhuhua Cai, Xueke Guo, Ge Zheng, Junmiao Xiang, Lingyun Liu, Dongmei Lin, Xiaohui Deng

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引用次数: 0

摘要

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）。这些水平的升高可能与自身抗体的存在有关。尽管TNF-α抑制剂有望提高妊娠率，但仍需进一步研究其对RPL患者的影响和机制：本研究旨在探讨RPL患者TNF-α水平升高与自身抗体之间的关联，并评估TNF-α抑制剂对妊娠结局的影响：方法：本研究共纳入249名RPL患者。方法：本研究共纳入249名RPL患者，对其血清中的TNF-α、自身抗体和补体水平进行了测量和监测。其中，138 名患者的 TNF-α 检测呈阳性，111 名呈阴性。对这些患者的病历进行了回顾性评估。此外，102名TNF-α水平升高的患者接受了TNF-α抑制剂治疗，并对其妊娠结局进行了评估：结果：与TNF-α阴性患者相比，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% vs. 12.6%，P< 0.05）。相反，TNF-α阳性患者的补体C3较低（t检验，P< 0.05）。使用TNF-α抑制剂降低了早期流产率（13.7% vs. 44.4%，P< 0.001），提高了足月分娩率（52.0% vs. 27.8%，P= 0.012）。此外，在怀孕5周前使用TNF-α抑制剂的患者早期流产率较低（7.7% vs. 24.3%，P= 0.033），足月分娩率较高（69.2% vs. 48.6%，P= 0.033）：结论：TNF-α在RPL的发生和发展中起作用，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，在妊娠5周前使用可能更有益。

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TNF-α-positive patients with recurrent pregnancy loss: The etiology and management.

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.

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来源期刊

Technology and Health Care HEALTH CARE SCIENCES & SERVICES-ENGINEERING, BIOMEDICAL

CiteScore

2.10

自引率

6.20%

发文量

282

审稿时长

>12 weeks

期刊介绍： Technology and Health Care is intended to serve as a forum for the presentation of original articles and technical notes, observing rigorous scientific standards. Furthermore, upon invitation, reviews, tutorials, discussion papers and minisymposia are featured. The main focus of THC is related to the overlapping areas of engineering and medicine. The following types of contributions are considered: 1.Original articles: New concepts, procedures and devices associated with the use of technology in medical research and clinical practice are presented to a readership with a widespread background in engineering and/or medicine. In particular, the clinical benefit deriving from the application of engineering methods and devices in clinical medicine should be demonstrated. Typically, full length original contributions have a length of 4000 words, thereby taking duly into account figures and tables. 2.Technical Notes and Short Communications: Technical Notes relate to novel technical developments with relevance for clinical medicine. In Short Communications, clinical applications are shortly described. 3.Both Technical Notes and Short Communications typically have a length of 1500 words. Reviews and Tutorials (upon invitation only): Tutorial and educational articles for persons with a primarily medical background on principles of engineering with particular significance for biomedical applications and vice versa are presented. The Editorial Board is responsible for the selection of topics. 4.Minisymposia (upon invitation only): Under the leadership of a Special Editor, controversial or important issues relating to health care are highlighted and discussed by various authors. 5.Letters to the Editors: Discussions or short statements (not indexed).