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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (6): 1039-1044. doi: 10.19723/j.issn.1671-167X.2023.06.013

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Anti-endothelial cell antibodies in predicting early miscarriage

Liang LUO1,2,Yun LI1,Hong-yan WANG1,Xiao-hong XIANG1,Jing ZHAO1,Feng SUN1,Xiao-ying ZHANG1,*(),Ru-lin JIA1,*(),Chun LI1   

  1. 1. Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing 100044, China
    2. Department of Chinese Medicine, the People's Hospital of Yubei District of Chongqing City, Chongqing 401120, China
  • Received:2023-08-20 Online:2023-12-18 Published:2023-12-11
  • Contact: Xiao-ying ZHANG,Ru-lin JIA E-mail:zhangxiaoying@pkuph.edu.cn;1036013457@qq.com
  • Supported by:
    the China International Medical Foundation(Z-2018-40-2101);Peking University People' s Hospital Scientific Research Development Funds(RD 2022-66)

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Abstract:

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.

Key words: Anti-endothelial cell antibodies, Early miscarriage, Risk factors

CLC Number: 

  • R593.2

Table 1

Comparisons of demographic characteristics between the early miscarriage group and control group"

Variables Early miscarriage group (n=35) Control group (n=87) Z/t/χ2 P
Age/years, ${\bar x}$±s 32.1±6.1 30.7±5.1 -1.129 0.264
Age at first conception/years, ${\bar x}$±s 26.9±5.1 28.0±4.6 1.125 0.265
Number of pregnancies, M (P25，P75) 3 (2, 4) 1 (1, 2) -6.402 < 0.001
Artificial insemination, n (%) 8 (22.9) 12 (13.8) 1.496 0.221
Hyperthyroidism, n (%) 0 (0) 1 (1.1) N/A >0.999
Hypothyroidism, n (%) 6 (17.1) 7 (8.0) 1.319 0.251
Hypertension, n (%) 4 (11.4) 1 (1.1) N/A 0.024
Diabetes, n (%) 2 (5.7) 1 (1.1) N/A 0.198
Hyperlipidemia, n (%) 0 (0) 2 (2.3) N/A >0.999
Uterine fibroids, n (%) 2 (5.7) 12 (13.8) N/A 0.346
Malignant tumor, n (%) 4 (11.4) 2 (2.3) N/A 0.056

Table 2

Comparison of laboratory indexes between the early miscarriage group and control group"

Variables Early miscarriage group (n=35) Control group (n=87) Z/t/χ2 P
WBC/(×109/L), ${\bar x}$±s 8.3 ± 4.5 8.9 ± 4.2 0.663 0.510
HGB/(g/L), ${\bar x}$±s 108.7 ± 24.2 110.3± 23.1 0.339 0.736
PLT/ (×109/L), ${\bar x}$±s 136.6 ± 89.3 171.3 ± 95.5 1.898 0.062
TG/(mmol/L)，${\bar x}$±s 2.7 ± 1.2 2.8 ± 1.9 0.384 0.702
HDL-C/(mmol/L), ${\bar x}$±s 1.6 ± 0.4 1.7 ± 0.5 1.383 0.171
LDL-C/(mmol/L), ${\bar x}$±s 3.1 ± 1.3 3.2 ± 1.0 0.211 0.834
T3/(μg/dL), ${\bar x}$±s 96.6 ± 48.4 121.0 ± 38.2 1.351 0.196
T4/(μg/dL), ${\bar x}$±s 8.6 ± 3.1 10.7 ± 3.7 1.582 0.128
ANA positive, n (%) 2 (5.7) 3 (3.4) N/A 0.624
AECA positive, n (%) 12 (34.3) 7 (8.0) 13.070 < 0.001
Anti-SSA antibody positive, n (%) 3 (8.6) 2 (2.3) N/A 0.142
Anti-SSB antibody positive, n (%) 2 (5.7) 0 (0) N/A 0.081
Anti-dsDNA antibody positive, n (%) 0 (0) 1 (1.1) N/A >0.999
Anti-U1-RNP antibody positive, n (%) 1 (2.9) 0 (0) N/A 0.287
Low C3, n (%) 4 (11.4) 8 (9.2) N/A 0.741
Low C4, n (%) 7 (20.0) 17 (19.5) 0.003 0.954
Elevated IgA, n (%) 0 (0) 2 (2.3) N/A >0.999
Elevated IgG, n (%) 6 (17.1) 4 (4.6) N/A 0.032
Elevated IgM, n (%) 1 (2.9) 3 (3.4) N/A >0.999
D-dimer/(μg/L), M (P25，P75) 412.5 (207.5, 791.0) 588.0 (346.0, 1138.8) -0.726 0.468

Table 3

Results of binary logistic regression analysis for early miscarriage"

Variables Univariate Multivariate
B Wald P OR 95%CI B Wald P OR 95%CI
Number of pregnancies 1.432 25.573 < 0.001 4.188 2.404-7.295 1.423 21.906 < 0.001 4.149 2.287-7.529
Hypertension 2.407 4.476 0.034 11.097 1.194-103.141
PLT/(×109/L) -0.004 3.288 0.070 0.996 0.992-1.000
AECA positive 1.786 11.292 0.001 5.963 2.105-16.889 1.456 4.743 0.029 4.288 1.157-15.893
Elevated IgG 1.457 4.583 0.032 4.293 1.131-16.296 1.821 4.534 0.033 6.177 1.156-33.015

Figure 1

Comparison of fetal survival rates between AECA-positive pregnant women and AECA-negative pregnant women ACEA, anti-endothelial cell antibodies."

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