Clinical Analysis Of Pregnancy Outcome And Related Factors In Immune-related Recurrent Spontaneous Abortion

Objective:To analysis the pregnancy outcomes of patients with immune-related recurrent spontaneous abortion,study the related factors of pregnancy outcomes,for purpose of providing evidence for clinical management and treatment,improving live-birth rate and decreasing the adverse pregnancy outcomes.Methods:A total of 281 patients with immune-related recurrent spontaneous abortion who visited and treated in the Department of Rheumatology and Immunology of the First Affiliated Hospital of Nanchang University since May 2018 to May 2021 were collected.According to pathogenesis,the patients were divided into autoimmune recurrent spontaneous abortion group and alloimmune recurrent spontaneous abortion group.Then,autoimmune recurrent spontaneous abortion patients were divided into good pregnancy group and adverse pregnancy group,alloimmune recurrent spontaneous abortion patients were divided into good pregnancy group and adverse pregnancy group.We analyzed the relationship between autoimmune recurrent spontaneous abortion,alloimmune recurrent spontaneous abortion and pregnancy outcome by comparing age,number of miscarriages,antiphospholipid antibody,25（OH）VD3,Th1/Th2 cells,Th17/Treg,and the use of GC/ASP/HCQ/heparin.The data were statistically analyzed by t-test,chi-square test and Logistic regression analysis.Results:（1）281 patients were 21-45 years old,with an average age of 31.98±4.84 years old and a median age of 31 years.The times of miscarriages ranged from 2 to 7,with an average of 2.45 and a median of 2.（2）The result of multivariate regression analysis of autoimmune RSA indicated that the number of abortion,anti-phospholipid antibody positive were risk factors for adverse pregnancy outcomes.Meanwhile,adequate 25（OH）VD₃,treat with GC/ASP/heparin were protective factors（OR<1）.（3）The result of multivariate regression analysis of alloimmune RSA showed that increased IL-17 was a risk factor for adverse pregnancy outcomes,While increased IL-10 and Treg、adequate 25（OH）VD₃、treat with GC/ASP/heparin were protective factors（OR<1）.Conclusions:（1）Several factors can increase the risk of adverse pregnancy outcomes in patients with autoimmune recurrent spontaneous abortion,including anti-phospholipid antibody positive,the number of abortions,lake of 25（OH）VD₃.（2）The patients with alloimmune RSA has the characteristic of rising levels of25（OH）VD₃and rising rate of Th1/Th2 and Th17/Treg,treating with GC、heparin can improve the live birth rate.（3）When 25（OH）VD₃is sufficient and treat with GC、heparin,the live birth rate can be appropriately increased in the patients with autoimmune RSA or alloimmune RSA.