血清孕酮、IL-6和甲状腺过氧化物酶抗体联合检测在先兆流产患者中的临床应用价值

Clinical value of combined detection of serum progesterone,IL-6 and thyroid peroxidase antibody in patients with threatened abortion

目的探讨血清孕酮、白细胞介素-6(IL-6)以及甲状腺过氧化物酶抗体(TPOAb)水平变化与先兆流产患者的关系及其临床价值。方法选择2018年1月至2019年7月在该院妇产科住院的先兆流产患者44例为研究对象,根据盆腔检查宫口表现,并结合B超检查,分为先兆流产继续妊娠组23例和难免流产组21例,另取同期30例正常妊娠孕妇作为对照组。检测孕酮、IL-6及TPOAb水平,运用SPSS22.0软件进行统计分析。结果(1)先兆流产继续妊娠组和难免流产组流产史、TPOAb、孕酮和IL-6水平与对照组相比,差异均有统计学意义(P<0.05)。(2)当孕酮、IL-6、TPOAb的截断值分别为23.50 ng/mL、6.45 pg/mL、28.15 IU/mL时,预测先兆流产发病风险的ROC曲线下面积分别为0.941、0.939、0.831;但是联合检测ROC曲线下面积高达0.962,约登指数为0.829。(3)多元Logistic回归分析显示孕酮水平降低是先兆流产患者的独立风险因素,比值比(OR)为19.356。经Pearson相关分析显示,先兆流产的发生与孕酮之间呈负相关(r=-0.709,P<0.05)。(4)先兆流产继续妊娠患者治疗前IL-6和TPOAb水平明显高于治疗后;而先兆流产继续妊娠患者治疗前孕酮水平明显低于治疗后,差异均有统计学意义(P<0.001)。结论在预测先兆流产患者风险因素时,孕酮是较好的预测指标,孕酮联合IL-6和TPOAb检测可预测先兆流产的发病风险。

Objective To investigate the relationship and their clinical value between serum progesterone,interleukin-6(IL-6)and thyroid peroxidase antibody(TPOAb)levels in the patients with threatened abortion.Methods 44 cases of threatened abortion hospitalized in Department of Gynecology and Obstetrics our hospital from January 2018 to July 2019 were selected and divided into 23 cases of threatened abortion continuing pregnancy group and 21 cases of inevitable abortion group according to pelvic examination and B-ultrasound examination.Another 30 cases of normal control group were selected in the same period.The levels of progesterone,IL-6 and TPOAb were detected and analyzed by SPSS 22.0.Results There were significant differences in abortion history,TPOAb,progesterone and IL-6 between threatened abortion continuing pregnancy group and inevitable abortion group compared with normal control group(P<0.05).When cut-off values of progesterone,IL-6 and TPOAb were 23.50 ng/mL,6.45 pg/mL and 28.15 IU/mL respectively,the areas under ROC curve were 0.941,0.939 and 0.831 for predicting risk factors of threatened abortion,but the area under ROC curve was as high as 0.962 and Youden index was 0.829 for combined detection.Multivariate logistic regression analysis showed that the decrease of progesterone level was an independent risk factor for threatened abortion,and its odds ratio(OR)was as high as 19.356.Pearson correlation analysis showed that there was a significant negative correlation between the occurrence of threatened abortion and progesterone(r=-0.709,P<0.05).The levels of IL-6 and TPOAb in threatened abortion continuing pregnancy group before treatment were significantly higher than those after treatment,while the level of progesterone in threatened abortion continuing pregnancy group before treatment was significantly lower than those after treatment,and the differences were statistically significant(P<0.001).Conclusion Progesterone is a good predictor of risk factors in predicting threatened abortion.When progesterone value is less than 23.5 ng/mL,combined detection of IL-6 and TPOAb can predict the risk of threatened abortion.