孕早期子宫动脉血流参数联合外周血Th1/Th2对不明原因复发性流产的预测价值研究

Predictive value of uterine artery blood flow parameters combined with peripheral blood Th1/Th2 in early pregnancy for unexplained recurrent miscarriage

目的 探究孕早期子宫动脉血流参数联合外周血Th1/Th2对不明原因复发性流产的预测价值研究。方法 选取山西省妇幼保健院妇产科2020年4月-2021年3年收治的96例不明原因复发性流产史的妊娠期患者为研究对象,患者入院后24 h内完成子宫动脉血流参数及外周血Th1/Th2细胞频数检测。所有患者随访观察至孕期28周,根据患者是否发生妊娠失败将其分为流产组和正常妊娠组。采用Logistic多因素回归分析影响不明原因复发性流产患者妊娠结局的相关因素。以受试者工作特征曲线(ROC)分析预测效能。结果 随访截止至患者妊娠28周,96例妊娠患者中流产72例,流产率75.00%,正常妊娠24例(25.00%)。Logistic多因素分析显示,干扰素-γ(IFN-γ)、白细胞介素-4(IL-4)、Th1/Th2水平及胎儿脐动脉血流阻力指数(RI)、子宫动脉收缩期最大血流速度与舒张末期血流速度比值(S/D)参数均为不明原因复发性流产患者妊娠结局的影响因素(P<0.05)。ROC分析显示,孕早期外周血Th1/Th2和RI、S/D单一及联合预测不明原因复发性流产妊娠结局的AUC分别为0.741(95%CI:0.626~0.851)、0.758(95%CI:0.644~0.871)、0.739(95%CI:0.619~0.844)、0.839(95%CI:0.746~0.933)。结论 孕早期子宫动脉血流参数和外周血Th1/Th2均可预测不明原因复发性流产妊娠结局,且联合预测效能更高。

Objective To explore the predictive value of uterine artery blood flow parameters combined with peripheral blood Th1/Th2 in early pregnancy for unexplained recurrent miscarriage. Methods 96 pregnant women with history of unexplained recurrent abortion admitted to the hospital from April 2020 to March 2021 and were selected as the research objects. The uterine artery blood flow parameters and peripheral blood Th1/Th2 cell frequency were detected within 24 hours after admission. All patients were followed up to 28 weeks of pregnancy, and the patients were divided into abortion group and normal pregnancy group according to whether pregnancy loss occurred.Logistic regression analysis was used to analyze related factors with affecting pregnancy outcome in patients of unexplained recurrent abortion.The predictive efficacy was analyzed by receiver operating characteristic curve(ROC). Results Up to 28 weeks of gestation, 72 cases of 96 pregnant patients had miscarriage, and the abortion rate was 75.00%.24 cases of normal pregnancy(25.00%). Logistic multivariate analysis showed that interferon-γ(IFN-γ)、the levels of interleukin-4(IL-4), Th1/Th2, fetal umbilical artery resistance index(RI) and the ratio of maximum systolic blood flow velocity to end diastolic blood flow velocity(S/D) of uterine artery were main influencing factors of pregnancy outcome in patients of unexplained recurrent abortion(P<0.05).ROC analysis showed that AUCs of Th1/Th2,RI and S/D of peripheral blood in early pregnancy for predicting pregnancy outcome of unexplained recurrent abortion were 0.741(95%CI:0.626 ~ 0.851),0.758(95%CI:0.644 ~ 0.871), 0.739(95%CI:0.619 ~ 0.844) and 0.839(95%CI:0.746 ~ 0.933) respectively.Conclusion Uterine artery blood flow parameters and peripheral blood Th1/Th2 in the first trimester can predict pregnancy outcome with unexplained recurrent miscarriage to a certain extent, and the combined prediction efficiency is higher.