不明原因性早期流产与甲状腺过氧化物酶抗体、孕酮及子宫动脉血流动力学参数相关性研究

Correlation between unexplained early abortion with thyroid peroxidase antibody,progesterone and uterine artery hemodynamic parameters

目的研究甲状腺过氧化物酶(TPO)抗体、孕酮及子宫动脉血流动力学参数与不明原因性早期流产的相关性。方法纳入2019年2月至2020年2月1200例不明原因性早期流产孕妇作为研究对象,所有患者在孕6~10周均行阴道三维超声检查,记录子宫动脉血流动力学参数[收缩期峰值与舒张末期流速比值(S/D)、阻力指数(RI)、搏动指数(PI)]。检测TPO抗体与血清孕酮水平,分析TPO抗体、血清孕酮与子宫动脉血流动力学相关性,分析TPO抗体、孕酮及子宫动脉血流参数对多次流产(流产次数≥3次)的诊断价值。结果TPO抗体阳性组684例,TPO抗体阴性组516例。TPO抗体阳性组血清孕酮低于TPO抗体阴性组,RI、PI及S/D均高于TPO抗体阴性组患者,差异均有统计学意义(P<0.05)。Pearson线性相关分析显示TPO抗体水平与RI、PI及S/D呈正相关(P<0.05),孕酮水平与RI、PI及S/D呈负相关(P<0.05)。1200例患者中流产次数<3次者530例,流产次数≥3次者670例。不同流产次数患者RI、PI及S/D水平差异均有统计学意义(P<0.05)。联合子宫动脉血流参数与血清TPO抗体、孕酮判断多次流产的AUC为0.838(SE=0.039,95%CI=0.763~0.914,P<0.05),灵敏度为0.911,特异度为0.766。结论TPO抗体、血清孕酮与子宫动脉血流参数与不明原因性早期流产有相关性,TPO抗体、血清孕酮及子宫动脉参数(RI、PI、S/D)对判断发生多次流产有一定价值,联合检测可提高对多次流产的诊断效能,临床应针对相关指标异常患者加强监测及干预,以避免再次流产。

Objective To study the correlation between unexplained early abortion with thyroid peroxidase(TPO)antibody,progesterone and uterine artery hemodynamic parameters.Methods A total of 1200 pregnant women with unexplained early abortion from February 2019 to February 2020 were included in the study.All patients underwent vaginal three-dimensional ultrasonography at 6 to 10 weeks of gestation,and the hemodynamic parameters of uterine artery[ratio of peak systolic velocity to end diastolic velocity(S/D),the resistance index(RI)and pulsatility index(PI)]were recorded.The TPO antibody and serum progesterone were detected,the correlation between TPO antibody,serum progesterone and uterine artery hemodynamic parameters were analyzed,and the diagnostic value of TPO antibody,progesterone and uterine artery hemodynamic parameters for multiple abortions(abortions≥3 times)were analyzed.Results There were 684 cases of positive TPO antibody and 516 cases of negative TPO antibody.The level of serum progesterone in patients with positive TPO antibody group was lower than that in patients with negative TPO antibody group,the RI,PI and S/D were higher than those in patients with negative TPO antibody group,and the differences were statistically significant(P<0.05).The Pearson linear correlation analysis showed that the TPO antibody level was positively correlated RI,PI and S/D(P<0.05),the progesterone level was negatively correlated with RI,PI and S/D(P<0.05).Among 1200 patients,530 had less than three abortions and 670 had three or more than three abortions.There were statistically significant differences of RI,PI and S/D levels in patients with different abortion times(P<0.05).The AUC of combining uterine artery hemodynamic parameter with serum TPO antibody and progesterone to determine multiple abortions was 0.838(SE=0.039,95%CI=0.763-0.914,P<0.05),the sensitivity was 0.911,and the specificity was 0.766.Conclusion TPO antibody,serum progesterone and uterine artery blood flow parameters are correlated with unexplained early abortion.TPO antibody,serum progesterone and uterine artery parameters(RI,PI and S/D)have some value in determination of multiple abortions.Combined detection could improve the diagnostic efficiency of multiple abortions.Clinical monitoring and intervention should be strengthened for patients with abnormal related indicators to avoid repeated abortions.