复发性流产危险因素分析及预测模型构建

Analysis of risk factors for recurrent spontaneous abortion and construction of prediction model

目的分析孕妇发生复发性流产(RSA)的危险因素,基于危险因素构建预测模型并评估其预测RSA发生的效能。方法选择2019年1月至2022年10月于新乡医学院第三附属医院生殖医学科建档的324例孕妇为研究对象,根据是否发生RSA将其分为正常组(n=234)和流产组(n=90)。采用单因素和多因素logistic回归分析孕妇发生RSA的危险因素,并根据筛选出的危险因素构建预测模型,绘制受试者操作特征(ROC)曲线评估该模型的预测效能。结果单因素分析结果显示,2组孕妇的25-羟维生素D[25-(OH)D]、孕酮(P)、同型半胱氨酸(Hcy)、纤维蛋白原(FIB)、D-二聚体(D-D)、促甲状腺激素(TSH)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)水平及搏动指数(PI)、阻力指数(RI)、收缩期峰值流速与舒张期最低流速比值(S/D)比较差异有统计学意义(P<0.05),2组孕妇的年龄、孕前体质量指数(BMI)、孕前月经周期、孕囊大小及游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平比较差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,25-(OH)D和P水平降低、Hcy和TPOAb水平升高及PI、RI、S/D升高是孕妇发生RSA的危险因素(P<0.05)。ROC曲线分析结果显示,构建的模型预测孕妇发生RSA的敏感度、准确度、阳性预测值、曲线下面积分别为92.60%、90.25%、89.26%、0.914。结论25-(OH)D和P水平降低、Hcy和TPOAb水平升高及PI、RI、S/D升高是孕妇发生RSA的危险因素,基于危险因素构建的模型预测孕妇发生RSA的效能较高。

Objective To analyze the risk factors of recurrent spontaneous abortion(RSA),construct a prediction model based on the risk factors,and evaluate its efficacy in predicting the occurrence of RSA.Methods A total of 324 pregnant women who were registered in the Department of Reproductive Medicine of the Third Affiliated Hospital of Xinxiang Medical University from January 2019 to October 2022 were selected as the research subjects,and they were divided into normal group(n=234)and abortion group(n=90)according to the presence or absence of RSA.Univariate and multivariate logistic regression were used to analyze the risk factors of RSA,a prediction model was constructed based on the selected risk factors,and predictive efficiency of the model was evaluated by drawing the receiver operating characteristic(ROC)curve.Results Univariate analysis showed that there were significant differences in 25-hydroxyvitamin D[25-(OH)D],progesterone(P),homocysteine(Hcy),fibrinogen(FIB),D-dimer(D-D),thyroid-stimulating hormone(TSH),thyroglobulin antibody(TGAb),thyroid peroxidase antibody(TPOAb),pulse index(PI),resistance index(RI)and ratio of peak systolic velocity to lowest diastolic velocity(S/D)between the two groups(P<0.05);there were no significant differences in age,pre-pregnancy body mass index,pre-pregnancy menstrual cycle,gestational sac size,free triiodothyronine(FT3)and free thyroxine(F4)between the two groups(P>0.05).Multivariate logistic regression analysis showed that low 25-(OH)D and P,as well as high Hcy,TPOAb,PI,RI and S/D,were risk factors for RSA in pregnant women(P<0.05).The ROC curve analysis results showed that the sensitivity,accuracy,positive predictive value and area under the curve of the constructed model in predicting the occurrence of RSA were 92.60%,90.25%,89.26%and 0.914,respectively.Conclusion Decreased 25-(OH)D and P as well as increased Hcy,TPOAb,PI,RI and S/D are risk factors for RSA,and the constructed model based on these risk factors has high efficiency in predicting the occurrence of RSA.