维生素D与复发性流产的相关性及其对妊娠结局的预测价值

Correlation Between Vitamin D and Recurrent Spontaneous Abortion and its Predictive Value for Pregnancy Outcome

目的研究维生素D与复发性流产(RSA)的关系,并探讨维生素D对RSA患者再次妊娠结局的预测价值。方法选取2020年6月-2021年6月于郑州大学第二附属医院定期围保的120例RSA患者作为RSA组,选取50名正常孕妇作为对照组。比较两组血清维生素D水平,以及RSA组不同妊娠结局、流产次数者维生素D水平,另采用Logistic回归分析维生素D水平与RSA发生的风险关系,ROC曲线分析维生素D对复发性流产妊娠结局的预测价值。结果RSA组和对照组25(OH)D水平分别为(14.92±7.01)ng/ml、(20.81±9.69)ng/ml,组间比较,差异有统计学意义(P<0.05)。RSA组维生素D充足及不足占比低于对照组,缺乏及严重缺乏占比高于对照组,差异有统计学意义(P<0.05)。RSA组中继续妊娠者和流产者25(OH)D水平分别(15.93±7.05)ng/ml、(12.48±6.38)ng/ml,组间比较,差异有统计学意义(P<0.05)。不同流产次数25(OH)D水平比较,差异有统计学意义(P<0.05);Logistic回归分析显示,维生素D缺乏是RSA发生的独立危险因素;ROC曲线分析显示,维生素D预测RSA患者再次发生流产具有一定的价值,曲线下面积为0.678,截断值、灵敏度和特异度分别为11.86 ng/ml、70.60%、60.00%。结论妊娠期女性的维生素D水平普遍缺乏,与正常孕妇比较,RSA患者孕早期血清维生素D水平较低;孕早期维生素D<11.86 ng/ml时,RSA患者再次发生流产的风险较高。

Objective To study the relationship between vitamin D and recurrent spontaneous abortion(RSA),and to explore the predictive value of vitamin D on the pregnancy outcome of RSA patients.Methods From June 2020 to June 2021,120 patients with RSA who were regularly surrounded in the Second Affiliated Hospital of Zhengzhou University were selected as the RSA group,and 50 normal pregnant women were selected as the control group.Serum vitamin D levels were compared between the two groups,as well as vitamin D levels in RSA group with different pregnancy outcomes and abortion times.Logistic regression was used to analyze the risk relationship between vitamin D level and RSA.ROC curve was used to analyze the predictive value of vitamin D on pregnancy outcome of recurrent spontaneous abortion.Results The levels of 25(OH)D in the RSA group and the control group were(14.92±7.01)ng/ml and(20.81±9.69)ng/ml,respectively,the difference between the two groups was statistically significant(P<0.05).The proportion of vitamin D sufficiency and insufficiency in the RSA group was lower than that in the control group,and the proportion of deficiency and severe deficiency was higher than that in the control group,with statistically significant differences(P<0.05).The levels of 25(OH)D in continuing pregnancy and abortion in RSA group were(15.93±7.05)ng/ml and(12.48±6.38)ng/ml,respectively,and the difference between the two groups was statistically significant(P<0.05).There was significant difference in 25(OH)D level among different abortion times(P<0.05).Logistic regression analysis showed that vitamin D deficiency was an independent risk factor for RSA.ROC curve analysis showed that vitamin D had a certain value in predicting recurrent abortion in RSA patients,the area under the curve was 0.678,and the cut-off value,sensitivity and specificity were 11.86 ng/ml,70.60%and 60.00%,respectively.Conclusion The vitamin D level of pregnant women is generally deficient.Compared with normal pregnant women,the serum vitamin D level of RSA patients in early pregnancy is lower.When vitamin D<11.86 ng/ml in early pregnancy,RSA patients have a higher risk of recurrent abortion.