血清SAA、IFN-γ及子宫动脉血流参数评估不明原因复发性流产效果

Evaluation of the levels of serum amyloid A and interferon-γ and the uterine artery blood flow parameters of pregnant women for their unexplained recurrent abortion

目的:分析不明原因复发性流产(URSA)患者血清淀粉样蛋白A(SAA)、血清干扰素-γ(IFN-γ)及子宫动脉血流参数及其预测妊娠结局价值。方法:前瞻性选取2021年2月-2023年2月本院收治URSA孕妇102例为观察组,产前检查正常妊娠孕妇98例为对照组。对比两组血清SAA、IFN-γ水平及子宫动脉血流参数;随访观察组至妊娠28周,多元logistic回归分析影响URSA孕妇妊娠结局的危险因素;绘制受试者工作特征(ROC)曲线分析血清SAA、IFN-γ水平及子宫动脉血流参数评估URSA孕妇妊娠结局价值。结果:观察组血清SAA(33.38±10.07 mg/L)、IFN-γ(155.98±5.81 pg/ml)水平及子宫动脉血流参数值均高于对照组(8.67±1.08 mg/L、28.55±1.53 pg/ml)(均P<0.05)。随访成功妊娠28周76例(非流产组),发生流产26例(流产组),流产组流产次数、血清SAA、IFN-γ水平及阻力指数(RI)、收缩期峰值流速/舒张期流速(S/D)均高于非流产组;经logistic回归分析,血清SAA、IFN-γ水平及RI、S/D参数升高均为影响URSA孕妇不良妊娠结局的风险因素(均P<0.05)。ROC曲线分析,SAA、IFN-γ联合RI、S/D检测预测URSA孕妇妊娠结局的曲线下面积0.762(95%CI:0.637-0.814),敏感度92.6%、特异度91.2%,预测效能高于单项指标(P<0.05)。结论:URSA孕妇血清SAA、IFN-γ水平及子宫动脉血流参数均明显升高,且各指标联合检测对预测URSA孕妇妊娠结局临床价值较好。

Objective:To analyze the levels of serum amyloid A(SAA)and interferon γ(IFN-γ)and the uterine artery blood flow parameters of pregnant women with unexplained recurrent abortion(URSA),and to study the levels of serum SAA and IFN-γ and the uterine artery blood flow parameters of the women for predicting their URSA.Methods:102 pregnant women with URSA were prospectively selected in observation group and 98 normal pregnant women were selected in control group from February 2021 to February 2023.The serum levels of SAA and IFN-γ and the uterine artery blood flow parameters of the women were compared between the two groups.The women in the two groups were followed up to 28 gestational weeks.Multivariate logistic regression was used to analyze the risk factors affecting the pregnancy outcomes of the women with URSA.Receiver operating characteristic(ROC)curve was drawn to analyze the values of the serum SAAand IFN-γ levels,and the uterine artery blood flow parameters of the women for evaluating their pregnancy outcomes.Results:The levels of serum SAA(33.38±10.07 mg/L)and IFN-γ(155.98±5.81 pg/ml)of the women in the observation group were significantly higher than those(8.67±1.08 mg/L and 28.55±1.53 pg/ml)of the women in the control group.The uterine artery blood flow parameters values of the women in the observation group were significantly higher than those of the women in the control group(all P<0.05).There were 76 cases with successful pregnancy till to 28 gestational weeks in group A and 26 cases with abortion in group B during the follow-up.The number of abortions,the serum SAAand IFN-γ levels,the values of the resistance index(RI),the peak systolic flow velocity/diastolic flow velocity(S/D)of the women in group B were significantly higher than those of the women in group A.Logistic regression analysis showed that the increase of the serum SAA and IFN-γ levels,and the values of RI and S/D of the women with URSA were the influencing factors of their pregnancy outcomes(all P<0.05).ROC curve analysis showed that the area under the curve of the levels of SAA and IFN-γ combined with the values of RIand S/D of the women for predicting their pregnancy outcomes was 0.762(95%CI 0.637-0.814),with a sensitivity of 92.6% and a specificity of 91.2%,and the predictive efficacy of which was significantly higher than that of the SAA level,the IFN-γ level,the RI value or the S/D value alone(P<0.05).Conclusion:The levels of serum SAA and IFN-γ and the values of uterine artery blood flow parameters of the pregnant women with URSA are significantly increased,which all have the better clinical values for predicting the pregnancy outcomes of the women.