基于广义多因子降维模型研究维生素D与抗米勒管激素在先兆流产中的交互作用

A Study on the interaction between vitamin D and anti-Müellerian hormone in threatened abortion based on a generalized multifactor dimension reduction model

目的基于广义多因子降维(GMDR)模型探讨研究维生素D(VD)与抗米勒管激素(AMH)在先兆流产中的交互作用。方法选取2022年1月至2023年1月于连云港市东方医院就诊的108例先兆流产患者为病例组,同期来院检查的108位健康孕妇作为对照组。比较两组患者的临床资料和妊娠相关生化指标情况;Logistic线性回归模型分析研究VD和AMH与先兆流产的关系;多因素Logistic回归分析先兆流产的独立影响因素,计算各因素比值比(OR);逐步回归评估各因素的重要性,依据赤池信息量准则(AIC)对因素进行排序,AIC越大则该因素对模型越重要;R软件构建列线图模型预测先兆流产风险,Bootstrap法(原始数据重复抽样1000次)验证,受试者操作特征(ROC)曲线和校准曲线评价模型的区分度与准确性;GMDR分析AMH和VD的交互作用。结果病例组和对照组患儿的BMI、糖尿病、多囊卵巢综合征(PCOS)、流产史、合并阴道炎均存在显著性差异;病例组睾酮(T)显著高于对照组,AMH、VD、人绒毛膜促性腺激素(β-HCG)、孕酮(P)显著低于对照组;VD降低和AMH降低均是发生先兆流产的危险因素;BMI、流产史、合并阴道炎、AMH、VD、P、β-HCG均是患者发生先兆流产的独立影响因素;先兆流产发生风险影响排名前5的因素分别是AMH、VD、β-HCG、P、合并阴道炎,表明AMH、VD、β-HCG、P、合并阴道炎组成的多因素模型对先兆流产风险评估具有较好的表现,且经验证模型区分度和准确度较好;在先兆流产中,最佳交互作用模型为AMH、VD之间的交互作用。结论VD和AMH在先兆流产中存在交互作用,二者可能在先兆流产的发生发展中发挥重要作用,但关于其交互作用的分子学机制还有待进一步研究,从而为先兆流产患者的治疗和预后提供更有力的科学依据。

Objective Exploring the interaction between vitamin D(VD)and anti-müllerian hormone(AMH)in threatened abortion based on a generalized multifactor dimensionality reduction(GMDR)model.Methods 108 patients with threatened miscarriage who visited Lianyungang Oriental Hospital from January 2022 to January 2023 were selected as the case group,while 108 healthy pregnant women who came to the hospital for examination during the same period were selected as the control group.Compare the clinical data and pregnancy related biochemical indicators of two groups of patients.Analyze and study the relationship between VD,AMH,and threatened abortion using a Logistic linear regression model.Multivariate Logistic regression analysis was used to identify the independent influencing factors of threatened miscarriage and calculate the odds ratio(OR)of each factor.Gradually regress to evaluate the importance of each factor,and rank the factors based on the Akaike information criterion(AIC).The larger the AIC,the more important the factor is to the model.The R software constructs a column chart model to predict the risk of threatened miscarriage,and the Bootstrap method(1000 repeated samples of raw data)is used to verify the model.The receiver operating characteristic(ROC)curve and calibration curve are used to evaluate the differentiation and accuracy of the model.GMDR analysis of the interaction between AMH and VD.Results There were significant differences in BMI,combined vaginitis,diabetes,polycystic ovary syndrome(PCOS)and abortion history between the case group and the control group.The testosterone(T)levels in the case group were significantly higher than those in the control group,while VD,AMH,β-human chorionic gonadotropin(β-HCG)and progesterone(P)were significantly lower than those in the control group.Reduced VD and AMH are both risk factors for threatened miscarriage.BMI,history of miscarriage,combined vaginitis,AMH,VD,P,β-HCG is an independent influencing factor for threatened miscarriage in patients.The top 5 factors affecting the risk of threatened miscarriage are AMH,VD,β-HCG,P,combined vaginitis,Indicating that a multifactor model composed of AMH,VD,β-HCG,P and combined vaginitis performs well in assessing the risk of threatened miscarriage,and has been verified to have good discrimination and accuracy.The optimal interaction model in threatened abortion is the interaction between AMH and VD.Conclusion There is an interaction between VD and AMH in threatened miscarriage,and the two may play an important role in the occurrence and development of threatened miscarriage.However,further research is needed on the molecular mechanism of their interaction,in order to provide stronger scientific evidence for the treatment and prognosis of threatened miscarriage patients.