血流动力学参数和血清维生素D、HCY对RSA患者再次妊娠流产的预测价值

Predictive value of hemodynamic parameters and serum vitamin D and HCY in re-pregnancy miscarriage in RSA patients

目的分析复发性流产(recurrent spontaneous abortion,RSA)患者子宫动脉血流动力学参数、血清维生素D、同型半胱氨酸(HCY)的表达水平及其对RSA患者再次妊娠流产的预测价值。方法选取2020年9月到2022年9月绵阳市中心医院82例RSA患者作为研究对象,根据再次妊娠结局是否正常分为再次正常组(33例)和再次流产组(49例),选择同期产前检查结果正常孕妇50例为对照组。3组行彩色多普勒超声检查及血清检测,比较3组搏动指数(PI)、收缩期峰值流速/舒张末期峰值流速(S/D)、阻力指数(RI)及血清25(OH)D、HCY水平;采用Logistic回归模型分析RSA发生的影响因素,各个指标和RSA的相关性则采用Pearson相关性法予以分析,受试者工作特征(ROC)曲线分析各指标对RSA的诊断价值。对再次流产组的流产胎儿绒毛组织染色体进行分析,比较绒毛染色体正常组和异常组子宫动脉血流动力学参数及血清25(OH)D、HCY水平。结果再次流产组PI、S/D、RI值、HCY水平高于对照组和再次正常组,血清25(OH)D水平低于对照组和再次正常组,差异有统计学意义(P<0.05)。PI、S/D、RI值与HCY水平上升、25(OH)D水平下降为有RSA史患者再次流产的危险因素(P<0.05)。Pearson相关性分析显示,有RSA史患者再次流产与PI、S/D、RI值及HCY水平呈正相关,与25(OH)D水平呈负相关(P<0.05)。ROC曲线显示,PI、S/D、RI及血清25(OH)D、HCY单独检测的AUC分别为0.827、0.849、0.804、0.834、0.813,联合检测的AUC为0.984,灵敏度为92.7%、特异度为96.0%,诊断价值高于单独检测。再次流产组胎儿绒毛染色体29例存在异常,20例正常;绒毛染色体正常与异常组子宫动脉血流动力学参数、血清25(OH)D、HCY水平比较,差异无统计学意义(P>0.05)。结论RSA患者子宫动脉血流动力学参数PI、S/D、RI值和HCY水平升高,血清维生素D水平下降是有RSA史患者再次流产的危险因素,各指标联合检测对有RSA史患者再次流产有一定预测价值。

Objective To analyze the uterine artery hemodynamic parameters,serum vitamin D and homocysteine expression levels in patients with recurrent spontaneous miscarriage(RSA)and their predictive value for recurrent miscarriage in RSA patients.Methods 82 RSA patients from Mianyang Central Hospital from September 2020 to September 2022 were selected as the research subjects.According to whether the outcome of the re-pregnancy was normal,they were divided into the re-normal group(33 cases)and the re-abortion group(49 cases),and 50 pregnant women with normal prenatal examination results in the same period were selected as the control group.Three groups underwent color Doppler ultrasound examination and serum testing,and the pulsatile index(PI),peak systolic/diastolic flow velocity(S/D),resistance index(RI),and serum 25(OH)D and HCY levels were compared among the three groups.The Logistic regression model was used to analyze the influencing factors of RSA occurrence.The correlation between various indicators and RSA was analyzed using Pearson correlation method.The diagnostic value of each indicator for RSA was analyzed using receiver operating characteristic(ROC)curve analysis.The chorionic tissue chromosomes of the aborted fetus in the re-abortion group were analyzed,and the uterine artery hemodynamic parameters and serum 25(OH)D and HCY levels were compared between the normal villus chromosome group and the abnormal group.Results The levels of PI,S/D,RI and HCY in the re-abortion group were higher than those in the control group and the re-normal group,and the serum 25(OH)D level was lower than that in the control group and the re-normal group,and the difference was statistically significant(P<0.05).The increase in PI,S/D,RI values and HCY levels,as well as the decrease in 25(OH)D levels,were risk factors for recurrent miscarriage in patients with a history of RSA(P<0.05).Pearson correlation analysis showed that re-miscarriage in patients with RSA history were positively correlated with PI,S/D,RI and HCY levels,and was negatively correlated with 25(OH)D level(P<0.05).The ROC curve showed that the AUC of PI,S/D,RI,and serum 25(OH)D,HCY detected separately were 0.827,0.849,0.804,0.834,and 0.813,respectively.The AUC of the combined detection was 0.984,with a sensitivity of 92.7%and a specificity of 96.0%,the diagnostic value was higher than that of detection alone.In the re-abortion group,there were 29 cases of abnormal fetal villus chromosomes,and 20 cases were normal.There was no significant difference in uterine artery hemodynamic parameters,serum 25(OH)D and HCY levels between the normal villus chromosome group and the abnormal group(P>0.05).Conclusion The increase of uterine artery hemodynamic parameters PI,S/D,RI and HCY levels in RSA patients,and the decrease in serum vitamin D level are risk factors for re-abortion in patients with a history of RSA.The combined detection of various indicators has certain predictive value for re-miscarriage in patients with a history of RSA.