Prognostic effect of ultrasonic arterial flow parameters combined with serum ACA and AMH detection on fetal saving outcome of threatened abortion
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摘要:
目的 先兆流产(TA)经治疗后仍可能出现保胎失败，本研究旨在分析超声动脉血流参数联合血清抗心磷脂抗体(ACA)、抗苗勒管激素(AMH)检测对保胎结局的预测作用，以提高TA保胎成功率。 方法 选取2021年5月—2023年5月黄河三门峡医院及南阳市中心医院收治的135例TA患者，根据保胎结局将其分为保胎成功组(83例)及保胎失败组(52例)。患者均行超声动脉血流参数及血清ACA、AMH检测，采用logistic回归模型分析保胎结局的影响因素，ROC曲线分析超声动脉血流参数和血清ACA、AMH对保胎结局的预测价值。 结果 与保胎成功组比较，保胎失败组舒张末期流速(D)、AMH水平降低，收缩期峰值流速(S)/D、搏动指数(PI)、阻力指数(RI)、ACA水平及自然流产史、阴道出血量≥50 mL占比升高(P < 0.05)；Logistic回归分析结果显示，阴道出血量≥50 mL、S/D、PI、RI及ACA高水平均为TA保胎失败的独立危险因素(P < 0.05，OR>1)，AMH高水平为保护因素(P < 0.05，OR < 1)；ROC分析结果显示，S/D、PI、RI、ACA及AMH单独及联合预测保胎结局的AUC分别为0.724、0.676、0.752、0.755、0.692及0.880，五项联合预测效能高于各项单独检测。 结论 TA患者超声动脉血流参数异常，其中S/D、PI、RI、ACA高水平是TA保胎失败的危险因素，AMH高水平为TA保胎失败的保护因素，五项联合检测对于TA保胎结局具有较高的预测价值。 Abstract:Objective Threatened abortion (TA) may still lead to abortive failure after treatment. In this study, ultrasound arterial flow parameters in combination with serum anti-cardiolipin antibody (ACA) and anti-Mullerian hormone (AMH) were detected to explore the predictive effect of these indicators on abortive outcome, with a view to improving the success rate of TA. Methods The current study is based on a total of 135 TA patients admitted to Sanmenxia Hospital and Nanyang Central Hospital of the Yellow River from May 2021 to May 2023. According to the outcome of fetal protection, they were divided into a successful group (n=83) and a failed group (n=52). All patients had their ultrasonic arterial blood flow parameters and serum hormone levels checked. The influencing factors of fetal survival outcome were analyzed by means of a logistic regression model. The receiver operating characteristic (ROC) curve was utilized to analyze the predictive value of ultrasonic arterial flow parameters, serum ACA and AMH in the outcome of fetal protection. Results In contrast with the abortive group, the end-diastolic flow rate (D) and AMH levels in the abortive group were decreased, while the peak systolic flow rate (S)/D, pulse index (PI), resistance index (RI), ACA level and spontaneous abortion history, and the proportion of vaginal bleeding ≥50 mL were increased in the abortive group (P < 0.05). Logistic regression analysis showed that vaginal bleeding of ≥50 mL, elevated high levels of S/D, PI, RI and ACA were independent risk factors for fetal failure of TA (P < 0.05, OR>1), and high levels of AMH were protective factors (P < 0.05, OR < 1). The results of the ROC analysis demonstrated that the AUC of S/D, PI, RI, ACA and AMH were 0.724, 0.676, 0.752, 0.755, 0.692 and 0.880, respectively, and the combined prediction efficiency of the five factors was found to be superior to that of each individual test. Conclusion Abnormal ultrasonic arterial flow parameters in TA patients, among which high levels of S/D, PI, RI and ACA are risk factors for the failure of TA, and high levels of AMH are protective risk factors. The five combined tests have a high level of predictive capacity for the outcome of TA. -
图 1 早期先兆流产孕妇子宫螺旋动脉血流频谱图
Figure 1. Doppler spectrum of spiral artery blood flow in pregnant women with early threatened abortion
图 2 超声动脉血流参数、ACA及AMH预测保胎失败的ROC曲线
Figure 2. ROC analysis of a panel of doppler, ACA, and AMH parameters for predicting early pregnancy loss
表 1 2组TA患者超声动脉血流参数指标比较(x±s)
Table 1. Comparison of ultrasonic arterial flow parameters between the two groups of TA patients(x±s)
组别 例数 S(cm/s) D(cm/s) S/D PI RI 保胎成功组 83 32.41±4.86 9.48±2.75 3.39±0.76 0.73±0.15 2.12±0.36 保胎失败组 52 33.76±5.27 6.14±2.04 5.47±1.13 0.95±0.23 2.79±0.33 t值 1.520 7.549 12.788 6.731 10.861 P值 0.131 < 0.001 < 0.001 < 0.001 < 0.001 
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表 2 2组TA患者血清ACA、AMH比较(x±s)
Table 2. Comparison of serum ACA and AMH between the two groups of TA patients(x±s)
组别 例数 ACA(mIU/mL) AMH(μg/L) 保胎成功组 83 3.86±0.44 10.05±1.83 保胎失败组 52 8.59±1.85 7.64±1.59 t值 22.351 7.823 P值 < 0.001 < 0.001
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表 3 2组TA患者临床资料比较
Table 3. Comparison of clinical data between the two groups of TA patients
项目 保胎成功组(n=83) 保胎失败组(n=52) 统计量 P值 年龄(x±s，岁) 31.26±3.96 32.04±4.51 1.055a 0.293 BMI(x±s) 23.56±1.24 23.75±1.19 0.880a 0.381 孕周(x±s，周) 8.04±1.45 8.16±1.26 0.492a 0.624 妊娠期合并症[例(%)] 糖尿病 13(15.66) 10(19.23) 0.288b 0.592 高脂血症 15(18.07) 11(21.15) 0.195b 0.659 高血压 16(19.28) 12(23.08) 0.281b 0.596 甲状腺功能减退 11(13.25) 9(17.31) 0.416b 0.519 吸烟史[例(%)] 16(19.28) 14(26.92) 1.081b 0.298 饮酒史[例(%)] 19(22.89) 15(28.85) 0.602b 0.438 孕产史[例(%)] 初产 53(63.86) 36(69.23) 0.411b 0.521 经产 30(36.14) 16(30.77) 双胎[例(%)] 8(9.64) 6(11.54) 0.124b 0.725 自然流产史[例(%)] 6(7.23) 10(19.23) 4.408b 0.036 阴道出血量[例(%)] ≥50 mL 22(26.51) 27(51.92) 8.932b 0.003 < 50 mL 61(73.49) 25(48.08) 注：a为t值，b为χ2值。
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表 4 TA保胎结局影响因素的logistic回归模型分析
Table 4. Logistic regression analysis of factors associated with pregnancy-sparing outcomes in patients with TA
变量 B SE Waldχ2 P值 OR值 95% CI 自然流产史 1.114 0.561 3.943 0.095 3.943 1.015~3.047 阴道出血量 0.749 0.267 7.869 < 0.001 2.115 1.253~3.569 D -0.578 0.316 3.346 0.105 0.561 0.302~1.042 S/D 0.915 0.374 5.985 < 0.001 2.497 1.200~5.197 PI 0.741 0.286 6.713 < 0.001 2.098 1.198~3.675 RI 0.881 0.369 5.700 < 0.001 2.413 1.171~4.974 ACA 0.494 0.231 4.573 0.031 1.639 1.042~2.577 AMH -0.695 0.284 5.989 < 0.001 0.499 0.286~0.871
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表 5 超声动脉血流参数、ACA及AMH对保胎结局的预测价值
Table 5. A predictive model based on ultrasonic arterial flow parameters, ACA, and AMH for pregnancy retention outcomes
项目 阈值 灵敏度(%) 特异度(%) AUC 95% CI 约登指数 S/D 3.95 65.38 73.49 0.724 0.641~0.798 0.389 PI 0.79 67.31 74.70 0.676 0.590~0.754 0.420 RI 2.43 80.77 69.88 0.752 0.670~0.822 0.507 ACA 5.26 mIU/mL 73.08 79.52 0.755 0.674~0.825 0.526 AMH 9.06 μg/L 78.85 71.08 0.692 0.607~0.769 0.499 联合 1.72a 92.31 84.34 0.880 0.813~0.930 0.767 注：联合预测采用LogP模式进行拟合；a为联合预测最佳截断值依据Log(P/1-P)模型生成。
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