摘要
目的 探讨不明原因复发性流产(URSA)患者绒毛及外周血非对称性二甲基精氨酸(ADMA)表达及其临床价值。方法 选取URSA患者168例,采用计算机产生随机数法将就诊患者以3∶1的比例分为训练集126例(URSA组)和测试集42例,另选取同期于我院进行终止妊娠的126例孕妇作为对照,对比训练集及对照组临床资料及外周血和绒毛组织ADMA表达,通过拟合曲线和阈值效应分析患者血清URSA表达与URSA发生的关系,采用多因素Logistics回归模型分析发生URSA的独立危险因素,构建列线图模型。结果 与对照组比较,URSA组患者IL-6、IL-117、Th17、Th17/Treg及血浆、绒毛组织ADMA表达显著增加,孕酮、IL-10、TGF-β及Treg显著降低(P<0.05)。IL-6、IL-17、Th17、Th17/Treg及血浆ADMA、绒毛组织ADMA是发生URSA的独立危险因素,而IL-10、TGF-β及Treg是发生URSA的保护因素(P<0.05)。当血浆ADMA≥1.43μmol/L时,血浆ADMA每增加0.6μmol/L,孕妇发生VRSA的风险增加17%,差异具有统计学意义(OR=0.115,95%CI:0.102~0.133,P<0.05);当绒毛ADMA≥1.92μmol/L时,绒毛ADMA每增加0.6μmol/L,孕妇发生URSA的风险增加14%,差异具有统计学意义(OR=1.192,95%CI:1.085~1.302,P<0.05)。依据独立影响因素构建的列线图预测模型具有较高的区分度、准确性和临床适用性。结论 ADMA在URSA患者血浆及绒毛组织中的表达增加,是URSA发生的独立危险因素,对URSA的发生具有一定的预测价值。
Objective To investigate the expression and clinical value of asymmetric dimethylarginine(ADMA) in villi and peripheral blood of patients with unexplained recurrent abortion(Ursa).Methods 168 patients with URSA were selected.The patients were divided into training set(126 cases,URSA group) and test set(42 cases) at a ratio of 3:1 by using computer-generated random number method.In addition,126 pregnant women who terminated their pregnancy in our hospital at the same time were selected as controls to compare the training set and the clinical data of the control group,as well as the ADMA expression in peripheral blood and villus tissue.The relationship between serum Ursa expression and the occurrence of Ursa was analyzed by fitting curves and threshold effect.Multivariate logistic regression model was used to analyze the independent risk factors of Ursa and construct a nomogram model.Results Compared with the control group,the expression of IL-6,IL-117,Th17,Th17/Treg,ADMA in plasma and villi increased significantly,progesterone,IL-10 and TGF-β And Treg decreased significantly(P<0.05).IL-6,IL-17,Th17,Th17/Treg,plasma ADMA and villus ADMA were independent risk factors for URSA,while IL-10 and TGF-β And Treg were the protective factors of URSA(P<0.05).When plasma ADMA ≥1.43 μ Mol/l,plasma ADMA increased by 0.6 μ Mol/L,the risk of pregnant women increased by 17%,and the difference was statistically significant(OR=0.115,95%CI:0.102~0.133,P<0.05).When the villus ADMA ≥1.92 μmol/L,villus ADMA increased by 0.6 μmol/L,the risk of Ursa in pregnant women increased by 14%,and the difference was statistically significant(OR=1.192,95%CI:1.085~1.302,P<0.05).The nomogram prediction model based on independent influencing factors has high discrimination,accuracy and clinical applicability.Conclusion The increased expression of ADMA in plasma and villi of patients with URSA is an independent risk factor for the occurrence of URSA,which has a certain predictive value for the occurrence of URSA.
作者
曾瑜
边亚芹
杨怡春
彭冬先
ZENG Yu;BIAN Yaqin;YANG Yichun;PENG Dongxian(Zhujiang Hospital,Southern Medical University,Guangzhou 510280,China;The Second Clinical Medical College of Southern Medical University,Guangzhou 510280,China;Shenzhen Longgang Central Hospital,Shenzhen 518100,Guangdong,China)
出处
《西部医学》
2024年第1期79-84,90,共7页
Medical Journal of West China
