子宫动脉血流参数联合血小板聚集功能预测不明原因复发性流产的价值研究

The Value of Uterine Artery Flow Parameters in Combination with Platelet Aggregation Function in Predicting Unexplained Recurrent Abortion

摘要: 目的：探讨子宫动脉血流参数联合血小板聚集功能预测不明原因复发性流产(URSA)的价值。方法：将2021年9月至2023年8月本院收治的94例URSA患者作为URSA组，另外将同期在本院进行产检的110例正常妊娠孕妇作为对照组。URSA患者随访至妊娠28周，根据妊娠结局分为正常妊娠组(n = 25)和流产组(n = 69)。比较2组患者子宫动脉血流参数、血小板聚集率；采用受试者工作特性(ROC)曲线评估子宫动脉血流参数、血小板聚集率对URSA患者妊娠结局的预测价值；采用二分类Logistic逐步回归分析探讨URSA患者妊娠结局的影响因素。结果：在搏动指数(PI)、动脉血流阻力指数(RI)、收缩期/舒张期血流速度比值(S/D)、血小板聚集率指标方面，URSA组相较于对照组更高(P < 0.05)。单因素分析显示，流产组年龄 ≥ 30岁占比、流产次数、有先兆流产症状占比大于正常妊娠组，PI、RI、S/D、血小板聚集率高于正常妊娠组(P < 0.05)。多因素分析显示，年龄(OR = 2.046, 95% CI: 1.455~2.878)、流产次数(OR = 1.914, 95% CI: 1.337~2.660)、PI (OR = 2.469, 95% CI: 1.627~3.749)、RI (OR = 2.418, 95% CI: 1.599~3.657)、S/D (OR = 3.364, 95% CI: 2.089~5.416)、血小板聚集率(OR = 2.795, 95% CI: 1.792~4.362)是URSA患者妊娠结局的影响因素(P < 0.05)。ROC曲线显示，子宫动脉血流参数、血小板聚集率及二者联合预测URSA患者妊娠结局的曲线下面积(AUC) (95% CI)分别为0.858 (0.807~0.910)、0.764 (0.753~0.816)、0.903 (0.852~0.955)。结论：子宫动脉血流参数水平、血小板聚集率升高与URSA患者妊娠结局密切相关，且二者联合预测URSA患者妊娠结局的价值较高。

Abstract: Objective: To explore the value of the combination of uterine artery flow parameters and platelet aggregation function in predicting unexplained recurrent abortion (URSA). Methods: 94 patients with URSA from September 2021 to August 2023 were selected as the URSA group, and 110 normal pregnant women who underwent prenatal examination were selected as the control group. The URSA patients were followed up until 28 weeks of gestation and divided into the normal pregnancy group (n = 25) and the abortion group (n = 69) according to the pregnancy outcome. The uterine artery blood flow parameters and platelet aggregation rate were compared between the two groups. The predictive value of the uterine artery flow parameters and platelet aggregation rate for the pregnancy outcomes of URSA patients was evaluated by ROC. Binary Logistic stepwise regression was employed to explore the influencing factors of the pregnancy outcomes of URSA patients. Results: The indexes of the pulse index (PI), the arterial flow resistance index (RI), the systolic/diastolic blood flow velocity ratio (S/D), and the platelet aggregation rate in the URSA group were higher than those in the control group (P < 0.05). Univariate analysis indicated that the proportion of patients aged ≥ 30 years old, the number of abortions, and the proportion of threatened abortion symptoms in the abortion group were higher than those in the normal pregnancy group, and the PI, RI, S/D, and platelet aggregation rates were higher than those in the normal pregnancy group (P < 0.05). Age (OR = 2.046, 95% CI: 1.455~2.878), the number of abortions (OR = 1.914, 95% CI: 1.337~2.660), PI (OR = 2.469, 95% CI: 1.627~3.749), RI (OR = 2.418, 95% CI: 1.599~3.657), S/D (OR = 3.364, 95% CI: 2.089~5.416), and the platelet aggregation rate (OR = 2.795, 95% CI: 1.792~4.362) were the influencing factors of the pregnancy outcomes of URSA patients (P < 0.05). The ROC curve demonstrated that the area under the curve (AUC) (95% CI) of the uterine artery flow parameters, the platelet aggregation rate, and their combined prediction of the pregnancy outcomes of URSA patients were 0.858 (0.807~0.910), 0.764 (0.753~0.816), and 0.903 (0.852~0.955), respectively. Conclusion: The level of the uterine artery blood flow parameters and the increase of the platelet aggregation rate are closely associated with the pregnancy outcome of URSA patients, and the combined value of the two is highly significant in predicting the pregnancy outcome of URSA patients.