AT-Ⅲ、D-二聚体和血小板聚集率联合维生素D在复发性流产中的预测价值OA
Predictive value of antithrombin-Ⅲ,D-dimer,platelet aggregation rate and vitamin D in the recurrent spontaneous abortion
目的 探讨血栓前状态标志物抗凝血酶-Ⅲ(antithrombin-Ⅲ,AT-Ⅲ)、D-二聚体(D-dimer,D-D)、血小板聚集率联合维生素D在复发性流产(recurrent spontaneous abortion,RSA)患者中的预测价值.方法 采用前瞻性研究方法,选取 2023 年 7 月至 2024 年 7 月在衡水市人民医院就诊的 100 例RSA患者作为RSA组,其中妊娠维持成功 32 例(A组),妊娠维持失败 68 例(B组).另选取同期进行体检的既往无流产史的100例健康妊娠期女性作为对照组.收集受试者的一般资料,检测AT-Ⅲ、D-D、血小板聚集率和维生素D水平,评估各项指标对RSA患者流产的诊断价值.采用Pearson相关性分析评估AT-Ⅲ、D-D、血小板聚集率、维生素D与RSA患者流产的相关性,采用单因素、多因素Logistic回归分析评价RSA患者流产的危险因素,通过受试者工作特征(receiver operating characteristic,ROC)曲线评估AT-Ⅲ、D-D、血小板聚集率联合维生素D对RSA患者流产的预测价值.统计学方法采用t检验、Kruskal-Wallis检验和χ2 检验.结果 RSA组的D-D水平和血小板聚集率均高于对照组[(184.12±22.87)µg/L与(123.16±23.91)µg/L,(82.19±25.45)%与(55.23±20.89)%,t值分别为 0.142、3.191,P值均<0.05].RSA组的AT-Ⅲ和维生素D水平均低于对照组[(101.82±9.11)%与(117.91±17.21)%,(22.15±1.86)µg/L与(36.25±3.87)µg/L,t值分别为 7.241、4.522,P值均<0.05].A组的D-D水平和血小板聚集率均低于B组[(152.24±28.34)µg/L与(192.42±25.93)µg/L,(63.21±21.49)%与(83.22±23.82)%,t值分别为0.942、2.931,P值均<0.05];A组的AT-Ⅲ和维生素D水平均高于B组[(112.42±8.27)%与(94.25±9.29)%,(26.51±1.32)µg/L与(21.22±1.82)µg/L,t值分别为2.142、1.423,P值均<0.05].多因素Logistic回归分析结果显示,AT-Ⅲ、D-D、血小板聚集率和维生素D是RSA患者流产的危险因素(P值均<0.05).Pearson相关性分析结果显示,D-D水平和血小板聚集率与RSA患者流产呈显著正相关(r值分别为 0.742、0.821,P值均<0.05),而AT-Ⅲ和维生素D水平与RSA患者流产呈显著负相关(r值分别为-0.842、-0.572,P值均<0.05).ROC曲线分析结果显示,AT-Ⅲ、D-D、血小板聚集率和维生素D水平对RSA患者流产具有独立的预测价值,4项指标联合应用时诊断价值最高(曲线下面积为0.923,95%CI:0.881～0.965,P<0.001).结论 AT-Ⅲ、D-D、血小板聚集率和维生素D水平均能为RSA患者流产风险评估提供有力支持,而这些指标的联合应用可以进一步提高预测的准确性.
Objective To explore the predictive value of prethrombotic state markers antithrombin-Ⅲ(AT-Ⅲ),D-dimer(D-D),platelet aggregation rate,and vitamin D in patients with recurrent spontaneous abortion(RSA).Methods A prospective study was conducted in 100 patients with RSA,who visited Hengshui People's Hospital from July 2023 to July 2024,were selected as the RSA group,including 32 cases with successful pregnancy maintenance(Group A),and 68 cases with failed pregnancy maintenance(Group B).Additionally,100 healthy pregnant women with no history of miscarriage who underwent physical examination during the same period were selected as the control group.The general information of the subjects were collected,the levels of AT-Ⅲ,D-D,platelet aggregation rate and vitamin D were detected,and the diagnostic value of each indicator for miscarriage in RSA patients was evaluated.Pearson correlation analysis was used to evaluate the correlation between AT-Ⅲ,D-D,platelet aggregation rate,vitamin D and miscarriage in RSA patients.The risk factors for miscarriage in RSA patients were analyzed by univariate and multivariate Logistic regression analysis.The predictive value of the combination of AT-Ⅲ,D-D,platelet aggregation rate,and vitamin D for miscarriage in RSA patients was evaluated using receiver operating characteristic(ROC)curve.Statistical analysis was performed using t-test,Kruskal-Wallis test and χ2 test.Results The levels of D-D and platelet aggregation rate in the RSA group were higher than those in the control group[(184.12±22.87)µg/L vs(123.16±23.91)µg/L,and(82.19±25.45)%vs(55.23±20.89)%,respectively;t values were 0.142 and 3.191,all P<0.05].The levels of AT-Ⅲand vitamin D in the RSA group were lower than those in the control group[(101.82±9.11)%vs(117.91±17.21)%,(22.15±1.86)µg/L vs(36.25±3.87)µg/L,respectively;t values were 7.241 and 4.522,all P<0.05].The levels of D-D and platelet aggregation rate in Group A were lower than those in the Group B[(152.24±28.34)µg/L vs(192.42±25.93)µg/L,(63.21±21.49)%vs(83.22±23.82)%;t values were 0.942 and 2.931,respectively,all P<0.05].The levels of AT-Ⅲ and vitamin D in Group A were higher than those in the Group B[(112.42±8.27)%vs(94.25±9.29)%,(26.51±1.32)µg/L vs(21.22±1.82)µg/L;t values were 2.142 and 1.423,respectively,all P<0.05].The results of multivariate Logistic regression analysis showed that AT-Ⅲ,D-D,platelet aggregation rate,and vitamin D were the risk factors for miscarriage in RSA patients(all P<0.05).The results of Pearson correlation analysis showed that D-D levels and platelet aggregation rate were significantly positively correlated with miscarriage in RSA patients(r values were 0.742 and 0.821,respectively,all P<0.05),while the levels of AT-Ⅲ and vitamin D were significantly negatively correlated with miscarriage in RSA patients(r values were-0.842 and-0.572,respectively,all P<0.05).The results of ROC curve analysis showed that AT-Ⅲ,D-D,platelet aggregation rate,and vitamin D levels had independent predictive value for miscarriage in RSA patients,especially when used in combination of four indicators(the area under the curve was 0.923,95%CI:0.881-0.965,P<0.001).Conclusion AT-Ⅲ,D-D,platelet aggregation rate,and vitamin D levels all provide strong support for miscarriage risk assessment in RSA patients,and the combined application of these indicators can further improve predictive accuracy.
王娇;李素叶;焦艳;王磊;崔家璐;冀雪霞;张聪祎
衡水市人民医院 生殖医学科,河北 衡水 053000衡水市人民医院 生殖医学科,河北 衡水 053000衡水市人民医院 生殖医学科,河北 衡水 053000衡水市人民医院 生殖医学科,河北 衡水 053000衡水市妇幼保健院 生殖医学科,河北 衡水 053000衡水市人民医院 生殖医学科,河北 衡水 053000衡水市第二人民医院 超声科,河北 衡水 053000
复发性流产抗凝血酶-ⅢD-二聚体血小板聚集率维生素D
Recurrent spontaneous abortionAntithrombin-ⅢD-dimerPlatelet aggregation rateVitamin D
《发育医学电子杂志》 2026 (1)
13-19,7
衡水市2023年度科技计划(2023014072Z)
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