基于免疫-炎症复合指数的复发性流产风险预测模型构建与验证OA

Objective To evaluate immune and inflammatory characteristics in patients with recurrent spontane-ous abortion(RSA),construct an immune-inflammatory composite index(ICI)based on independent risk factors,and develop and validate an ICI-based risk prediction model.Methods A retrospective analysis was conducted on patients with RSA and healthy pregnant women treated at Maoming People's Hospital between January 2022 and December 2024.Differences in immune and inflammatory indicators between groups were analyzed.Independent risk factors for RSA were i-dentified using binary logistic regression,and the ICI was constructed accordingly.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive performance of the ICI and to stratify risk.A multivariable prediction model based on the ICI was further established.Model performance was assessed using ROC curves,calibration curves,and decision curve analysis(DCA).Results CD56+natural killer(NK)cells,lymphocyte-to-monocyte ra-tio(LMR),homocysteine(HCY),and cyclic citrullinated peptide(CCP)were identified as independent risk factors for RSA(P＜0.05).The ICI constructed from these variables demonstrated good predictive performance,with an area under the curve(AUC)of 0.87,sensitivity of 0.77,and specificity of 0.83.The multivariable prediction model incorporating ICI,platelet-to-lymphocyte ratio(PLR),and CCP achieved an AUC of 0.83,sensitivity of 0.78,specificity of 0.95,and overall accuracy of 0.86,indicating good discrimination and predictive capability.Conclusion Patients with RSA exhibit significant immune-inflammatory imbalance.The ICI,composed of CD56+NK cells,LMR,HCY,and CCP,demonstrates strong predictive value for RSA risk.The combined model integrating ICI,PLR,and CCP further improves risk stratification and may serve as a practical tool for identifying high-risk populations in clinical settings.