早孕期子宫动脉血流动力学参数、血清Hcy及D-二聚体在复发性流产中的检测价值

目的 研究早孕期子宫动脉血流动力学参数、同型半胱氨酸（homocysteine，Hcy）及D-二聚体在复发性流产（recurrent spontaneous abortion，RSA）中的检测价值。方法 选取2020年11月至2022年11月宣城市人民医院72例RSA患者作为研究对象，同期选取无自然流产病史的50名孕妇作为对照组。两组在早孕期行彩色多普勒超声检查及血清检测，比较两组孕妇的搏动指数（pulsatile index，PI）、收缩期峰值流速/舒张末期峰值流速（ratio of peak flow velocity during systole to diastole，S/D）、阻力指数（resistance index，RI）及血清Hcy、D-二聚体水平。采用Logistic回归模型分析RSA发生的影响因素，受试者操作特征曲线（receiver operating characteristic curve，ROC曲线）分析各指标对RSA的检测价值。结果 RSA组患者的PI、S/D、RI、Hcy、D-二聚体均高于对照组（P<0.05）；PI、S/D、RI、Hcy、D-二聚体升高为RSA发病的危险因素（P<0.05）；ROC曲线显示PI、S/D、RI、Hcy、D-二聚体单独检测的曲线下面积（area under the curve，AUC）分别为0.778、0.826、0.819、0.778、0.756，联合检测的AUC为0.858，敏感度为75.0%、特异性为80.0%，诊断价值优于单独检测。结论 RSA患者早孕期子宫动脉血流动力学参数升高，血清Hcy及D-二聚体升高为其发病危险因素，各指标联合检测对疾病诊断有一定的预测价值。

The detection value of early pregnancy uterine artery hemodynamic parameters, serum Hcy and D-dimer in recurrent spontaneous abortion

Objective To study the value of hemodynamics parameters, homocysteine (Hcy) and D-dimer levels in uterine artery during early pregnancy in patients with recurrent spontaneous abortion (RSA). Methods A total of 72 patients with RSA in Xuancheng People’s Hospital from November 2020 to November 2022 were enrolled, and another 50 healthy women with normal results on prenatal ultrasonography were set as control group. Both groups underwent color Doppler ultrasonography and serum detection during early pregnancy, then parameters including pulsatile index (PI), ratio of peak flow velocity during systole to diastole (S/D), resistance index (RI), Hcy and D-dimer were compared between two groups. Logistic regression model was used to analyze the influencing factors of RSA occurrence, and receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of each index to RSA. Results The values of PI, S/D, RI, Hcy and D-dimer in RSA group were higher than those in control group (P<0.05). The values of PI, S/D, RI, Hcy and D-dimer increased as risk factors for RSA (P<0.05). ROC curve denoted that the area under the curve (AUC) of PI, S/D, RI, Hcy and D-dimer dimerin the diagnosis of RSA were 0.778, 0.826, 0.819, 0.778 and 0.756, respectively, and the AUC of combined detection of the above five parameters was 0.858, with a sensitivity of 75.0% and a specificity of 80.0%, indicating that the diagnostic value of joint detection was better than that of single detection. Conclusion The ascending uterine artery hemodynamic parameters, elevated Hcy and D-dimer level during early pregnancy are the risk factors for RSA patients, and the combined detection of all indicators has certain predictive value for RSA diagnosis.