同型半胱氨酸、子宫动脉血流参数与反复妊娠丢失患者胰岛素抵抗和妊娠结局的关系

摘要 目的：探讨同型半胱氨酸（Hcy）、子宫动脉血流参数与反复妊娠丢失（RPL）患者胰岛素抵抗和妊娠结局的关系。方法：选择2020年6月至2022年10月昆明市妇幼保健院收治的162例RPL患者作为RPL组和同期82例规律产检的健康孕妇作为对照组。按照妊娠结局将RPL患者分为活产组（85例）和流产组（77例）。检测血清Hcy水平，胰岛素抵抗指数（HOMA-IR），超声检查子宫动脉血流参数，包括子宫动脉收缩期峰值/舒张末期流速（S/D）、搏动指数（PI）、血流阻力指数（RI）。Pearson相关性分析Hcy、子宫动脉血流参数与HOMA-IR的相关性。采用多因素Logistic回归分析RPL 患者妊娠结局的影响因素。采用受试者工作特征（ROC）曲线分析Hcy、子宫动脉血流参数对RPL 患者妊娠结局的预测价值。结果：RPL组血清Hcy水平，S/D、PI、RI以及HOMA-IR均高于对照组（P＜0.05）。RPL组血清Hcy，S/D、PI、RI与HOMA-IR均呈正相关（P＜0.05）。流产组血清Hcy水平，S/D、PI、RI以及HOMA-IR均高于活产组（P＜0.05），多因素Logistic回归分析显示高HOMA-IR、高Hcy、高S/D、高RI、染色体异常是RPL患者流产的危险因素（P＜0.05）。ROC曲线分析显示联合Hcy、S/D、RI预测RPL患者流产的曲线下面积（AUC）为0.849，高于单独预测。结论：RPL患者子宫动脉血流参数S/D、RI、PI和血清Hcy水平均增高，高S/D、RI和Hcy与RPL患者胰岛素抵抗以及流产风险增加有关。联合S/D、RI和Hcy可提高RPL流产风险评估效能。

Relationship between Homocysteine, Uterine Artery Blood Flow Parameters and Insulin Resistance and Pregnancy Outcome in Patients with Recurrent Pregnancy Loss

ABSTRACT Objective: To investigate the relationship between homocysteine (Hcy), uterine artery blood flow parameters and insulin resistance and pregnancy outcome in patients with recurrent pregnancy loss (RPL). Methods: 162 RPL patients admitted to Kunming Maternal and Child Health Hospital from June 2020 to October 2022 were selected as the RPL group and 82 healthy pregnant women underwent regular prenatal examinations during the same period as the control group. RPL patients were divided into live birth group (85 cases) and abortion group (77 cases) according to the pregnancy outcome. Serum Hcy level, insulin resistance index (HOMA-IR), uterine artery blood flow parameters, including uterine artery peak systolic/end diastolic velocity (S/D), pulsatility index (PI) and blood flow resistance index (RI) were detected. The correlation between Hcy, uterine artery blood flow parameters and HOMA-IR were analyzed by Pearson correlation analysis. The influencing factors of pregnancy outcomes in RPL patients were analyzed by multivariate Logistic regression analysis.The predictive value of Hcy and uterine artery blood flow parameters on the pregnancy outcome of RPL patients was analyzed by receiver operating characteristic (ROC) curve. Results: The serum Hcy level, S/D, PI, RI and HOMA-IR in RPL group were higher than those in control group (P<0.05). The serum Hcy, S/D, PI and RI in RPL group were positively correlated with HOMA-IR (P<0.05). The serum Hcy level, S/D, PI, RI and HOMA-IR in abortion group were higher than those in live birth group (P<0.05). Multivariate Logistic regression analysis showed that high HOMA-IR, high Hcy, high S/D, high RI and chromosomal abnormalities were risk factors for abortion in RPL patients (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of combined Hcy, S/D and RI in predicting abortion in RPL patients was 0.849, which was higher than that of single prediction. Conclusion: The levels of uterine artery blood flow parameters S/D, RI, PI and serum Hcy in RPL patients were increased, high S/D, RI and Hcy were relate to insulin resistance and increased risk of abortion in RPL patients.Combined S/D, RI and Hcy could improve the efficacy of RPL abortion risk assessment.