基于自身抗体和淋巴细胞免疫表型不明的复发性流产再孕早期流产预测模型构建  

A predictive model of early pregnancy abortion in unknown recurrent abortion was constructed based on autoantibody and lymphocyte immunophenotype

作　　者：张寄云 张艺婕 张晓余 ZHANG Jiyun;ZHANG Yijie;ZHANG Xiaoyu(Department of Clinical Laboratory,Changzhou Maternal and Child Health Hospital,Changzhou 213200,China)

机构地区：[1]常州市妇幼保健院检验科,常州213200

出　　处：《国际免疫学杂志》2024年第6期670-675,共6页International Journal of Immunology

摘　　要：目的基于自身抗体和淋巴细胞免疫表型构建不明原因复发性流产(recurrent spontaneous abortion,RSA)再孕早期流产的预测模型并进行验证。方法回顾性分析常州市妇幼保健院在2021年5月至2023年5月收治的195例不明原因RSA再孕患者,观察患者早期流产情况并将其分为早期流产组(58例)和未早期流产组(137例)。分析影响患者早期流产的因素,并以此构建Nomogram列线图模型预测早期流产发生风险;用受试者工作特征(receiver operating characteristics,ROC)曲线下面积(area under curve,AUC)分析预测模型对早期流产的预测效能。结果早期流产组抗心磷脂抗体(anticardiolipin antibody,ACA)阳性占比、抗精子抗体(anti-sperm antibody,AsAb)阳性占比、抗β2糖蛋白1抗体(anti-β2 glycoprotein 1 antibody,aβ2-GP1)阳性占比、抗双链DNA抗体(double-stranded DNA,dsDNA)阳性占比、狼疮抗凝物(lupus anticoagulant,LA)阳性占比、CD4^(+)/CD8^(+)>2占比、CD16^(+)CD56^(+)≥13.5%占比均高于未早期流产组[63.79%(37/58)比37.23%(51/137);41.38%(24/58)比24.09%(33/137);39.66%(23/58)比16.06%(22/137);34.48%(20/58)比12.41%(17/137);29.31%(17/58)比11.68%(16/137);70.69%(41/58)比41.61%(57/137);67.24%(39/58)比38.69%(53/137);χ^(2)值分别为11.61、5.89、12.78、12.92、9.01、13.79、13.33,P值均<0.05]。二元Logistic回归分析显示,ACA阳性、aβ2-GP1阳性、dsDNA阳性、CD4^(+)/CD8^(+)水平、CD16^(+)CD56^(+)水平是患者早期流产的独立危险因素(OR值和95%CI分别为3.82,1.86~7.85;5.03,2.01~12.61;6.49,2.66~15.79;4.16,2.47~6.70;5.87,1.85~18.64,P值均<0.05)。基于上述影响因素构建的列线图预测模型经Bootstrap法内部验证显示C-index指数为0.82(95%CI:0.74~0.93),预测患者早期流产的校正曲线趋近于理想曲线(χ^(2)=0.27,P=0.65)。绘制ROC曲线结果显示,列线图模型预测患者早期流产的敏感度为85.70%、特异性为86.60%,AUC为0.87(95%CI:0.78~0.96)(P<0.05)。结论基于ACA阳性、aβ2-GP1阳性、dsObjective To construct and validate a predictive model for unexplained recurrent spontaneous abortion(RSA)in early pregnancy based on autoantibodies and lymphocyte immunophenotype.Method The retrospective analysis was performed on 195 patients with unexplained RSA who were admitted to Changzhou Maternal and Child Health Care Hospital from May 2021 to May 2023.The early abortion of the patients were observed and divided into early abortion group(58 cases)and non-early abortion group(137 cases).The influencing factors of early abortion were analyzed,and a Nomogram model was constructed to predict the risk of early abortion.The receiver operating characteristic(ROC)was used to analyze the predictive efficiency of the prediction model for early miscarriage.Result The proportion of anticardiolipin antibody(ACA)positive in early abortion group,anti-sperm antibody(anti-sperm antibody,AsAb)positive ratio,anti-β2 glycoprotein 1 antibody(anti-β2 glycoprotein 1 antibody,aβ2-GP1)positive rate,anti-double-stranded DNA antibody(double-stranded DNA,dsDNA,lupus anticoagulant,LA)positive,CD4^(+)/CD8^(+)>2 ratio,CD16^(+)CD56^(+)≥13.5%ratio were higher than those in the non-early abortion group[63.79%(37/58)vs 37.23%(51/137);41.38%(24/58)vs 24.09%(33/137);39.66%(23/58)vs 16.06%(22/137);34.48%(20/58)vs 12.41%(17/137);29.31%(17/58)vs 11.68%(16/137);70.69%(41/58)vs 41.61%(57/137);67.24%(39/58)vs 38.69%(53/137);χ^(2)values were 11.61,5.89,12.78,12.92,9.01,13.79,13.33,all P values<0.05].Binary Logistic regression analysis showed that positive ACA,positive aβ2-GP1,positive dsDNA,CD4^(+)/CD8^(+)level and CD16^(+)CD56^(+)level were independent risk factors for early abortion(OR and 95%CI were 3.82,1.86~7.85;5.03,2.01~12.61;6.49,2.66~15.79;4.16,2.47~6.70;5.87,1.85~18.64,all P values<0.05).Internal validation of the nomogram prediction model based on the above influencing factors showed that the C-index was 0.82(95%CI:0.74~0.93),and the calibration curve for predicting early abortion was close to the ideal curve(χ^(2)=0.27,P=0.65).Th

关 键 词：复发性流产 再次妊娠 早期流产 自身抗体 淋巴细胞免疫表型 预测模型 

分 类 号：R714.21[医药卫生—妇产科学] R446.6[医药卫生—临床医学]