血清TNF-α、维生素D对不明原因复发性流产患者再次妊娠活产率的影响
The Impact of Serum TNF-α and Vitamin D on the Live Birth Rate of Patients with Unexplained Recurrent Spontaneous Abortion in Subsequent Pregnancies

目的：探讨不明原因复发性流产(URSA)患者再次妊娠孕早期外周血TNF-α、维生素D水平对妊娠结局的影响。方法：选取2022年1月至2023年6月于郑州大学第二附属医院收治的83例URSA再次妊娠早孕期患者作为研究对象，根据妊娠结局分为妊娠成功组(n = 49)和妊娠失败组(n = 34)，检测TNF-α水平和维生素D水平，记录临床资料。采用logistic回归和ROC分析评估影响因素和预测效能。结果：妊娠成功组TNF-α低于妊娠失败组，维生素D高于妊娠失败组(均P < 0.05)。TNF-α < 3.005 pg/ml、维生素D > 18.39 ng/ml是影响URPL再次妊娠活产率的因素(P < 0.05)。ROC分析显示TNF-α和维生素D曲线下面积分别为0.778和0.704，联合预测曲线下面积为0.819。结论：URPL再次妊娠患者血清TNF-α、维生素D水平与活产率有关，TNF-α低水平、维生素D高水平是妊娠成功的保护因素，二者有望作为预测活产的有效指标。
Objective: To explore the impact of peripheral blood TNF-α and vitamin D levels during early preg-nancy on pregnancy outcomes in patients with unexplained recurrent spontaneous abortion (URSA). Methods: A total of 83 patients with URSA in early pregnancy, admitted to the Second Affiliated Hospital of Zhengzhou University from January 2022 to June 2023, were selected for the study. Pa-tients were categorized into the successful pregnancy group (n = 49) and the pregnancy failure group (n = 34). Serum TNF-α levels and vitamin D levels were measured, and clinical data were rec-orded. Logistic regression and ROC analysis were employed to assess influencing factors and predic-tive efficacy. Results: The TNF-α level in the successful pregnancy group was lower than that in the pregnancy failure group, and the vitamin D level was higher in the successful pregnancy group (both P < 0.05). TNF-α < 3.005 pg/ml and vitamin D > 18.39 ng/ml were factors influencing the live birth rate of URSA recurrent pregnancies (P < 0.05). ROC analysis showed TNF-α and vitamin D to have areas under the curves of 0.778 and 0.704, respectively, and the combined predictive curve had an area under the curve of 0.819. Conclusion: Serum TNF and vitamin D levels in patients with URSA recurrent pregnancies are associated with the live birth rate. Low TNF-α levels and high vita-min D levels are protective factors for successful pregnancy, and both have the potential to serve as effective indicators for predicting live births.