2025 年第 12 期 第 20 卷

复发性流产患者D-二聚体与纤维蛋白原比值及纤维蛋白原与白蛋白比值和保胎结局的关系

The relationship between D-dimer to fibrinogen ratio, fibrinogen to albumin ratio and the outcome of fetal protection in patients with recurrent spontaneous abortion

作者：何瑞丽1陈义兵2

英文作者：He Ruili1 Chen Yibing2

单位：1郑州大学第一附属医院产科，郑州450000；2郑州大学第一附属医院遗传与产前诊断中心，郑州450000

英文单位：1Department of Obstetrics the First Affiliated Hospital of Zhengzhou University Zhengzhou 450000 China; 2Genetic and Prenatal Diagnosis Center the First Affiliated Hospital of Zhengzhou University Zhengzhou 450000 China

关键词：复发性流产；D-二聚体与纤维蛋白原比值；纤维蛋白原与白蛋白比值；保胎结局

英文关键词：Recurrentspontaneousabortion;D-dimertofibrinogenratio;Fibrinogentoalbuminratio; Outcomeoffetalprotection

• 摘要：

• 目的 探讨复发性流产（RSA）患者D-二聚体与纤维蛋白原比值（DFR）、纤维蛋白原与白蛋白比值（FAR）和保胎结局的关系。方法 选取2022年5月至2024年11月郑州大学第一附属医院100例RSA患者为观察组，按照1∶1匹配选取同期100例健康孕妇为对照组。比较2组DFR、FAR，并比较观察组不同保胎结局患者临床资料、DFR、FAR，Logistic回归分析RSA患者保胎结局的影响因素，限制性立方样条分析DFR、FAR与RSA患者保胎结局的非线性关系，受试者工作特征（ROC）曲线分析DFR、FAR对RSA患者保胎结局的预测价值。结果 观察组DFR、FAR均高于对照组［（0.29±0.06）比（0.15±0.04）、（0.25±0.05）比（0.12±0.03）］（t=19.415、22.295，均P＜0.05）。保胎失败患者既往人工流产史、流产次数＞3次占比及DFR、FAR均高于保胎成功患者，超过既往流产时间比例低于保胎成功患者（均P＜0.05）。采用倾向性评分匹配法调整既往人工流产史、流产次数、保胎时间等变量前后，Logistic回归分析显示，DFR、FAR均为RSA患者保胎结局的影响因素（均P＜0.05）。DFR、FAR水平与RSA患者保胎失败风险呈非线性关系（均P＜0.05），DFR≥0.25、FAR≥0.20时，RSA患者保胎失败风险随着其水平升高呈上升趋势（均P＜0.05）。ROC分析结果显示，DFR、FAR单独及联合预测RSA患者保胎结局的曲线下面积分别为0.752、0.745、0.881。结论 DFR、FAR与RSA患者保胎结局呈非线性关系，DFR≥0.25、FAR≥0.20时，RSA患者保胎失败风险呈升高趋势，且二者可用于辅助评估患者保胎结局。

• Objective To investigate the relationship between D-dimer to fibrinogen ratio (DFR), fibrinogen to albumin ratio (FAR) and the outcome of fetal protection in patients with recurrent spontaneous abortion (RSA). Methods A total of 100 patients with RSA in the First Affiliated Hospital of Zhengzhou University from May 2022 to November 2024 were selected as the observation group, and 100 healthy pregnant women in the same period were selected as the control group according to 1∶1 matching. The DFR and FAR of the two groups were compared, and the clinical data, DFR and FAR of patients with different tocolysis outcomes in the observation group were compared. Logistic regression was used to analyze the influencing factors of tocolysis outcomes in RSA patients, and restricted cubic spline was used to analyze the nonlinear relationship between DFR, FAR and tocolysis outcomes in RSA patients. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of DFR and FAR for the outcome of RSA. Results The DFR and FAR of the observation group were higher than those of the control group ［(0.29±0.06) vs (0.15±0.04), (0.25±0.05) vs (0.12±0.03)］(t=19.415, 22.295, both P＜0.05). The previous history of induced abortion, the proportion of abortion times >3, DFR and FAR of patients with failed tocolysis were higher than those of patients with successful tocolysis, and the proportion of more previous abortion time was lower than that of patients with successful tocolysis (all P＜0.05). Before and after propensity score matching method was used to adjust the variables such as previous history of induced abortion, number of abortions, and time of tocolation, Logistic regression analysis showed that DFR and FAR were the influencing factors of tocolation outcome in RSA patients (both P＜0.05). The levels of DFR and FAR had a nonlinear relationship with the risk of failed tocolysis in RSA patients (both P＜0.05). When DFR≥0.25 and FAR≥0.20, the risk of failed tocolysis in RSA patients increased with the increase of DFR and FAR levels (both P＜0.05). The results of ROC analysis showed that the area under the curve of DFR, FAR alone and in combination to predict the tocolysis outcomes in RSA patients was 0.752, 0.745 and 0.881, respectively. Conclusion DFR and FAR have a nonlinear relationship with the outcome of fetal protection in RSA patients. When DFR≥0.25 and FAR≥0.20, the risk of fetal protection failure in RSA patients increases, and the two can be used to assist in evaluating the outcome of fetal protection in patients.