The relationship between vitamin D and immune microenvironment of pregnant women with early threatened abortion and its predictive value for pregnancy outcome
Objective To investigate the correlation between vitamin D(VD)and the immune microenvironment of early threatened abortion(TA)in pregnant women,and to assess its predictive value on pregnancy outcomes.Methods A total of 110 early TA pregnant women treated at Langfang People's Hospital,Hebei Province,from January 2021 to September 2022 were selected as the research subjects and included in the training set.They were divided into a study group(oral progesterone+VD,55 cases)and a control group(oral progesterone only,55 cases)using a random number table method.Based on the pregnancy outcome of early TA pregnant women,they were categorized into pregnancy failure group(38 cases)and continued pregnancy group(72 cases).Additionally,36 early TA pregnant women treated at the same hospital from January 2020 to January 2021 were selected as the validation set.Clinical data,immune microenvironment,and VD levels of pregnant women were collected.Pearson correlation analysis was used to assess correlations.Multivariable logistic regression analysis was employed to identify the risk factors affecting pregnancy failure,and a nomogram prediction model was constructed for evaluation.Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of VD levels on pregnancy outcomes.Results In the research group,levels of interleukin(IL)-4,IL-10,transforming growth factor β(TGF-β),and VD in pregnant women were significantly higher compared to the control group(t=2.186,6.809,2.648 and 5.780 respectively,P＜0.05).Conversely,levels of IL-17,IL-23,and interferon y(IFN-γ)were significantly lower in the research group compared to the control(t=3.521,3.777 and 4.330 respectively,P＜0.05).Correlation analysis showed positive associations of VD with IL-4,IL-10,and TGF-β(r=0.569,0.709 and 0.602 respectively,P＜0.05),and negative associations with IL-17,IL-23,and IFN-γ(r=-0.537,-0.584 and-0.634 respectively,P＜0.05).In the group of pregnant women with pregnancy failure,a history of ≥ 2 abortions,genital tract mycoplasma/chlamydia infection,and luteal insufficiency,as well as the levels of IL-17,IL-23,and IFN-y,were significantly higher compared to the group with continuing pregnancies(x2=5.609,8.399 and 16.082 respectively;t=4.668,4.793 and 3.919 respectively).Conversely,in the pregnancy failure group,the levels of IL-4,IL-10,TGF-β,and VD were significantly lower compared to the continuing pregnancy group(t=8.019,12.362,9.131 and 4.755 respectively),with statistically significant differences(P＜0.05).Multivariable logistic regression analysis showed that a history of ≥2 abortions(OR=1.720,95％CI:1.488-2.376),genital tract mycoplasma/chlamydia infection(OR=1.301,95％CI:1.164-1.597),IL-17 levels ≥35 pg/mL(OR=2.088,95％CI:1.649-2.577),and VD levels＜25ng/mL(OR=2.634,95％CI:1.548-3.870)were independent risk factors for early pregnancy failure in women with TA(P＜0.05).ROC curve analysis indicated that VD level predicting pregnancy failure had an area under the curve(AUC)of 0.815(95％CI:0.779-2.069),with an optimal cutoff value of 25ng/mL,sensitivity of 96.04％,and specificity of 60.31％.The predictive model evaluation of pregnancy failure demonstrated high accuracy,effectiveness,safety,and practicality.Conclusion VD is positively correlated with IL-4,IL-10,and TGF-β,and negatively correlated with IL-17,IL-23,and IFN-γ.History of ≥2 abortions,genital tract mycoplasma/chlamydia infection,IL-17 levels ≥35pg/mL,and VD＜25ng/mL are independent risk factors for early pregnancy failure in women with TA.VD levels have a certain predictive value for pregnancy failure.
万方数据
维普
