Establishment and validation of a predictive model for adverse pregnancy outcomes in preeclampsia based on the expression level of miRNA-517 in serum exosomes
Objective To analyze the expression of miRNA-517 in the serum of preeclampsia (PE) pregnant women and to establish a predictive model for adverse pregnancy outcomes of PE.Methods 121 PE pregnant women who received obstetric treatment at the Second Affiliated Hospital of Hainan Medical University from January 2021 to December 2022 were selected as the PE group,and 127 healthy pregnant women during the same time were selected as the control group. The expression levels of miRNA-517,miRNA-518,and miRNA-519 in the serum of patients between the two groups were compared. PE pregnant women were divided into a poor pregnancy outcome group ( 31 cases ) and a good pregnancy outcome group ( 90 cases ) based on different pregnancy outcomes. Multivariate Logistic regression analysis was used to analyze the influencing factors of adverse pregnancy outcomes in PE pregnant women. A column chart model was established based on independent predictive factors combined with their influence weights. R software was used to draw a column chart and a ROC curve was drawn to verify the predictive value of the column chart.Results ①The miRNA-517 and miRNA-518 in the serum of pregnant women in the PE group were higher than those in the control group,while the miRNA-519 in the serum were significantly lower than those in the control group,the differences were statistically significant ( P<0.05). ② Univariate analysis showed that the proportion of systolic blood pressure,diastolic blood pressure,24-hour urine protein quantification,D-dimer,thrombocytopenia,and miRNA-517 of patients in the poor pregnancy outcome group were significantly higher than those in the good pregnancy outcome group ( P<0.05 ) . Multivariate Logistic analysis showed that diastolic blood pressure D-dimer,miRNA-517,and thrombocytopenia were independent risk factors for adverse pregnancy outcomes in PE pregnant women ( OR>1,P<0.05). ③ A column chart model was established based on the above four factors with an AUC of 0.917 (95％ CI:0.901-0.979,P<0.05),with a sensitivity of 94.5％ and specificity of 90.3％. The discriminability evaluation index C-Index of the model was 0.912 (95％ CI:0.878-0.975). The goodness of fit test results showed that the predicted risk of adverse pregnancy outcomes for each PE pregnant woman was in good agreement with the actual observed values (P>0.05). Conclusion The expression level of serum miRNA-517 in pregnant women with PE is abnormally elevated. The nomogram model is highly effective in assessing the risk of adverse pregnancy outcomes in pregnant women with PE based on the expression of serum miRNA-517.
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