Analysis Of Clinical Characteristics And Socio-Psychological Factors In Patients With Recurrent Spontaneous Abortion

Objective To summarize the clinical data of patients with recurrent spontaneous abortion(RSA),analyze the possible socio-psychological factors of RSA,and provide scientific basis for its clinical diagnosis and intervention.Methods A total of 659 women of childbearing age who were admitted to the Lanzhou University Second Hospital from February 2018 to February 2019 were selected as the research subjects according to the inclusion and exclusion criteria.324 RSA patients who attended the Reproductive Medicine Center of the hospital were selected as the case group,335 healthy pregnant women who were expectant and delivered in the obstetrics department of the hospital during the same period were selected as the control group.The clinical data of 324 RSA patients were summarized and further subdivided into subgroups: according to the age of the patients,270 cases in subgroup <35 years old and 54 cases in subgroup ≥35 years old,according to the number of spontaneous abortions of the patients were divided into 2 spontaneous abortions subgroup 206 cases(group A),3 spontaneous abortions subgroup 79 cases(group B),>3 spontaneous abortions subgroup 39 cases(group C).SPSS 21.0 software was used to statistically process the collected data,and the differences in clinical indicators and the incidence rate of pathogenic causes between different age groups and different numbers of spontaneous abortions were compared.The socio-psychological data of 659 subjects were collected through a questionnaire survey,logistic regression model and classification tree model were used to analyze the socio-psychological risk factors of RSA.Results(1)Among 324 patients with RSA,the prevalence of chromosomal abnormalities,reproductive anatomical abnormalities,endocrine abnormalities,autoimmune abnormalities,coagulation abnormalities,infection and male-related factor abnormalities were 5.56%,20.99%,20.37%,18.83%,21.60%,13.27% and 8.95%,respectively.The number of pathogenic causes(0~4)accounted for 39.81%,26.54%,20.06%,11.43%,and 2.16%,respectively.(2)C3,C4,PT,male age,and DFI were significantly different between the patients aged ≥35 years and those aged <35 years(P <0.05);the incidence of endocrine abnormalities in the two subgroups was statistically significant(P < 0.05).(3)Comparison of the three subgroups of A,B,and C,the differences in the levels of TSH,PLT,Hcy and D-dimer were statistically significant(P <0.05);there were statistically significant differences in the incidence of endocrine and coagulation abnormalities in patients in groups A,B and C(P < 0.05).(4)Logistic regression model suggested that age ≥35 years old,college education or above,history of all decoration or furnishings,and depressive symptoms are risk factors for RSA,couple’s sexual life ≥5 times / month is a protective factor for RSA;six risk factors were screened out by the classification tree model,namely depressive symptoms,the frequency of couple’s sexual life,anxiety symptoms,history of all decoration or furnishings,age,and educational level.(5)The sensitivity of Logistic regression model was 0.725,the specificity was 0.630,the Youden index was 35.5%,the prediction accuracy was 67.7%,the area under curve(AUC)was 0.721,and the standard error was 0.020.The sensitivity of the classification tree model was 0.778,the specificity was 0.690,the Youden index was 46.8%,the prediction accuracy was 73.3%,the AUC was 0.806 and the standard error was 0.017.The difference of AUC between the two models was statistically significant(Z=3.244,P=0.001).Conclusion(1)The incidence of coagulation abnormalities is the highest among the causes of RSA,followed by abnormal reproductive anatomy and endocrine abnormalities;The causes of RSA are complex and diverse,which may be the result of the combined action of multiple causes.(2)There are differences in the clinical indicators and the incidence rate of the pathogenic causes of RSA in different age groups and the frequency of abortion.Clinically,it is necessary to pay attention to the comprehensive screening of the etiology of RSA patients to achieve the purpose of personalized treatment.(3)Age,education level,the frequency of couple’s sexual life,history of all decoration or furnishings,anxiety and depression symptoms are risk factors for RSA;the prediction effect of classification tree model in this study is better than that of logistic regression model,but the two statistical models have their own advantages and disadvantages,which can be used in combination with the actual situation.