Analysis Of Related Factors Of Recurrent Pregnancy Loss Combined With Metabolic Syndrome And Role Of Triglyceride Glycemic Body Mass Index In Predicting Recurrent Pregnancy Loss

Objective:By analyzing the clinical data of patients with recurrent pregnancy loss(RPL),to understand the occurrence of metabolic syndrome(MS)and its components in patients with RPL,and to compare the differences among patients with MS,without MS,and with different amounts of MS components,to understand the clinical characteristics of patients with RPL and MS.It is helpful to guide the early diagnosis、treatment and intervention of such patients and improve the pregnancy outcome.Methods:A total of 382 RPL patients in the Reproductive Center outpatient Department of the First Affiliated Hospital of Anhui Medical University from November 2021 to November 2022 were selected,and 150 women who underwent assisted reproduction and assisted pregnancy due to male factors during the same period were selected as part of the control group.According to the diagnostic criteria of MS,RPL patients were divided into the combined MS group(RPL-MS group)and the non-combined MS group(RPL-NMS group).The differences of clinical data and biochemical indicators between the two groups were analyzed,and the indicators with statistical differences were included in Logistic regression analysis.According to the number of MS components combined,RPL patients were divided into MSO(0 components),MS1(1 components),MS2(2 components),MS3(3 components)and MS4(≥4 components),comparing the statistically significant factors in the Logistic regression analysis.Results:(1)The detection rate of MS in RPL patients was 17.54%,and the most common components of MS were abdominal obesity and lipid metabolism disorders.The incidence of MS components in RPL-MS group was significantly higher than that in RPL-NMS group,and the difference was statistically significant(P<0.05).(2)There were no significant differences in demographic data,life history,past medical history and menstrual and reproductive history between RPL-MS group and RPL-NMS group(P>0.05).(3)Compared with RPL-NMS group,BMI,complement 3,complement 4,FPG,FINS,TG,non-HDL-C,VLDL-C,APOB and FIB in RPL-MS group were higher and significantly increased,while 25-(OH)D,HDL-C and APOA1 were significantly decreased(P<0.05).(4)The results of Logisitic regression analysis suggested that the increase of BMI,FINS,VLDL-C and the decrease of 25-(OH)D and APOA1 were the risk factors for MS in RPL patients.(5)With the increase of the number of MS components in RPL patients,BMI,FINS and VLDL-C increased gradually,while 25-(OH)D and APOA1 decreased in general.BMI,FINS,and VLDL-C were significantly higher in the RPL group(P<0.05),and there was no significant difference between 25-(OH)D and APOA 1 in the two groups(P>0.05).Conclusion:(1)The detection rate of MS in RPL patients was 17.54%,and MS was a pathogenic factor in RPL.(2)Decreased levels of 25-(OH)D and APOA1,and increased levels of BMI,FINS and VLDL increase the risk of MS in RPL patients.(3)The levels of BMI,25-(OH)D,FINS,VLDL and APOA1 were closely correlated with the number of MS components in RPL patients.It is recommended to screen RPL patients for MS onset,and improve the screening of 25-(OH)D,blood lipid,insulin and other related indicators,so as to detect metabolic abnormalities as soon as possible.Objective:To analyze the metabolism of blood glucose,blood lipid and insulin in patients with recurrent pregnancy loss(RPL),and to compare the predictive efficacy of triglyceride glycemic index(TyG),triglyceride glycemic constitution index(TyG-BMI),and HOMA-IR for the occurrence of RPL.Methods:A total of 573 patients with RPL were selected as the RPL group,and 652 women who received assisted reproductive technology for male infertility were selected as the control group.The general data of the two groups were retrospectively analyzed.The levels of body mass index(BMI),fasting blood glucose(FPG),fasting triglyceride(FTG),fasting insulin(FINS),TyG index,TyG-BMI index and HOMA-IR were compared between the two groups.Spearman correlation analysis was used to verify the correlation between TyG index,TyG-BMI index and HOMA-IR.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of TyG index,TyG-BMI index and HOMA-IR for RPL occurrence,and the optimal predictive cut-off point was calculated.Results:(1)The BMI,FPG,FTG,TyG index,TyG-BMI index and HOMA-IR in the RPL group were significantly higher than those in the control group(P<0.05).There was no significant difference in age or fasting insulin between the two groups(P>0.05).(2)TyG index and TyG-BMI index were positively correlated with HOMA-IR,and the correlation coefficients were 0.442 and 0.505,respectively(P<0.001).(3)ROC curve analysis showed that the area under the curve of TyG-BMI index predicting RPL was 0.579(95%CI 0.551-0.607,P<0.001),which was greater than that of TyG index(0.557,95%CI 0.529-0.585,P<0.001).P<0.001)and HOMA-IR of 0.535(95%CI 0.507-0.563,P<0.05),among which the difference between TyG-BMI index and HOMA-IR index area under the curve was statistically significant(P<0.05).The optimal cut-off points of TyG-BMI index,TyG index and HOMA-IR for predicting RPL were 172.3(sensitivity 75.7%,specificity 37.06%),8.32(sensitivity 59.44%,specificity 51.61%)and 3.58(sensitivity 25.87%,specificity 81.62%),respectively.Conclusion:(1)The incidence of overweight,abnormal blood glucose,lipid and insulin metabolism in RPL patients is higher than that in normal women.(2)TyG index and TyG-BMI index can be used as indicators of insulin metabolic status in RPL population besides HOMA-IR,and TyG-BMI index is better at predicting RPL occurrence than HOMA-IR.The TyG-BMI index had the highest predictive value for RPL occurrence at 172.3.