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目的：探讨血清抗米勒管激素（AMH）、D-二聚体（D-D）、高迁移率族蛋白B1（HMGB-1）水平与多囊卵巢综合征（PCOS）患者早期先兆流产的关系。方法：选取2021年3月~2023年8月期间我院收治的122例PCOS患者，均接受相关治疗后成功妊娠。根据PCOS患者妊娠期间是否发生早期先兆流产将其分为先兆流产组（n=54）和正常组（n=68）。检测并比较两组血清AMH、D-D、HMGB-1水平。收集两组临床资料，采用单因素和多因素Logistic回归分析PCOS患者妊娠期间发生早期先兆流产的影响因素。采用受试者工作特征（ROC）曲线评估血清AMH、D-D、HMGB-1水平对PCOS患者妊娠期间发生早期先兆流产的预测价值。结果：122例PCOS患者接受治疗后成功妊娠，妊娠期间发生早期先兆流产54例，早期先兆流产发生率为44.26%（54/122）。先兆流产组血清AMH水平低于正常组，血清D-D、HMGB-1水平高于正常组（P＜0.05）。先兆流产组流产史比例、肥胖比例、睾酮（T）、空腹血糖（FPG）、胰岛素抵抗指数（HOMA-IR）均高于正常组（P＜0.05）。合并流产史、肥胖、HOMA-IR增加、血清AMH水平降低、血清D-D水平升高、HMGB-1水平升高是PCOS患者妊娠期间发生早期先兆流产的危险因素（P＜0.05）。血清AMH、D-D、HMGB-1单独及联合预测PCOS患者妊娠期间发生早期先兆流产的曲线下面积（AUC）分别为0.770、0.780、0.714、0.905，联合检测的预测效能高于单独检测（Z=2.750，P=0.006；Z=2.362，P=0.018；Z=3.316，P=0.001）。结论：妊娠期间发生早期先兆流产的PCOS患者血清AMH水平降低，血清D-D、HMGB-1水平升高，是患者妊娠期间发生早期先兆流产的危险因素，三指标联合检测在预测PCOS患者妊娠期间发生早期先兆流产方面具有较高的价值。

英文摘要:

Objective: To investigate the relationship between serum anti-millerian hormone (AMH), D-dimer (D-D), high mobility group protein B1 (HMGB-1) levels and early threatened abortion in polycystic ovary syndrome (PCOS) patients. Methods: 122 PCOS patients who were admitted in our hospital from March 2021 to August 2023 were selected, all patients were successfully pregnant after receiving relevant treatment. PCOS patients were divided into threatened abortion group (n=54) and normal group (n=68) according to whether early threatened abortion occurred during pregnancy. The serum AMH, D-D and HMGB-1 levels were detected and compared between two groups. The clinical data of two groups were collected, and the influencing factors of early threatened abortion in PCOS patients during pregnancy were analyzed by univariate and multivariate Logistic regression. The predictive value of serum AMH, D-D and HMGB-1 levels for early threatened abortion in PCOS patients during pregnancy were evaluated by receiver operating characteristic (ROC) curve. Results: 122 PCOS patients were successfully pregnant after treatment, there were 54 cases of early threatened abortion during pregnancy, the incidence of early threatened abortion was 44.26% (54/122). The serum AMH level in threatened abortion group was lower than that in normal group, and the serum D-D, HMGB-1 levels were higher than those in normal group (P<0.05). The proportion of abortion history, obesity, testosterone (T), fasting blood glucose (FPG) and insulin resistance index (HOMA-IR) in threatened abortion group were higher than those in normal group (P<0.05). The abortion history, obesity, HOMA-IR increased, serum AMH level decreased, serum D-D level increased, and HMGB-1 level increased were risk factors for early threatened abortion in PCOS patients during pregnancy (P<0.05). The area under the curve (AUC) of serum AMH, D-D and HMGB-1 alone and in combination for predicting early threatened abortion in PCOS patients during pregnancy were 0.770, 0.780, 0.714 and 0.905, respectively, the predictive efficacy of combined detection was higher than that of single detection (Z=2.750, P=0.006. Z=2.362, P=0.018. Z=3.316, P=0.001). Conclusion: Serum AMH level decrease in PCOS patients with early threatened abortion during pregnancy, the serum D-D and HMGB-1 levels are increase, which are risk factors for early threatened abortion during pregnancy, the combined detection of three indicators has a high value in predicting early threatened abortion in PCOS patients during pregnancy.

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