1.Clinical Efficacy of Yiqi Wenyang Lishui Formula in Treating Heart Failure with Yang Deficiency and Fluid Retention Syndrome:Changes in Cardiac Function and Remodeling,and Analysis of Risk Factors Affecting Therapeutic Efficacy
Min SHI ; Chuanwei ME ; Bing HE ; Hongli SHI ; Xueyan ZHANG ; Yong SUI ; Yan LI
Journal of Guangzhou University of Traditional Chinese Medicine 2025;42(11):2637-2643
Objective To investigate the effects of Yiqi Wenyang Lishui Formula(derived from Wuling San combined with Astragali Radix and Descurainiae Semen Lepidii Semen)on cardiac function and remodeling in heart failure(HF)patients with yang deficiency and fluid retention syndrome and to analyze risk factors for influencing therapeutic efficacy.Methods A total of 120 HF patients with yang deficiency and fluid retention syndrome admitted to Liaocheng Hospital of Traditional Chinese Medicine from February 2022 to January 2024 were enrolled and randomly divided into observation group(n=60)and control group(n=60)using a random number table.The control group received conventional western therapy,while the observation group received Yiqi Wenyang Lishui Formula additionally.Both groups were treated for 2 months.Changes in cardiac function indicators and remodeling markers were observed.Clinical efficacy was evaluated,and univariate and binary logistic regression analyses were performed to identify independent risk factors affecting treatment outcomes.Results(1)The total effective rate was 81.67%(49/60)in the observation group versus 70.00%(42/60)in the control group.Intergroup comparison(by chi-square test)showed that the efficacy in the observation group was superior to the control group(P<0.05).(2)After treatment,both groups showed significant reductions compared to those before treatment in left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),and N-terminal pro-brain natriuretic peptide(NT-proBNP)(P<0.01).The reduction in LVEDD,LVESD,and serum NT-proBNP levels in the observation group was significantly greater than that in the control group(P<0.05 or P<0.01).(3)Univariate analysis revealed that New York Heart Association(NYHA)functional classification,LVEDD,LVESD,and NT-proBNP levels were significantly associated with the therapeutic efficacy of the Yiqi Wenyang Lishui Formula in heart failure patients with yang deficiency and fluid retention syndrome(P<0.05).(4)Logistic regression identified NYHA classification,LVEDD,LVESD,and NT-proBNP as independent risk factors(P<0.05)in affecting therapeutic effect of Yiqi Wenyang Lishui Formula in treating HF with yang deficency and fluid retention syndrome,increasing the risk of ineffective treatment by 4.12-fold,1.21-fold,1.19-fold,and 1.00-fold,respectively.Conclusion Yiqi Wenyang Lishui Formula effectively improves cardiac function and remodeling in HF patients with yang deficiency and fluid retention syndrome.NYHA classification,LVEDD,LVESD,and NT-proBNP are independent risk factors for influencing efficacy,warranting close monitoring for optimized therapeutic adjustments.
2.Exploration of clear surgical margin in human papillomavirus positive oropharyngeal cancer treated with transoral robotic surgery.
Hongli GONG ; Chengzhi XU ; Chunping WU ; Pengyu CAO ; Yongzheng CHEN ; Jianfang WU ; Meiqin SHI ; Ming ZHANG ; Liang ZHOU ; Lei TAO
Journal of Clinical Otorhinolaryngology Head and Neck Surgery 2025;39(11):1016-1027
Objective:To analyze the relationship between the optimal surgical margin value and clinical prognosis of transoral robotic surgery(TORS) in treating human papillomavirus(HPV) -positive oropharyngeal squamous cell carcinoma. Methods:A single-center, prospective, observational cohort study was conducted, enrolling patients with early and moderated stage(≤T3 stage) oropharyngeal carcinoma undergoing TORS between July 2020 and April 2024. The proposed optimal surgical margin cutoff value for TORS was set as 2 mm. The primary objectives were to evaluate the optimal clear margin for TORS and its association with overall survival(OS) and progression-free survival(PFS). Logistic regression was used to analyze correlations between surgical margins and clinical variables, while Cox regression models assessed the impact of surgical margins on OS and PFS. Results:A total of 90 patients(60 males, 66.7%) were included, all had squamous cell carcinoma, with a mean age of 58.0±9.0 years(range: 39-84 years) old. The 1, 2 and 3-year OS rates were 92.3%, 89.9% and 85.0%, respectively, while the 1, 2 and 3-year PFS rates were all 90.1%. For surgical margins ≤2 mm, the 1, 2 and 3-year OS rates were 80.8%, 69.3% and 69.3%, respectively, and PFS rates were 77.9% across three time points. For surgical margins>2 mm, the 1, 2 and 3-year OS rates were 96.5%, 96.5% and 90.6%, respectively, with PFS rates of 94.6%. Logistic regression showed no correlation between surgical margins and tumor type, T/N stage, smoking, alcohol use, or gender(P>0.05). Cox analysis identified surgical margins>2 mm as a significant factor improving PFS(HR=0.14, 95%CI 0.02-0.90, P=0.038). Conclusion:This systematic analysis suggests setting a 2 mm and longer as clear surgical margin for TORS. Margins>2 mm are associated with superior postoperative PFS rate and prolonged PFS time in HPV-positive oropharyngeal carcinoma patients.
Adult
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Aged
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Aged, 80 and over
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Female
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Humans
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Male
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Middle Aged
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Carcinoma, Squamous Cell/virology*
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Human Papillomavirus Viruses/isolation & purification*
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Margins of Excision
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Oropharyngeal Neoplasms/virology*
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Papillomavirus Infections/virology*
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Prognosis
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Prospective Studies
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Robotic Surgical Procedures/methods*
3.USP20 as a super-enhancer-regulated gene drives T-ALL progression via HIF1A deubiquitination.
Ling XU ; Zimu ZHANG ; Juanjuan YU ; Tongting JI ; Jia CHENG ; Xiaodong FEI ; Xinran CHU ; Yanfang TAO ; Yan XU ; Pengju YANG ; Wenyuan LIU ; Gen LI ; Yongping ZHANG ; Yan LI ; Fenli ZHANG ; Ying YANG ; Bi ZHOU ; Yumeng WU ; Zhongling WEI ; Yanling CHEN ; Jianwei WANG ; Di WU ; Xiaolu LI ; Yang YANG ; Guanghui QIAN ; Hongli YIN ; Shuiyan WU ; Shuqi ZHANG ; Dan LIU ; Jun-Jie FAN ; Lei SHI ; Xiaodong WANG ; Shaoyan HU ; Jun LU ; Jian PAN
Acta Pharmaceutica Sinica B 2025;15(9):4751-4771
T-cell acute lymphoblastic leukemia (T-ALL) is a highly aggressive hematologic malignancy with a poor prognosis, despite advancements in treatment. Many patients struggle with relapse or refractory disease. Investigating the role of the super-enhancer (SE) regulated gene ubiquitin-specific protease 20 (USP20) in T-ALL could enhance targeted therapies and improve clinical outcomes. Analysis of histone H3 lysine 27 acetylation (H3K27ac) chromatin immunoprecipitation sequencing (ChIP-seq) data from six T-ALL cell lines and seven pediatric samples identified USP20 as an SE-regulated driver gene. Utilizing the Cancer Cell Line Encyclopedia (CCLE) and BloodSpot databases, it was found that USP20 is specifically highly expressed in T-ALL. Knocking down USP20 with short hairpin RNA (shRNA) increased apoptosis and inhibited proliferation in T-ALL cells. In vivo studies showed that USP20 knockdown reduced tumor growth and improved survival. The USP20 inhibitor GSK2643943A demonstrated similar anti-tumor effects. Mass spectrometry, RNA-Seq, and immunoprecipitation revealed that USP20 interacted with hypoxia-inducible factor 1 subunit alpha (HIF1A) and stabilized it by deubiquitination. Cleavage under targets and tagmentation (CUT&Tag) results indicated that USP20 co-localized with HIF1A, jointly modulating target genes in T-ALL. This study identifies USP20 as a therapeutic target in T-ALL and suggests GSK2643943A as a potential treatment strategy.
4.The predictive value of serum HOXA6 and HOXA10 levels for endometrial receptivity in patients with diminished ovarian reserve
Clinical Medicine of China 2025;41(6):458-465
Objective:To investigate the predictive value of serum HOXA6 and HOXA10 levels in assessing endometrial receptivity in patients with diminished ovarian reserve (DOR).Methods:A total of 248 DOR patients treated at Xi'an People's Hospital from January 2021 to October 2023 were enrolled, with 200 healthy female volunteers as controls. Serum HOXA6 and HOXA10 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Endometrial thickness was assessed via transvaginal ultrasound on days 20-24 of the menstrual cycle, and endometrial receptivity was classified into high receptivity (≥8 mm), moderate receptivity (6-8 mm) and low receptivity (<6 mm) group. Follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels were detected by chemiluminescence immunoassay on day 3 of the menstrual cycle. Follicle count and size were recorded via transvaginal ultrasound. Normally distributed data were expressed as Mean±SD, comparison between two groups was performed by independent samples t-test, comparison among multiple groups was performed by one-way ANOVA, pairwise comparison was performed by Tukey's HSD post hoc test. Categorical data were presented as rates or percentages and analyzed by χ2 test. Logistic regression identified independent risk factors for DOR, and Pearson correlation analyzed relationships between HOXA6/HOXA10, endometrial receptivity, and ovarian reserve. Receiver operating characteristic (ROC) curves evaluated the diagnostic value of HOXA6 and HOXA10 in predicting endometrial receptivity. Results:Serum levels of both HOXA6 [(120.34±15.16) ng/L] and HOXA10 [(98.46±12.61) ng/L] in the DOR group were significantly higher than those in the control group [(80.27±10.54) ng/L and (60.36±8.80) ng/L, respectively, t=31.70, 36.20, both P<0.001]. Endometrial thickness in the DOR group [(7.4±1.3) mm] was significantly less than that in the control group [(10.0±1.1) mm]. Serum FSH levels [(12.03±2.54) U/L] were significantly higher in the DOR group compared to the control group [(8.08±2.82) U/L], while AMH levels [(1.56±0.45) μg/L] and the number of follicles [(3.52±1.63) μg/L] were significantly lower than those in the control group [(5.07±1.05) μg/L and (10.09±2.06), respectively]. The differences between the two groups for these parameters were statistically significant ( t=22.52, 15.58, 18.10, 33.58, respectively; all P<0.001). Pearson correlation analysis revealed that serum HOXA6 and HOXA10 levels were negatively correlated with endometrial thickness, AMH levels, and the number of follicles in DOR patients (HOXA6: r=-0.773, -0.647, -0.721, respectively, all P<0.001; HOXA10: r=-0.788, -0.682, -0.834, respectively, all P<0.001), and positively correlated with serum FSH levels ( r=0.667 and 0.670, respectively, both P<0.001). Multivariate logistic regression analysis indicated that serum HOXA6 ( OR=1.179, 95% CI: 1.144-1.215, P<0.001), HOXA10 ( OR=1.223, 95% CI: 1.177-1.270, P<0.001), and FSH levels ( OR=1.827, 95% CI: 1.569-2.129, P<0.001) were independent risk factors for DOR in women. Endometrial thickness ( OR=0.264, 95% CI: 0.205-0.340, P<0.001), serum AMH levels ( OR=0.126, 95% CI: 0.078-0.205, P<0.001), and the number of follicles ( OR=0.058, 95% CI: 0.024-0.143, P<0.001) were identified as protective factors against DOR. ROC curve analysis showed that the AUCs for serum HOXA6, HOXA10, and their combination in predicting poor endometrial receptivity in DOR patients were 0.770, 0.820, and 0.864, respectively. The AUC value for HOXA10 was slightly higher than that for HOXA6, and the combined prediction model had the highest AUC value. Conclusion:Serum HOXA6 and HOXA10 levels demonstrate a statistically significant association with ovarian reserve function and endometrial receptivity. These findings suggest their potential as diagnostic biomarkers for assessing endometrial receptivity in patients with diminished ovarian reserve (DOR).
5.Current status and influencing factors of fear of ulcer recurrence in patients with diabetic foot
Qian WANG ; Hongjuan ZHU ; Na SHI ; Zhenhua XIA ; Hongli YU ; Liwei WANG
Chinese Journal of Nursing 2025;60(20):2486-2492
Objective To explore the fear of ulcer recurrence in patients with diabetic foot and analyze its influencing factors,so as to provide strategies for medical staff to implement comprehensive and personalized nursing interventions.Methods From February 2024 to March 2025,convenience sampling was used to select inpatients and outpatients with diabetic foot ulcers from 6 tertiary hospitals in China as the survey subjects.The general information questionnaire,ADL,MNA,PSQI,Diabetic Foot Self-Management Behavior Scale and FOP-Q-SF were used to investigate and analyze the results.Results A total of 191 questionnaires were distributed and 186 valid questionnaires were returned,with an effective recovery rate of 97.38%.The total score of ulcer recurrence fear of diabetic foot patients was(31.78±7.41).Binary Logistic regression analysis showed that nutritional status,sleep quality,duration of diabetes,other chronic diseases,family per capita monthly income and medical insurance were the influencing factors of ulcer recurrence fear in patients with diabetic foot(P<0.05).Conclusion Patients with diabetic foot have a high level of fear of ulcer recurrence.Nutritional status,sleep quality,duration of diabetes,combined with other chronic diseases,family per capita monthly income,and medical insurance are its influencing factors.Nursing staff should take targeted nursing measures according to its influencing factors to reduce the occurrence of patients' fear of ulcer recurrence.
6.Construction and validation of a model for jointly predicting early pregnancy loss at 6 weeks of gestation after IVF-ET based on serum FGF-21,AMH,and NRP-1
Hongwei ZHANG ; Nan WANG ; Guoxi SHI ; Junying ZHAI ; Hongli NIU ; Ying WANG
The Journal of Practical Medicine 2025;41(22):3480-3489
Objective To investigate the predictive value of pre-transfer serum fibroblast growth factor 21(FGF-21),anti-Müllerian hormone(AMH),and neuropilin-1(NRP-1)for early pregnancy loss at 6 weeks following in vitro fertilization-embryo transfer(IVF-ET),and to establish an early predictive model based on serum biochemical markers.Methods This prospective study consecutively enrolled 322 women who achieved clinical pregnancy after IVF-ET at our center between September 2022 and September 2024.Participants were randomly divided into a modeling cohort(n=225)and a validation cohort(n=97)at a 7:3 ratio.According to ultrasound findings at 6 weeks of gestation,patients in the modeling cohort were classified into an early pregnancy loss group(n=59)and an ongoing pregnancy group(n=166).Baseline clinical characteristics and pre-transfer serum levels of FGF-21,AMH,and NRP-1 were collected.Multivariate logistic regression was applied to identify inde-pendent risk factors for early pregnancy loss and to construct a predictive model.Model discrimination,calibra-tion,and stability were evaluated using receiver operating characteristic(ROC)curves,the Hosmer-Lemeshow goodness-of-fit test,and bootstrap resampling in both cohorts.Results Univariate analysis revealed that the FSH/LH ratio,antral follicle count,and number of retrieved oocytes were significantly associated with early pregnancy loss(P<0.001).Compared with the ongoing pregnancy group,women with early loss showed significantly elevated pre-transfer serum FGF-21 levels,whereas AMH and NRP-1 levels were markedly reduced(P<0.001).Multivariate logistic regression demonstrated that an FSH/LH ratio<1.8(OR=1.629,P=0.002)and higher FGF-21 levels(OR=1.338,P=0.002)were independent risk factors,while higher AMH(OR=0.741,P=0.010)and NRP-1 levels(OR=0.874,P=0.007)were protective.Stratified analysis indicated that among patients with FSH/LH≥1.8,FGF-21 levels were significantly higher and AMH and NRP-1 levels significantly lower(all P<0.001).Interaction analysis further suggested that the FSH/LH ratio significantly modified the associations between these biomarkers and pregnancy loss risk(P for interaction<0.05).Specifically,in the higher FSH/LH subgroup,the risk effect of FGF-21 was amplified,while the protective effects of AMH and NRP-1 were more pronounced.The combined predictive model achieved C-indices of 0.869(95%CI:0.826~0.926)in the modeling cohort and 0.835(95%CI:0.811~0.907)in the validation cohort.Its AUC for predicting early pregnancy loss was 0.934 in the modeling co-hort and 0.909 in the validation cohort,both significantly outperforming individual markers(AUCs:FGF-21=0.867,AMH=0.881,NRP-1=0.853;Z=2.024,1.831;P<0.001).Decision curve analysis showed that the model provided consistent net clinical benefit across threshold probabilities of 0.1~0.4,underscoring its clinical utility.Conclusions Elevated pre-transfer serum FGF-21 and reduced AMH and NRP-1 levels are strongly associ-ated with early pregnancy loss at 6 weeks after IVF-ET.The predictive model developed in this study demonstrates robust accuracy and stability,offering substantial clinical application value for early risk stratification.
7.The predictive value of serum HOXA6 and HOXA10 levels for endometrial receptivity in patients with diminished ovarian reserve
Clinical Medicine of China 2025;41(6):458-465
Objective:To investigate the predictive value of serum HOXA6 and HOXA10 levels in assessing endometrial receptivity in patients with diminished ovarian reserve (DOR).Methods:A total of 248 DOR patients treated at Xi'an People's Hospital from January 2021 to October 2023 were enrolled, with 200 healthy female volunteers as controls. Serum HOXA6 and HOXA10 concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Endometrial thickness was assessed via transvaginal ultrasound on days 20-24 of the menstrual cycle, and endometrial receptivity was classified into high receptivity (≥8 mm), moderate receptivity (6-8 mm) and low receptivity (<6 mm) group. Follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) levels were detected by chemiluminescence immunoassay on day 3 of the menstrual cycle. Follicle count and size were recorded via transvaginal ultrasound. Normally distributed data were expressed as Mean±SD, comparison between two groups was performed by independent samples t-test, comparison among multiple groups was performed by one-way ANOVA, pairwise comparison was performed by Tukey's HSD post hoc test. Categorical data were presented as rates or percentages and analyzed by χ2 test. Logistic regression identified independent risk factors for DOR, and Pearson correlation analyzed relationships between HOXA6/HOXA10, endometrial receptivity, and ovarian reserve. Receiver operating characteristic (ROC) curves evaluated the diagnostic value of HOXA6 and HOXA10 in predicting endometrial receptivity. Results:Serum levels of both HOXA6 [(120.34±15.16) ng/L] and HOXA10 [(98.46±12.61) ng/L] in the DOR group were significantly higher than those in the control group [(80.27±10.54) ng/L and (60.36±8.80) ng/L, respectively, t=31.70, 36.20, both P<0.001]. Endometrial thickness in the DOR group [(7.4±1.3) mm] was significantly less than that in the control group [(10.0±1.1) mm]. Serum FSH levels [(12.03±2.54) U/L] were significantly higher in the DOR group compared to the control group [(8.08±2.82) U/L], while AMH levels [(1.56±0.45) μg/L] and the number of follicles [(3.52±1.63) μg/L] were significantly lower than those in the control group [(5.07±1.05) μg/L and (10.09±2.06), respectively]. The differences between the two groups for these parameters were statistically significant ( t=22.52, 15.58, 18.10, 33.58, respectively; all P<0.001). Pearson correlation analysis revealed that serum HOXA6 and HOXA10 levels were negatively correlated with endometrial thickness, AMH levels, and the number of follicles in DOR patients (HOXA6: r=-0.773, -0.647, -0.721, respectively, all P<0.001; HOXA10: r=-0.788, -0.682, -0.834, respectively, all P<0.001), and positively correlated with serum FSH levels ( r=0.667 and 0.670, respectively, both P<0.001). Multivariate logistic regression analysis indicated that serum HOXA6 ( OR=1.179, 95% CI: 1.144-1.215, P<0.001), HOXA10 ( OR=1.223, 95% CI: 1.177-1.270, P<0.001), and FSH levels ( OR=1.827, 95% CI: 1.569-2.129, P<0.001) were independent risk factors for DOR in women. Endometrial thickness ( OR=0.264, 95% CI: 0.205-0.340, P<0.001), serum AMH levels ( OR=0.126, 95% CI: 0.078-0.205, P<0.001), and the number of follicles ( OR=0.058, 95% CI: 0.024-0.143, P<0.001) were identified as protective factors against DOR. ROC curve analysis showed that the AUCs for serum HOXA6, HOXA10, and their combination in predicting poor endometrial receptivity in DOR patients were 0.770, 0.820, and 0.864, respectively. The AUC value for HOXA10 was slightly higher than that for HOXA6, and the combined prediction model had the highest AUC value. Conclusion:Serum HOXA6 and HOXA10 levels demonstrate a statistically significant association with ovarian reserve function and endometrial receptivity. These findings suggest their potential as diagnostic biomarkers for assessing endometrial receptivity in patients with diminished ovarian reserve (DOR).
8.Case 06 (2025): A case of pregnancy complicated by type 1 diabetes with severe diabetic nephropathy and retinopathy
Hongli HUANG ; Huixia YANG ; Geng SONG ; Shuxian WANG ; Ye FENG ; Yumei WEI ; Yu SUN ; Sufang SHI ; Xiaoyong YUAN ; Jing ZHANG
Chinese Journal of Perinatal Medicine 2025;28(1):51-56
This paper reported a type 1 diabetes patient who had severe diabetic nephropathy, retinopathy, hypertension, and hypothyroidism before pregnancy. The patient's blood glucose control was poor before pregnancy, and the complications were not properly treated. This was an unintended pregnancy, with a pre-pregnancy glycated hemoglobin A1c of 7.8% and early pregnancy urine protein of 3.81-4.53 g/24 h. Considering the patient's poor blood glucose control before pregnancy and the lack of proper treatment for multiple complications including nephropathy, a multidisciplinary consultation at an external hospital recommended termination of the pregnancy. However, the patient was determined to continue the pregnancy and was referred to Peking University First Hospital. Through strict blood glucose control, monitoring and evaluation of complications, and comprehensive management, the patient's blood glucose and blood pressure were well controlled during pregnancy. Regular monitoring of urine protein, renal function, and ocular fundus was conducted. At 31 weeks and 4 days of gestation, the patient's 24-hour urine protein significantly increased. After promoting fetal lung maturity, a cesarean section was performed at 34 weeks and 1 day of gestation, resulting in a successful delivery with good maternal and neonatal outcomes. At the 42-day postpartum follow-up, the patient's blood glucose and blood pressure were stable, urine protein returned to pre-pregnancy levels, and the infant was in good general condition.
9.Construction and validation of a model for jointly predicting early pregnancy loss at 6 weeks of gestation after IVF-ET based on serum FGF-21,AMH,and NRP-1
Hongwei ZHANG ; Nan WANG ; Guoxi SHI ; Junying ZHAI ; Hongli NIU ; Ying WANG
The Journal of Practical Medicine 2025;41(22):3480-3489
Objective To investigate the predictive value of pre-transfer serum fibroblast growth factor 21(FGF-21),anti-Müllerian hormone(AMH),and neuropilin-1(NRP-1)for early pregnancy loss at 6 weeks following in vitro fertilization-embryo transfer(IVF-ET),and to establish an early predictive model based on serum biochemical markers.Methods This prospective study consecutively enrolled 322 women who achieved clinical pregnancy after IVF-ET at our center between September 2022 and September 2024.Participants were randomly divided into a modeling cohort(n=225)and a validation cohort(n=97)at a 7:3 ratio.According to ultrasound findings at 6 weeks of gestation,patients in the modeling cohort were classified into an early pregnancy loss group(n=59)and an ongoing pregnancy group(n=166).Baseline clinical characteristics and pre-transfer serum levels of FGF-21,AMH,and NRP-1 were collected.Multivariate logistic regression was applied to identify inde-pendent risk factors for early pregnancy loss and to construct a predictive model.Model discrimination,calibra-tion,and stability were evaluated using receiver operating characteristic(ROC)curves,the Hosmer-Lemeshow goodness-of-fit test,and bootstrap resampling in both cohorts.Results Univariate analysis revealed that the FSH/LH ratio,antral follicle count,and number of retrieved oocytes were significantly associated with early pregnancy loss(P<0.001).Compared with the ongoing pregnancy group,women with early loss showed significantly elevated pre-transfer serum FGF-21 levels,whereas AMH and NRP-1 levels were markedly reduced(P<0.001).Multivariate logistic regression demonstrated that an FSH/LH ratio<1.8(OR=1.629,P=0.002)and higher FGF-21 levels(OR=1.338,P=0.002)were independent risk factors,while higher AMH(OR=0.741,P=0.010)and NRP-1 levels(OR=0.874,P=0.007)were protective.Stratified analysis indicated that among patients with FSH/LH≥1.8,FGF-21 levels were significantly higher and AMH and NRP-1 levels significantly lower(all P<0.001).Interaction analysis further suggested that the FSH/LH ratio significantly modified the associations between these biomarkers and pregnancy loss risk(P for interaction<0.05).Specifically,in the higher FSH/LH subgroup,the risk effect of FGF-21 was amplified,while the protective effects of AMH and NRP-1 were more pronounced.The combined predictive model achieved C-indices of 0.869(95%CI:0.826~0.926)in the modeling cohort and 0.835(95%CI:0.811~0.907)in the validation cohort.Its AUC for predicting early pregnancy loss was 0.934 in the modeling co-hort and 0.909 in the validation cohort,both significantly outperforming individual markers(AUCs:FGF-21=0.867,AMH=0.881,NRP-1=0.853;Z=2.024,1.831;P<0.001).Decision curve analysis showed that the model provided consistent net clinical benefit across threshold probabilities of 0.1~0.4,underscoring its clinical utility.Conclusions Elevated pre-transfer serum FGF-21 and reduced AMH and NRP-1 levels are strongly associ-ated with early pregnancy loss at 6 weeks after IVF-ET.The predictive model developed in this study demonstrates robust accuracy and stability,offering substantial clinical application value for early risk stratification.
10.Relationship between NLRP,NF-κB and Caspase-1 levels in peripheral blood mononuclear cells and pregnancy outcome in patients with recurrent spontaneous abortion and reproductive tract infection
Guoxi SHI ; Hongli NIU ; Hongwei ZHONG ; Nan WANG ; Junying ZHAI ; Ying WANG
Chinese Journal of Nosocomiology 2025;35(11):1665-1669
OBJECTIVE To analyze the levels of NOD like receptor thermal protein domain associated protein 3(NLRP3),nuclear factor κB(NF-κB)and Caspase-1 in peripheral blood mononuclear cells in patients with recur-rent spontaneous abortion(RSA)and reproductive tract infection(RTI),and the relationship between above inde-xes and pregnancy outcome.METHODS A total of 136 patients with RSA and RTI who were admitted to Nanyang First People's Hospital from Mar.2021 to Apr.2024 were selected as the study group,70 patients with RSA but without RTI during the same period were selected as the control group,and those patients with RSA and RTI who were pregnant again were divided into the continued pregnancy group and the abortion group based on their preg-nancy outcomes.The levels of NLRP,NF-κB and caspase-1 in peripheral blood mononuclear cells were compared between the study group and the control group,Multivariate logistic regression analysis was used to identify risk factors for adverse pregnancy outcomes in patients with RSA and RTI.Receiver's operating characteristic(ROC)curves were used to evaluate the value of NLRP,NF-κB,and Caspase-1 in peripheral blood mononuclear cells in predicting pregnancy outcomes of patients with RSA and RTI.RESULTS The levels of NLRP,NF-κB and caspase-1 in the study group were(1.93±0.49),(1.82±0.41)and(2.23±0.41)respectively,which were higher than those in the control group(P<0.05).The proportion of abortion in the study group was 39.79%,which was higher than that in the control group(P=0.036).Pre-pregnancy body mass index(BMI)and the levels of glycated hemoglobin,triacylglycerol,NLRP,NF-κB and Caspase-1 in the abortion group were higher than those in the continued pregnancy group.Multivariate logistic regression analysis showed that NLRP3(OR=4.721,95%CI:1.336-16.680,P=0.016),NF-κB(OR=4.669,95%CI:1.495-14.58,P=0.008),caspase-1(OR=4.358,95%CI:1.260-15.070,P=0.023)and pre-pregnancy BMI(OR=2.927,95%CI:1.280-6.693,P=0.011)were risk factors affecting pregnancy outcomes of patients with RSA and RTI(P<0.05).ROC curves indicated that the area under the curve(AUC)of NLRP,NF-κB and Caspase-1 for pregnancy outcome in patients with RSA combined with RTI was 0.846,0.885 and 0.938.CONCLUSION The NLRP,NF-κB and Caspase-1 in peripheral blood mononuclear cells is highly expressed in patients with RSA and RTI,and the high expression of the above indicators is closely related to the adverse pregnancy of patients,which can be used as a predictor of pregnancy outcomes in patients with RSA and RTI.

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