摘要
目的:探讨影响宫颈环形电切术(LEEP)后孕妇发生胎膜早破的预测因素,建立预测模型,并初步验证模型的临床应用价值。方法:选择浙江大学金华医院有LEEP术史的88例孕妇的病例资料作为训练数据集进行回顾性分析,使用logistic回归分析与胎膜早破有关的影响因素,建立预测模型。使用受试者工作特性曲线分析模型预测能力。前瞻性研究纳入LEEP术后54例孕妇资料作为验证数据集,对模型的预测能力进行初步验证。结果:单因素logistic回归分析发现,年龄、孕次和中孕期宫颈长度(CL)是胎膜早破发生相关的高危因素,多因素logistic回归分析结果显示,中孕期CL(OR=0.08,95%CI为0.03~0.24,P<0.001)是胎膜早破的独立预测因素。建立回归模型Logit(P)=3.918-2.511×CL,曲线下面积(AUC)为0.89(95%CI为0.80~0.97),该模型预测是否胎膜早破的CL最佳阈值为24.5mm,其灵敏度、特异度、Youden指数、阳性预测值、阴性预测值和准确率分别为88.9%、84%、0.729、84.7%、88.3%、86.5%。验证数据集的AUC为0.93(95%CI:0.86~1.00),其灵敏度、特异度、Youden指数、阳性预测值、阴性预测值和准确率分别为93.3%、82.1%、0.754、83.9%、92.5%、87.7%。结论:中孕期CL是LEEP术后胎膜早破的独立预测因素,对于LEEP术后孕妇,因此严密监测LEEP术后孕妇的中孕期CL,有助于医生进行临床评估,避免不必要的临床治疗,降低LEEP术后孕妇胎膜早破的风险。
Objective:To investigate the prognostic factors for the premature rupture of the membrane(PROM)in pregnant women after loop electrosurgical excision procedure(LEEP),construct and preliminary validate the prognostic model.Methods:88 women after LEEP in Jinhua hospital Zhejiang University were included in the retrospective study.The influence factors of PROM were analyzed by logistic regression analysis for construct a prognostic model.A receiver operating characteristic curve was established.Then analysis the predictive ability of the model.54 women who underwent LEEP were included in the prospective study as a validation data.The clinical value of PROM prognostic model for pregnant women after LEEP was preliminary validated.Results:Univariate logistic regression analysis found that age,pregnant frequency and cervical length(CL)during middle pregnancy were related with high risk factors of PROM.Multivariate logistic regression analysis found that cervical length(OR=0.08,95%CI:0.03~0.24,P<0.001)during middle pregnancy was an independent predictor of PROM.The regression model was Logit(P)=3.918-2.511×CL.The areas under the ROC(AUC)was 0.89(95%CI:0.80~0.97).The sensitivity,specificity,Youden index,positive predictive value(PPV),negative predictive value(NPV)and accuracy with the cut off value of 24.5mm were 88.9%,84%,0.729,84.7%,88.3%and 86.5%respectively.The areas under the ROC of the Validation data was 0.93(95%CI:0.86~1.00).The sensitivity,specificity,Youden index,PPV,NPV and accuracy were 93.3%,82.1%,0.754,83.9%,92.5%and 87.7%.Conclusions:CL is an independent predictor of PROM in the second trimester of pregnancy after LEEP.For such women after LEEP,CL should be closely monitored during middle pregnancy in order to evaluate the clinical outcome and avoid the unnecessary clinical treatment.
作者
楼叶琳
胡洋
周一波
Lou Yelin;Hu Yang;Zhou Yibo(Department of Ultrasonography,Jinhua Hospital Zhejiang University,Jinhua Municipal Central Hospital,Jinhua 321000;Department of Urology,Jinhua Hospital Zhejiang University,Jinhua Municipal Central Hospital,Jinhua 321000)
出处
《现代妇产科进展》
CSCD
北大核心
2020年第12期910-913,共4页
Progress in Obstetrics and Gynecology
基金
浙江省基金-数理医学学会联合基金项目(No:LSY19H180006)
浙江省医药卫生科技计划科技平台项目(No:2018ZD054)。
关键词
预测模型
宫颈长度
宫颈环形电切术
胎膜早破
Prognostic model
Cervical length
Loop electrosurgical excision procedure
Premature rupture of the membrane
