摘要
目的分析影响复发性剖宫产术后子宫瘢痕妊娠(RCSP)发生的危险因素,并建立列线图预测模型。方法回顾性分析204例剖宫产术后子宫瘢痕妊娠(CSP)患者的临床资料,根据是否发生RCSP分为RCSP组(n=38)与非RCSP组(n=166)。比较两组患者的一般资料、前次CSP孕期资料和治疗后情况,并采用多因素Logistic回归模型筛选影响RCSP发生的危险因素。基于各危险因素,采用R软件建立列线图预测模型,并使用受试者工作特征(ROC)曲线评估模型的区分度。结果204例CSP患者的RCSP发生率为18.63%(38/204)。两组患者流产次数、早期阴道流血情况、前次CSP分娩时孕龄、前次CSP剩余肌层厚度比较,差异均有统计学意义(均P<0.05);Logistic回归分析显示,相较于流产次数为0次者、前次CSP分娩时孕龄<42 d者、无早期阴道流血者、前次CSP子宫剩余肌层厚度>3 mm者,流产次数≥3次、前次CSP分娩时孕龄>56 d、早期阴道流血、前次CSP剩余肌层厚度<2 mm是影响RCSP发生的独立危险因素(均P<0.05)。基于上述危险因素建立列线图预测模型预测RCSP发生的概率,验证结果显示ROC曲线下面积为0.861,列线图校准曲线斜率接近1。结论流产次数≥3次、早期阴道流血、前次CSP分娩时孕龄>56 d、前次CSP子宫剩余肌层厚度<2 mm的CSP患者发生RCSP的风险增加。基于上述危险因素建立的列线图预测模型具有良好的区分度与一致性,可为预防RCSP发生提供一定的指导。
Objective To analyze the risk factors influencing the incidence of recurrent cesarean scar pregnancy(RCSP),and to establish a nomogram prediction model.Methods A retrospective analysis was conducted on the clinical data of 204 cesarean scar pregnancy(CSP)patients,and the patients were divided into RCSP group(n=38)and non-RCSP group(n=166)according to the occurrence of RCSP.The general data,gestational data and post-therapeutic conditions of previous CSP were compared between the two groups,and the multivariate Logistic regression model was used to screen the risk factors influencing the incidence of RCSP.R software was employed to establish a nomogram prediction model based on various risk factors,and the discrimination of the model was evaluated using the receiver operating characteristic(ROC)curve.Results The incidence rate of RCSP was 18.63%(38/204)among the 204 CSP patients.There were statistically significant differences between the two groups in the number of abortions,vaginal bleeding during the early stage,childbearing age in previous CSP,and residual myometrial thickness in previous CSP(all P<0.05).Logistic regression analysis revealed that,as compared with patients with the number of abortion equal to 0,childbearing age in previous CSP<42 days,no vaginal bleeding during the early stage,or residual myometrial thickness in previous CSP>3 mm,the number of abortions≥3,childbearing age in previous CSP>56 days,vaginal bleeding during the early stage,and residual myometrial thickness in previous CSP<2 mm were the independent risk factors influencing the incidence of RCSP(all P<0.05).Based on the aforementioned risk factors,a nomogram prediction model was established for predicting the probability of developing RCSP,and the verification result showed that the area under the ROC curve was 0.861 and the slope of the nomogram calibration curve was close to 1.Conclusion The risk for developing RCSP is increased in CSP patients with the number of abortions≥3,with vaginal bleeding during the early stage,with chil
作者
王丽
黄晓虹
邓姝艳
谢清
廖卫娟
WANG Li;HUANG Xiao-hong;DENG Shu-yan;XIE Qing;LIAO Wei-juan(Department of Obstetrics and Gynecology,the Second People′s Hospital of Beihai City,Beihai 536000,China)
出处
《广西医学》
CAS
2021年第24期2923-2927,3020,共6页
Guangxi Medical Journal
基金
广西北海市科学研究与技术开发计划(北科合201912401)。
