摘要
目的通过分析产妇产后发生盆腔器官脱垂(POP)的相关影响因素,建立并验证个体化预测产后POP发生风险的列线图模型。方法选取2019年1月至2020年11月在本院建档并分娩的340例产妇作为研究对象,并根据产妇产后是否出现POP将其分为POP组(59例)和非POP组(281例)。在单因素分析的基础上,建立多因素Logistic逐步回归模型筛选影响POP发生的危险因素。而后,应用“rms”程序包绘制预测产后POP发生风险的列线图模型,并通过受试者工作特征(ROC)曲线、校准曲线、Hosmer-Lemeshow拟合优度检验评估该模型。结果多因素Logistic回归分析显示,年龄、孕前BMI、自然分娩、产次、新生儿体质量是产妇产后POP发生的独立危险因素(OR值分别是1.201、1.466、2.624、4.599、19.193,P<0.05)。ROC分析显示,本研究建立的产后POP发生风险预测模型区分度较好(AUC=0.855,95%CI:0.799~0.911);校准曲线接近斜率为1的直线;Hosmer-Lemeshow拟合优度检验显示模型校准度较好(χ^(2)=16.428,P=0.377)。结论本研究基于产妇年龄、孕前BMI、分娩方式、产次、新生儿体质量这5项独立影响因素,构建了预测产妇产后POP发生风险的列线图模型,具有较好的准确度与区分度,可为临床工作提供参考依据。
Objective To establish and verify an individualized nomogram model for predicting the risk of postpartum pelvic organ prolapse(POP)by analyzing the related factors of postpartum POP.Methods A total of 340 parturient women who were registered and delivered in our hospital from January 2019 to November 2020 were selected as the research objects,and they were divided into POP group(59 cases)and non-POP group(281 cases)according to whether there was POP after delivery.On the basis of univariate analysis,a multivariate Logistic stepwise regression model was established to screen the risk factors affecting the occurrence of POP.Then,the“rms”package was used to draw the nomogram model for predicting the risk of postpartum POP.The model was evaluated by receiver operating characteristic(ROC)curve,calibration curve and Hosmer-Lemeshow goodness of fit test.Results Multivariate Logistic regression analysis showed that age,pre-pregnancy body mass index,natural delivery,parity and neonatal body weight were independent risk factors of postpartum POP(OR=1.201,1.466,2.624,4.599 and 19.193,respectively,P<0.05).ROC analysis showed that the risk prediction model of postpartum POP established in this study had good discrimination(AUC=0.855,95%CI:0.799-0.911).The calibration curve was close to the straight line with slope 1,Hosmer-Lemeshow goodness of fit test showed that the model calibration was good(χ^(2)=16.428,P=0.377).Conclusion Based on the five independent influencing factors of maternal age,pre-pregnancy body mass index,way of delivery,parity and neonatal body weight,this study constructed a nomogram model to predict the risk of postpartum POP,with good accuracy and discrimination,and can provide reference basis for clinical work.
作者
周明
孙艳
李义菊
方翠莲
张晓红
ZHOU Ming;SUN Yan;LI Yiju;FANG Cuilian;ZHANG Xiaohong(Department of Obstetrics and Gynecology,XuanCheng City Central Hospital,Anhui Xuancheng 242000,China;Department of Obstetrics and Gynecology,Xuancheng People's Hospital,Anhui Xuancheng 242000,China)
出处
《中国妇幼健康研究》
2022年第4期13-17,共5页
Chinese Journal of Woman and Child Health Research
基金
安徽省卫生健康适宜技术项目(SYJS-1915)。
关键词
产后
盆腔器官脱垂
列线图
预测模型
postpartum
pelvic organ prolapse
nomogram
prediction model
