摘要
目的构建双胎妊娠孕妇子痫前期(PE)风险预测模型,为PE早期筛查和预防提供依据。方法选择在湖州市妇幼保健院产检并分娩的双胎妊娠孕妇467人,随访期内发生PE 60例纳入病例组,随机选择未发生PE 60人纳入对照组。收集一般资料、血液生化检测指标和子宫动脉阻力指数(UtA-RI);采用logistic回归模型分析预测因子并建立列线图;采用Bootstrap法进行内部验证,采用受试者操作特征(ROC)曲线、校准曲线和决策曲线分析法分别检验模型的区分度、校准度和临床实用性。结果病例组年龄<35岁47例,占78.33%;孕前体质指数(BMI)≥25 kg/m^(2)21例,占35.00%;受孕方式以试管婴儿为主,33例占55.00%。对照组年龄<35岁57人,占95.00%;孕前BMI≥25 kg/m^(2)8人,占13.33%;受孕方式以自然妊娠为主,39人占65.00%。多因素logistic回归分析结果显示,年龄、孕前BMI、受孕方式、胎盘生长因子(PLGF)和UtA-RI是双胎妊娠孕妇发生PE的风险预测因子,建立的列线图曲线下面积为0.827(95%CI:0.755~0.899),灵敏度为0.767,特异度为0.733;验证显示模型的区分度、校准度良好,临床净获益较高。结论本研究建立的列线图对双胎妊娠孕妇PE风险具有较好的预测价值。
Objective To construct a prediction model for preeclampsia(PE)risk in twin-pregnant women,so as to pro-vide the basis for early screening and prevention of PE.Methods A total of 467 twin-pregnant women who underwent prenatal examination and delivered at Huzhou Maternal and Child Health Hospital were selected.Sixty cases with pre-eclampsia(PE)were included in the case group,and 60 women without PE were included in the control group.Gener-al information,blood biochemical indicators and uterine artery resistance index(UtA-RI)were collected.A logistic re-gression model was used to screen predictive factors and establish a nomogram.The Bootstrap method was performed for the internal validation;the receiver operating characteristic(ROC)curve,calibration curve and decision curve analy-sis were employed to evaluate the discrimination,calibration and clinical utility of the nomogram,respectively.Results In the case group,there were 47 individuals(78.33%)aged younger than 35 years,21 individuals(35.00%)with pre-pregnancy body mass index(BMI)of 25 kg/m^(2) and above,and 33 individuals(55.00%)with in vitro fertilization.In the control group,there were 57 individuals(95.00%)aged younger than 35 years,8 individuals(13.33%)with pre-pregnan-cy BMI of 25 kg/m^(2) and above,and 39 individuals(65.00%)with natural pregnancy.Multivariable logistic regression analysis identified age,pre-pregnancy BMI,method of conception,placental growth factor(PLGF)and UtA-RI as risk prediction factors for PE in twin-pregnant women.The established nomogram had an area under the ROC curve of 0.827(95%CI:0.755-0.899),a sensitivity of 0.767,a specificity of 0.733,a good discrimination and calibration,and a relatively high clinical net benefit.Conclusion The nomogram established by age,pre-pregnancy BMI,method of con-ception,PLGF and UtA-RI has a good predictive value for the risk of PE in twin-pregnant women.
作者
陆艳
李琼珊
孟迪云
梅丽娜
丁忠英
李雯雯
储华
秦玲
LU Yan;LI Qiongshan;MENG Diyun;MEI Lina;DING Zhongying;LI Wenwen;CHU Hua;QIN Ling(Department of Obstetrics,Huzhou Maternal and Child Health Hospital,Huzhou,Zhejiang 313000,China)
出处
《预防医学》
2024年第4期283-287,共5页
CHINA PREVENTIVE MEDICINE JOURNAL
基金
浙江省医药卫生科技计划项目(2021KY1084)
浙江省医药卫生科技计划项目(2022KY1226)
湖州市科学技术局公益性应用研究项目(2019GYB15)。
