摘要
目的:基于血栓弹力图(TEG)参数构建妊娠期高血压(HDCP)不良妊娠结局的Nomogram预测模型。方法:选取2020年1月-2023年2月于本院进行分娩的110例HDCP患者,开展前瞻性研究。统计不良妊娠结局发生情况,根据妊娠结局分为良好组和不良组。比较两组临床资料,分析HDCP不良妊娠结局的预测因素,构建Nomogram预测模型,对Nomogram预测模型进行验证。结果:本研究中HDCP患者不良妊娠结局发生率为37.3%(41/110);不良组年龄、病情程度、分娩孕周、孕早期规律补充叶酸、24h尿蛋白(24hPRO)、胱抑素C(CysC)、D-二聚体(D-D)、超敏C-反应蛋白(hs-CRP)、可溶性血管内皮生长因子受体-1(sVEGFR-1)、血小板活化因子(PAF)、微小RNA-124-3p(miR-124-3p)、血小板计数(PLT)、R值(R)、最大振幅MA值(MA)、凝血综合指数CI值(CI)与良好组比较,差异有统计学意义(P<0.05);可使模型性能优良且影响因素最少λ对应的预测因素有10个,分别为病情程度、D-D、hs-CRP、sVEGFR-1、PAF、PLT、miR-124-3p、R、MA、CI,且均为不良妊娠结局的影响因素(P<0.05);根据影响因素构建HDCP不良妊娠结局的Nomogram预测模型,受试者工作特征(ROC)曲线显示该模型预测不良妊娠结局的曲线下面积(AUC)为0.911(95%CI0.805~0.962),预测敏感度、特异度分别为95.3%、97.3%,具有良好预测效能,决策曲线(DCA)显示该模型在预测不良妊娠结局发生风险方面具有良好临床效用。结论:TEG参数中R、MA、CI是HDCP发生不良妊娠结局的影响因素,基于TEG参数构建HDCP不良妊娠结局的Nomogram预测模型在预测不良妊娠结局发生风险方面具有良好预测效能和临床效用。
Objective:To establish a Nomogram prediction model for the adverse pregnancy outcomes of pregnant women with hypertensive disorder complicating pregnancy(HDCP)based on TEG parameters.Methods:110 pregnant women with HDCP who gave birth in hospital from January 2020 to February 2023 were selected for this prospective study.The incidence of the adverse pregnancy outcomes of the women was analyzed.These women were divided into group A(women with normal pregnancy outcomes)and group B(women with adverse pregnancy outcomes).The clin-ical data of the women was compared between the two groups.A Nomogram prediction model for the adverse pregnan-cy outcomes of the pregnant women with HDCP was established and verified.Results:In this study,the incidence of the adverse pregnancy outcomes of the pregnant women with HDCP was 37.3%(41/110).The age,the disease degree of HDCP,the delivery gestational weeks,the regularly supplement folic acid during the first trimester of pregnancy,the values of 24h urine protein(24h PRO),the levels of cystatin C(CysC),D dimer(D-D),hypersensitive reactive protein(hs-CRP),soluble vascular endothelial growth factor receptor 1(sVEGFR 1),platelet activating factor(PAF)and MicrorNA 1243p(miR 1243p),the platelet count(PLT),and the values of R Value(R),maximum amplitude MA(MA)and the coagulation index(CI)of the women in group B were significantly different from those of the women in group B(P<0.05).There were 10 predictors that could improve the model performance with the leastλ,including the disease degree of HDCP,the D-D level,the hs-CRP level,the sVEGFR 1 level,the PAF level,the PLT,the miR 1243p level,the R value,the MA value and the CI value,and all of which were the influential factors of the adverse pregnancy outcomes of the women(P<<0.05).A Nomogram predictive model for the adverse pregnancy outcomes based on these influencing factors was constructed,and receiver operating characteristic(ROC)curve.showed that the area under the curve(AUC)of this model for predicting the adverse pregnancy outcomes of the women with HDCP was 0.911(95%CI 0.805-0.962),and the predictive sensitivity and specificity of this model for the adverse pregnancy outcomes were 95.3%and 97.3%,and which had showed the good predictive efficacy.Decision curve(DCA)showed that this model had good clinical efficacy in predicting the risk of the adverse pregnancy outcomes of the women with HDCP.Conclusion:R,MA and CI of TEG parameters are the influential factors of the adverse pregnancy outcomes of the women with HDCP.This Nomogram model constructed based on TEG parameters for pre dicting the adverse pregnancy outcomes of the women with HDCP has good efficacy and clinical application effect.
作者
潘燕
PAN Yan(Hangzhou Obstetrics and Gynecology Hospital,Zhejiang Province,310016)
出处
《中国计划生育学杂志》
2024年第2期405-411,共7页
Chinese Journal of Family Planning
基金
2020年浙江省医药卫生科技计划项目:2020KY762。
关键词
妊娠期高血压
血栓弹力图
不良妊娠结局
Nomogram预测模型
Hypertensive disorder complicating pregnancy
Thromboelastogram
Adverse pregnancy outcomes
Nomogram prediction model
