摘要
目的分析妊娠期糖尿病孕妇发生不良妊娠结局的危险因素,并构建Nomogram预测模型。方法选取2020年1月至2022年5月广东医科大学附属第二医院和广东医科大学顺德妇女儿童医院(佛山市顺德区妇幼保健院)收治的290例妊娠期糖尿病患者作为研究对象,根据是否发生不良妊娠结局分为发生组(n=105)和未发生组(n=185)。同时选取同期同一医院的150例妊娠期糖尿病患者作为验模组,用验模组的数据对已建立的妊娠期糖尿病孕妇发生不良妊娠结局风险的预测模型进行验证。绘制受试者工作特征(ROC)曲线分析连续性变量的预测价值;采用Logistic回归分析影响妊娠期糖尿病孕妇发生不良妊娠结局的危险因素;采用内部数据验证Nomogram模型临床效能。结果与未发生组相比,发生组患者年龄、孕前体重指数(BMI)、甘油三酯(TC)更大或更高,有糖尿病家族史、口服葡萄糖耐量试验(OGTT)血糖指标3项异常、有不良孕产史者占比更高(P<0.05);年龄、孕前BMI、TC的曲线下面积(AUC)分别为0.722、0.635、0.598;年龄、孕前BMI、TC、糖尿病家族史、OGTT血糖指标3项异常、不良孕产史均为影响妊娠期糖尿病患者发生不良妊娠结局的危险因素。Nomogram模型预测妊娠期糖尿病患者发生不良妊娠结局的风险C-index为0.757(95%CI:0.679~0.871);模型预测妊娠期糖尿病患者发生不良妊娠结局的风险阈值>0.07;模型验证中,ROC曲线结果显示AUC为0.836(95%CI:0.774~0.898),H-L拟合优度检验显示χ2=11.219,P=0.219。结论年龄、孕前BMI、TC、糖尿病家族史、OGTT血糖指标3项异常、不良孕产史均为影响妊娠期糖尿病患者发生不良妊娠结局的危险因素,且基于变量构建的模型有较好的预测能力。
Objective To analyze the risk factors for adverse pregnancy outcomes in pregnant women with gestational diabetes mellitus and construct a Nomogram prediction model.Methods A total of 290 patients with gestational diabetes mellitus admitted to the Second Affiliated Hospital of Guangdong Medical University and Shunde Women′s and Children′s Hospital of Guangdong Medical University(Shunde District Maternal and Child Health Hospital)from January 2020 to May 2022 were selected as the study subjects,and they were divided into the occurrence group(n=105)and the non-occurrence group(n=185)according to whether they had adverse pregnancy outcomes.At the same time,150 patients with gestational diabetes mellitus from the same hospital during the same period were selected as the model-testing group,and the data of the model-testing group were used to validate the established prediction model of the risk of adverse pregnancy outcomes in pregnant women with gestational diabetes mellitus.The predictive value of continuous variables was analyzed by plotting receiver operating characteristic(ROC)curves.The risk factors affecting the occurrence of adverse pregnancy outcomes in pregnant women with gestational diabetes mellitus were analyzed by Logistic regression.The clinical efficacy of Nomogram model was verified by using internal data.Results Compared with the non-occurrence group,patients in the occurrence group were older in age,higher in pre-pregnancy body mass index(BMI),and triglycerides(TC),had a higher proportion of family history of diabetes mellitus,abnormalities in three blood glucose indexes of the oral glucose tolerance test(OGTT),and a history of adverse pregnancy and childbirth(P<0.05).The areas under the ROC curve(AUC)for age,pre-pregnancy BMI,and TC were 0.722,0.635,and 0.598,respectively.Age,pre-pregnancy BMI,TC,family history of diabetes mellitus,abnormalities in three blood glucose indexes of OGTT,and history of adverse pregnancy and childbirth were all risk factors affecting the occurrence of adverse pregnancy outcomes in patients with gestational diabetes mellitus.The Nomogram model predicted that the risk of adverse pregnancy outcomes in patients with gestational diabetes mellitus had a C-index of 0.757(95%CI:0.679-0.871).The risk threshold for predicting adverse pregnancy outcomes in patients with gestational diabetes mellitus by the model was>0.07.In the validation of the model,the results of the ROC curve showed an AUC of 0.836(95%CI:0.774-0.898),and the H-L goodness-of-fit test showedχ2=11.219,P=0.219.Conclusions Age,pre-pregnancy BMI,TC,family history of diabetes mellitus,abnormalities in three blood glucose indexes of OGTT,and history of adverse pregnancy and delivery are all risk factors for adverse pregnancy outcomes in patients with gestational diabetes mellitus,and the model constructed on the basis of the variables has good predictive ability.
作者
谭冰
曾巧莉
方凌燕
郭润民
TAN Bing;ZENG Qiaoli;FANG Lingyan;GUO Runmin(Department of Endocrinology,Second Affiliated Hospital of Guangdong Medical University,Zhanjiang 524000,Guangdong,China;Department of Science and Education,Shunde Women and Children′s Hospital of Guangdong Medical University(Shunde District Maternal and Child Health Hospital),Foshan 528000,Guangdong,China;Department of Cardiology,Second Affiliated Hospital of Guangdong Medical University,Zhanjiang 524000,Guangdong,China)
出处
《中国性科学》
2024年第2期66-70,共5页
Chinese Journal of Human Sexuality
基金
国家自然科学基金资助项目(81873649)
湛江市非资助科技攻关计划项目(2020B01406)
湛江市科技计划项目(2021B01302)。
