目的:探讨冻融胚胎移植(frozen embryo transfer，FET)妊娠后妊娠期高血压疾病(hypertensive disorders of pregnancy，HDP)发病的影响因素，构建HDP发病的预测模型。方法:纳入2019年1月—2023年5月于兰州大学第一医院生殖医学中心行FET的周期临床资料，根据排除标准剔除不符合的周期，对所纳入患者的一般临床资料、FET相关资料和HDP发病情况进行统计分析。采用最小绝对收缩和选择算子(least absolute shrinkage and selection operator，LASSO)回归技术对预测因子进行选择，按照7∶3的比例将最终纳入的4 079个周期随机分配为训练集(n=2 855)和验证集(n=1 224)。采用多因素Logistic回归分析建立HDP发病的预测模型并采用列线图表示。采用曲线下面积(area under the curve，AUC)、Hosmer-Lemeshow拟合优度检验和决策曲线分析(decision curve analysis，DCA)评估模型。结果:根据LASSO回归分析计算选择7个非零系数变量，进行多因素Logistic回归分析后，将内膜准备方案、多囊卵巢综合征(polycystic ovary syndrome，PCOS)、子宫内膜异位症、卵巢储备功能减退、女方高血压家族史、体质量指数和妊娠囊数量共7个因素作为预测因子建立模型并用列线图展示，训练集AUC为0。728，验证集AUC为0。734，Hosmer-Lemeshow检验显示该模型拟合好(P=0。867，平均绝对误差=0。004)，DCA提示当患者临床妊娠的阈值概率在7％～64％之间时，应用该列线图可增加净收益。结论:建立的FET妊娠HDP发病预测模型具有一定的区分能力，可为临床提供参考，但仍需进一步开发更有效的预测因子。
A Nomogram Prediction Model for Gestational Hypertension after Frozen Embryo Transfer
Objective:To explore the influencing factors of hypertensive disorders of pregnancy(HDP)after frozen embryo transfer(FET)by a predictive model of HDP.Methods:The clinical data of FET cycles in the Reproductive Medicine Center of the First Hospital of Lanzhou University from January 2019 to May 2023 were included.The cycles that meet the exclusion criteria were excluded.The general clinical data,FET-related data and HDP incidence of the included patients were statistically analyzed.The least absolute shrinkage and selection operator(LASSO)regression technique was used to select the predictors.According to the ratio of 7∶3,the final 4 079 cycles were randomly assigned to the training set(n=2 855)and the validation set(n=1 224).The nomogram prediction model of HDP incidence was established by multiple Logistic regression analysis and use a nomogram to represent it.The area under the curve(AUC),Hosmer-Lemeshow goodness-of-fit test and decision curve analysis(DCA)were used to evaluate this model.Results:Seven non-zero coefficient variables were selected according to LASSO regression analysis.After multivariate Logistic regression analysis,seven factors including endometrial preparation,polycystic ovary syndrome(PCOS),endometriosis,diminished ovarian reserve,family history of hypertension,body mass index,and number of intrauterine gestational sacs were used as the predictors to establish a model and displayed in a nomogram.The AUC of the training set was 0.728,and the AUC of the validation set was 0.734.The Hosmer-Lemeshow test showed that the model fitted well(P=0.867,mean absolute error=0.004).DCA suggested that when the threshold probability of clinical pregnancy was between 7％and 64％,the application of this nomogram could increase the net benefit.Conclusions:The prediction model of HDP after FET has a certain ability to distinguish,which can provide reference for clinical practice,but further development of more effective predictive factors is still necessary.
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