妊娠期肝内胆汁淤积症不良围生儿结局预测模型的建立与应用研究
Study on the establishment and application of prediction model for adverse perinatal outcome of intrahepatic cholestasis of pregnancy
盛佳 1施锦金 1郑敏珠 1蔡锋成1
作者信息
- 1. 杭州市妇产科医院分娩中心,浙江杭州 310000
- 折叠
摘要
目的 对妊娠期肝内胆汁淤积症(ICP)患者对不良围生儿结局的影响展开探讨和分析,研究ICP与不良围生儿结局的关联性及构建预测模型.方法 回顾性分析杭州市妇产科医院2018年1月至2023年 1 月收治的200例ICP患者资料进行调查,根据严重程度进行区分,分别为轻度组(n=110)和重度组(n=90),将110例轻度ICP患者设为A组,90例重度ICP患者设为B组,另选取100例无ICP的健康孕产妇作为对照组.比较3组不良围生儿结局的发生率,另外,根据ICP患者不良围生儿结局的实际发生情况,将其划分为良好组(n=120)和不良组(n=80).在此基础上,对良好组与不良组的临床特征差异进行仔细观察,并借助多因素Logistic回归分析模型进行进一步的分析研究ICP不良围生儿结局的发生情况和危险因素并构建其预测模型.结果 通过对三组胎儿生长受限及不良围生儿结局的总发生率进行比较,我们发现其呈现出这样的规律:对照组的总发生率低于轻度组,而轻度组又低于重度组(P＜0.05).进一步分析发现,在不良组中,年龄≥36岁、处于重度ICP状态、合并妊娠糖尿病或高血压、存在胎盘病理异常、ICP发生时间＜34周、为双胎妊娠的产妇所占比例明显高于良好组(P＜0.05);经多因素Logistic回归性分析证实重度ICP、年龄≥36岁、合并妊娠糖尿病、胎盘病理异常、合并妊娠高血压、ICP发生时间＜34周、双胎妊娠是引起围生儿发生不良结局的危险因素;绘制ROC曲线结果显示AUC值均＞0.500,说明上述指标对于围生儿发生不良结局具有良好的预测价值;于以上影响因素建立列线图风险模型,校准曲线C-index值为0.934,ROC曲线的AUC值分别为0.930.结论 ICP是严重并发症,是围生期儿童死亡率上升的关键因素之一,病情越严重、出现越早,不良围生儿结局概率越高.产妇年龄(≥36岁)、合并妊娠糖尿病、合并妊娠高血压、胎盘病理异常、双胎妊娠等都被视为发生不良围生儿结局的危险因素.建立预测模型可预测ICP患者不良围生儿结局可能,临床应及早介入,减少围生儿不良结局风险.
Abstract
Objective To explore and analyze the influence of patients with intrahepatic cholestasis of pregnancy(ICP)on adverse perinatal outcomes,to study the correlation between ICP during pregnancy and adverse perinatal outcomes,and to build a prediction model.Methods The data of 200 patients with ICP during pregnancy admitted to Hangzhou Women's Hospital from January 2018 to January 2023 were retrospectively analyzed,and they were divided into mild group(n=1 10)and severe group(n=90)according to their severity.110 patients with ICP during mild pregnancy were set as group A,90 patients with ICP during severe pregnancy as group B,and 100 healthy pregnant women without ICP during pregnancy were selected as control group.The incidence of adverse perinatal outcomes in three groups was compared.In addition,according to the actual occurrence of adverse perinatal outcomes in ICP patients during pregnancy,they were divided into good group(n=120)and bad group(n=80).On this basis,the differences of clinical characteristics between the good group and the bad group were carefully observed,and the occurrence and risk factors of adverse perinatal outcome of ICP during pregnancy were further analyzed with the help of multivariate Logistic regression analysis model,and its prediction model was constructed.Results By comparing the total incidence of fetal growth restriction and adverse perinatal outcomes among the three groups,we found that the total incidence of the control group was lower than that of the mild group,and the mild group was lower than that of the severe group(P＜0.05).Further analysis showed that in the bad group,the proportion of women who were over 36 years old,were in severe ICP state,complicated with gestational diabetes or hypertension,had placental pathological abnormalities,and had ICP for less than 34 weeks,and were twins pregnant was significantly higher than that in the good group(P＜0.05).Logistic regression analysis showed that severe ICP,age ≥36 years old,complicated with gestational diabetes mellitus,pla-cental pathological abnormality,complicated with pregnancy-induced hypertension,ICP occurrence time＜34 weeks,and twin pregnancy were the risk factors for adverse perinatal outcomes.The results of ROC curve show that AUC values are all above 0.500,which shows that the above indices have good predictive value for perinatal adverse outcomes.Based on the above factors,the nomogram risk model is established.The C-index value of the calibration curve is 0.934,and the AUC value of the ROC curve is 0.930 respectively.Conclusion ICP during pregnancy is a serious complication and one of the key factors for the increase of perinatal mortality.The more serious the condition and the earlier it appears,the higher the probability of adverse perinatal outcomes.Maternal age(≥ 36 years old),complicated pregnancy(diabetes,hypertension),placental pathological abnormality and twin pregnancy are all regarded as risk factors for adverse perinatal outcome.The establishment of prediction model can predict the possibility of adverse perinatal outcome of ICP patients during pregnancy,and clinical intervention should be carried out as early as possible to reduce the risk of adverse perinatal outcome.
关键词
妊娠期/肝内胆汁淤积症/不良围生儿结局/预测模型Key words
pregnancy/intrahepatic cholestasis/bad perinatal outcome/prediction model引用本文复制引用
基金项目
浙江省医药卫生科技计划项目(2024KY226)
出版年
2024
NETL
NSTL
万方数据