首页|妊娠期高血压疾病患者孕晚期发生胎儿生长受限的危险因素及预测模型的建立

妊娠期高血压疾病患者孕晚期发生胎儿生长受限的危险因素及预测模型的建立

Risk factors and prediction model for fetal growth restriction in patients with gestational hypertension during late pregnancy

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目的 分析妊娠期高血压疾病(HDP)患者孕晚期发生胎儿生长受限(FGR)的危险因素并建立预测模型.方法 回顾性收集2021年1月至2022年12月济宁医学院附属医院315例孕晚期HDP患者临床资料,根据是否发生FGR分为FGR组和非FGR组.收集HDP患者的临床资料,采用单因素和多因素logistic回归分析评估HDP患者孕晚期发生FGR的危险因素并建立预测模型,Hosmer-Lemeshow检验模型拟合优度.采用受试者工作特征(ROC)曲线分析预测模型对HDP患者孕晚期发生FGR的预测价值.结果 315例HDP患者孕晚期FGR发生率为26.35%(83/315).单因素分析显示,FGR组孕前BMI低于非FGR组,收缩压、舒张压和脐动脉搏动指数(PI)、阻力指数(RI)、收缩期末流速/舒张期末流速比值(S/D)高于非FGR组(均P<0.05).多因素logistic回归分析显示,孕前BMI降低和收缩压升高、舒张压升高、PI升高、RI升高、S/D升高为HDP患者孕晚期发生FGR的独立危险因素(均P<0.05).HDP患者孕晚期发生FGR的预测方程y=-4.246+0.062 ×孕前BMI+0.080 ×收缩压+0.102 ×舒张压+0.716 ×PI+1.200 ×RI+0.382 ×S/D,Hosmer-Lemeshow检验P>0.05,拟合优度良好.ROC曲线分析显示,该模型预测HDP患者孕晚期发生FGR的曲线下面积、灵敏度、特异度分别为0.939(95%CI:0.907~0.963)、86.75%、87.07%.结论 孕前BMI、血压、脐动脉血流参数为HDP患者孕晚期发生FGR的影响因素,基于此建立的模型对HDP患者孕晚期发生FGR的预测价值较高.
Objective To analyze the risk factors for fetal growth restriction(FGR)in late pregnancy of patients with gestational hypertension(HDP)and establish a predictive model.Methods A retrospective collection of clinical data was conducted on 315 late pregnancy HDP patients at Affiliated Hospital of Jining Medical University from January 2021 to December 2022.The patients were divided into FGR group and non FGR group based on whether FGR occurred.We collected clinical data of HDP patients and used univariate and multivariate logistic regression analysis to evaluate the risk factors for FGR in late pregnancy of HDP patients and establish a prediction model.Hosmer Lemeshow tested the goodness of fit of the model.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of the predictive model for FGR in late pregnancy of HDP patients.Results The incidence of late pregnancy FGR in 315 patients with HDP was 26.35%(83/315).Univariate analysis showed that the pre pregnancy body mass index(BMI)of the FGR group was lower than that of the non FGR group,and the systolic blood pressure,diastolic blood pressure,umbilical artery pulsatility index(PI),resistance index(RI),and end systolic flow velocity/end diastolic flow velocity ratio(S/D)were higher than those of the non FGR group(all P<0.05).Multivariate logistic regression analysis showed that a decrease in BMI before pregnancy and an increase in systolic blood pressure,diastolic blood pressure,PI,RI,and S/D were independent risk factors for FGR in late pregnancy in HDP patients(all P<0.05).The predictive equation for late pregnancy FGR in HDP patients was y=-4.246+0.062 x pre-pregnancy BMI+0.080 x systolic blood pressure+0.102×diastolic blood pressure+0.716×PI+1.200×RI+0.382×S/D.The Hosmer Lemeshow test showed P>0.05,indicating a good goodness of Fit.The ROC curve analysis showed that the area under the curve,sensitivity,and specificity of the model for predicting FGR in late pregnancy of HDP patients were 0.939(95%CI:0.907-0.963),86.75%,and 87.07%,respectively.Conclusions Pre-pregnancy BMI,blood pressure,and umbilical artery blood flow parameters are influencing factors for the occurrence of FGR in late pregnancy in HDP patients.The model established based on these factors has high predictive value for FGR in late pregnancy in HDP patients.

Hypertension,pregnancy-inducedFetal growth restrictionRisk factorsPredictive model

郭丽珠、韩道旭、王继水、王春霞

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济宁医学院附属医院妇产科,济宁 272100

高血压,妊娠性 胎儿生长受限 危险因素 预测模型

山东省中医药科技项目

2019-0469

2024

中国医师杂志
中华医学会 湖南省医学会

中国医师杂志

CSTPCD
影响因子:0.876
ISSN:1008-1372
年,卷(期):2024.26(7)