目的 建立并验证在孕早期预测孕期发生妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)的风险预测模型.方法 选取2017年1月至2022年10月于川北医学院附属医院住院分娩且符合纳入排除标准的93名ICP孕妇和265名健康孕妇为研究对象,通过查阅电子病历系统回顾性收集孕妇的一般人口学信息和孕早期血液指标.用多因素逻辑回归模型筛选ICP发病的独立影响因素,并基于这些因素开发一个列线图模型来预测ICP的发病风险.分别使用受试者工作特征的曲线下面积、Hosmer-Lemeshow检验和决策曲线分析评估该模型的区分度、校准度和临床实用性,同时使用Bootstrap法(1 000次)对模型进行内部验证.结果 研究显示ICP的独立影响因素为:流产史、中性粒细胞计数、平均血小板体积、血小板比容和血小板体积分布宽度.利用这些因素开发了一个列线图模型来预测ICP的发病风险,同时对其性能进行评估.该模型曲线下面积为0.719(95％CI:0.656-0.781),Hosmer-Lemeshow检验P值为0.311.结论 基于流产史、中性粒细胞计数、平均血小板体积、血小板比容和血小板体积分布宽度这5个指标开发的列线图模型在孕早期预测孕妇发生ICP的风险有一定的临床价值.
Establishment and validation of prediction model for first-trimester intrahepatic cholestasis of pregnancy
Objective To establish and validate a prediction model for assessing the risk of intrahepatic cholestasis of pregnancy(ICP)during early pregnancy.Methods This study selected 93 pregnant women diagnosed with ICP and 265 healthy pregnant women who were hospitalized and delivered at the Affiliated Hospital of North Sichuan Medical College between January 2017 and October 2022.General demographic information and blood inflammatory indicators during the first trimester were collected retrospectively from the electronic medical record system.Multivariate logistic regression model was used to identify independent factors that influence the onset of ICP.Subsequently,a nomogram was developed to predict the risk of ICP based on these identified factors.Receiver operating characteristic analysis,Hosmer-Lemeshow test and decision curve analysis were used to demonstrate the discrimination,calibration,and clinical utility of the model,respectively.Also,the model was internally validated using the bootstrap method(1 000 times).Results The study showed that the independent influence factors for ICP were the following factors:history of abortion,neutrophil count,mean platelet volume,plateletcrit,and platelet volume distribution width.Using these factors,a nomogram was developed to predict the risk of ICP and also evaluated the performance of the model.Area under the curve of the nomogram was 0.719(95％CI:0.656-0.781),and the Hosmer-Lemeshow test yielded a P value of 0.311.Conclusion The nomogram developed based on five indicators:history of abortion,neutrophil count,mean platelet volume,plateletcrit,and platelet volume distribution width,have moderate clinical value in predicting the risk of ICP in pregnant women in the first trimester.
intrahepatic cholestasis of pregnancyfirst trimesterroutine blood testsinflammatory factorsprediction model
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