摘要
目的 基于危险因素构建子痫前期早期肾损伤预测风险模型,并评估其预测效能.方法 选取南京医科大学第四附属医院2021年1月至2023年11月收治的96例子痫前期患者为研究对象,依据早期肾损伤发生情况分为肾损伤组、无肾损伤组,比较两组临床资料,Logistic多因素回归分析影响子痫前期早期肾损伤的危险因素.采用R软件基于影响子痫前期早期肾损伤的危险因素构建子痫前期早期肾损伤风险列线图模型,拟合优度、受试者工作特征曲线(ROC)评估该模型预测效能.结果 子痫前期患者早期肾损伤发生率约43.75％(42/96).两组高血糖、高血压疾病、重度子痫前期比例及尿酸、同型半胱氨酸、胱抑素C水平比较,差异有统计学意义(P<0.05),年龄、孕周、体重、脂肪肝比例、前置胎盘比例等指标比较,差异无统计学意义(P>0.05).Logistic多因素回归分析结果显示:高血糖(OR=1.842,95％CI:1.627-2.152)、高血压疾病(OR=1.798,95％CI:1.696-2.054)、重度子痫前期(OR=1.854,95％CI:1.683-2.325)、尿酸水平高(OR=1.825,95％CI:1.622-2.278)、同型半胱氨酸水平高(OR=1.825,95％CI:1.624-2.357)、胱抑素C水平高(OR=1.818,95％CI:1.658-2.274)是影响子痫前期早期肾损伤的危险因素.基于上述危险构建的子痫前期早期肾损伤风险列线图模型C-index指数为0.899(95％CI:0.812-0.935),证实该列线图模型预测效能较好.结论 高血糖、高血压疾病、重度子痫前期、尿酸、同型半胱氨酸、胱抑素C是影响子痫前期早期肾损伤的危险因素,据此构建的列线图模型预测子痫前期早期肾损伤的效能良好.
Abstract
Objective Based on the risk factors,the prediction risk model of early preeclampsia kidney injury was constructed and its prediction efficiency was evaluated.Methods 96 cases of preeclampsia patients admitted to the Fourth Affiliated Hospital of Nanjing Medical University from January 2021 to November 2023 were selected as the research objects,and were divided into kidney injury group and no kidney injury group according to the occurrence of early kidney injury,the clinical data of the two groups were compared,and the risk factors affecting early kidney injury of preeclampsia were identified by Logistic multivariate regression analysis. R software was used to construct a risk nomogram model of early preeclampsia kidney injury based on the risk factors affecting early preeclampsia kidney injury. Goodness of fit and receiver operating characteristic curve ( ROC) were used to evaluate the predictive efficiency of the model. Results The incidence of early kidney injury in preeclampsia patients was about 43.75％(42/96). There were statistically significant differences in the proportions of hyperglycemia,hypertension,severe preeclampsia and the levels of uric acid,homocysteine and cystatin C between the two groups (P<0.05),while there were no statistically significant differences in age,gestational age,body weight,fatty liver ratio and placenta previa ratio ( P>0.05 ) . Logistic multivariate regression analysis showed:hyperglycemia (OR=1.842,95％CI:1.627-2.152),hypertension (OR=1.798,95％CI:1.696-2.054),severe preeclampsia (OR=1. 854,95％CI:1.683-2.325),high uric acid level (OR=1.825,95％CI:1.622-2.278),high homocysteine level (OR=1.825,95％CI:1.624-2.357),high cystatin C level (OR=1.818,95％CI:1.658-2.274) were risk factors for kidney injury in early preeclampsia. The C-index of the risk profile model of early preeclampsia kidney injury constructed based on the above risks was 0.899 (95％CI:0.812-0.935),which confirmed that the model had good predictive efficacy.Conclusion Hyperglycemia,hypertension,severe preeclampsia,uric acid,homocysteine,cystatin C are risk factors for early preeclampsia kidney injury,and the nomogram model based on this construction is effective in predicting early preeclampsia kidney injury.
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