Herrera模型在中国上海预测早产的应用研究

Application of Herrera Biopsychosocial Model in predicting preterm delivery in Shanghai

目的评价Herrera产前生物社会心理模型预测早产的效果及其在上海地区的适用性。方法利用Herrera模型对前来医院接受产前检查的孕13用及以上的孕妇进行调查和随访，分别在13～27孕用、28-32孕周和33孕用至分娩3个时期对其妊娠情况进行评分和危险分组。记录研究对象的围产期结局。结果Herrera模型判定的高危妊娠者发生早产的危险性增大（OR=10．4。95％CI：3．1-34．8），模型的阳性预测值和阴性预测值分别为18．8％和97．8％。ROC曲线分析发现，33孕用至分娩时期模型评分预测效果优于其他两个时期，ROC曲线下面积为0．807（95％CI：0．703-0．910）。仅有2名孕产妇存在焦虑，故未能对模型社会心理部分的预测效果进行评价。结论Herrera模型可以有效预测早产的发生，但该模型的社会心理因素指标不太适宜上海孕产妇妊娠期危险因素评价，还需要根据上海的社会经济情况进行修正。

Objective To assess the predictive effect of Herrera Biopsychosocial Model on preterm delivery and to assess its applicability in Shanghai. Methods A prospective cohort study was conducted in The Affiliated Obstetrical and Gynecological Hospital of Fudan University. Eligible pregnant women whose initial prenatal visit occurred at 13^th week of gestation or later were invited to participate in the follow-up study. The biopsychosocial risk assessments were carried out in three different gestational periods （ 13 - 27 weeks, 28 - 32 weeks, 33 weeks to delivery） for each patient and risk scores were recorded at each follow-up. Complications of pregnancy and labor were recorded in Pregnancy Outcome Form. Results High risk pregnancy of the Herrera Model was significantly associated with the risk of preterm delivery （OR： 10.4,95% CI：3.1-34.8） as compared with low risk pregnancy. Its positive predictive value was 18.8% and the negative predictive value was 97.8%. ROC analysis indicated that scores in the period from 33 weeks of gestation to delivery showed a better predictive effect than scores in the other two periods, Its area under the ROC curves was 0. 807 （95% CI： 0. 703 -0. 910）. The psychosocial factors＇ predictive effects of Herrera model were not evaluated in this study for there were only 2 pregnant women with anxiety symptoms. Conclusion Herrera Model was clinically valid to predict preterm delivery. However, psychosocial factors of Herrera Model were not fully applicable to the prediction in Shanghai. This model need further revision and evaluation before being put to use in Shanghai.