慢性肾脏病孕妇妊娠风险预测模型的构建及验证

Construction and validation of pregnancy risk prediction model for pregnant women with chronic kidney disease

目的通过分析慢性肾脏病(CKD)孕妇的妊娠早期肾脏功能及妊娠结局,构建CKD孕妇妊娠风险预测模型。方法收集2009年3月至2018年12月于北京大学第一医院进行产前检查并分娩的313例CKD孕妇共322例次单胎妊娠,其中120例次出现早产、低出生体重儿、重度子痫前期、胎儿丢失者为不良妊娠结局组,余202例次为对照组。回顾性分析CKD孕妇的肾脏病史及妊娠早期的肾脏功能,分析其与早产、低出生体重儿、重度子痫前期、胎儿丢失等不良妊娠结局的关系;并对孕妇妊娠早期的CKD分期,肌酐、尿素、白蛋白、血红蛋白水平,24 h尿蛋白定量及是否合并慢性高血压进一步行logistic回归分析,以分析不良妊娠结局的相关因素。结果322例次CKD孕妇中,有120例次(37.3%,120/332)出现不良妊娠结局。logistic回归分析发现,孕妇妊娠早期的CKD分期、白蛋白水平、24 h尿蛋白定量、是否合并慢性高血压,是其发生不良妊娠结局的独立预测因素,建立预测模型logit(P)=2.107+0.255×24 h尿蛋白定量(g/24 h)-0.107×白蛋白水平(g/L)+1.677×是否合并高血压(是为1,否为0)+0.639×CKD分期。该模型预测不良妊娠结局的曲线下面积为0.812,界值、敏感度、特异度、约登指数分别为0.436、0.658、0.856、0.802。结论CKD孕妇妊娠早期的CKD分期、白蛋白水平、24 h尿蛋白定量、是否合并高血压,是发生不良妊娠结局的主要危险因素,可预测不良妊娠结局的发生,值得进一步研究。

Objective To construct the pregnancy risk prediction model of chronic kidney disease (CKD) pregnant women by analyzing their renal function and pregnancy outcome in the first trimester.Method Totally 313 CKD women with 322 pregnancies who had deliveries in Peking University First Hospital from March 2009 to December 2018 were retrospectively analyzed. The history of kidney disease and renal function in the first trimester were collected, and the relationship between CKD and premature delivery, low birth weight infants, severe preeclampsia and fetal loss were analyzed.Result Among 322 pregnancies with CKD, 120 (37.3%, 120/322) had adverse pregnancy outcomes. CKD stage, serum creatinine, urea, albumin, hemoglobin, 24-hour urine protein quantity and whether complicated with hypertension were independent predictors of adverse pregnancy outcome. A prediction model logit (P)=2.107+0.255×24-hour urine protein quantitative (g/24-hour)-0.107×albumin (g/L)+1.677×whether complicated with hypertension (1 or 0)+ 0.639×CKD stage was established. The area under curve value of the model was 0.812, the best threshold, sensitivity, specificity and Yoden index were 0.436, 0.658, 0.856 and 0.802, respectively.Conclusion CKD stage, serum albumin, 24-hour urine protein quantity in the first trimester and hypertension are the main risk factors of adverse pregnancy outcome, which could predict the occurrence of adverse pregnancy outcome of CKD pregnant women and deserve further study.