心脏病妊娠风险分级在妊娠合并心脏病中的临床应用及预测价值分析

The Clinical Application and Predictive Value of Risk Classificaiton System in Pregnancies Complicated with Cardiac Disease

目的:探讨中华医学会的心脏病不同妊娠风险分级母儿并发症情况及其与CARPREGⅡ风险评分法对妊娠期心血管并发症的预测价值分析。方法:对2016年1月1日至2018年12月31日339例妊娠合并心脏病的孕产妇进行妊娠风险分级,分析患者心血管并发症、产科并发症及胎儿并发症与妊娠风险分级间的关系,并对其与CARPREGⅡ风险评分对心血管并发症的预测价值使用ROC曲线进行分析。结果:①妊娠风险分级Ⅰ级130例(38.3%),Ⅱ级73例(21.5%),Ⅲ级51例(15.0%),Ⅳ级45例(13.3%),Ⅴ级40例(11.8%)。妊娠风险分级越高,纽约心脏病协会(NYHA)心功能分级Ⅲ~Ⅳ级所占比例越高(χ^2=190.271,P<0.001)。②妊娠合并心脏病妇女心血管并发症发生率为13.0%,产科并发症和胎儿并发症的发生率分别为13.9%和24.5%。不同妊娠分级的心血管并发症(心功能衰竭、呼吸衰竭、血栓/栓塞、死亡)和胎儿并发症(孕早中期流产、围产儿死亡、早产、胎儿生长受限)发生率及产科并发症中妊娠期高血压疾病的发生率比较,差异均有统计学意义(P<0.05),且妊娠风险分级越高,其胎儿并发症、心血管并发症及妊娠期高血压疾病的发生率有增加的趋势。③ROC曲线分析发现,妊娠风险分级预测心血管并发症的曲线下面积(AUC)为0.866(95%CI 0.802~0.930),CARPREGⅡ评分法的AUC为0.808(95%CI 0.722~0.894)。结论:中华医学会的心脏病妊娠风险分级方法简单,利于对妊娠合并心脏病孕妇的分层及个体化管理,对于妊娠期心血管并发症有良好的预测价值。

Objective:To describe the maternal and neonatal complications in pregnancy with heart disease and compare the predictive value of Chinese Medical Association risk classification system and CARPREGⅡscoring system.Methods:The pregnancy risks of 339 pregnant women with heart disease were evaluated from 1st Jan 2016 to 31st Dec 2018.The relationship between pregnancy risk classification and cardiovascular complications,obstetric complications and fetal complications was analyzed.ROC curve was used for comparison of Chinese Medical Association risk classification system and CARPREGⅡscoring system in prediction of cardiovascular complications.Results:①130 women were included in risk categoryⅠ(38.3%),73 women in categoryⅡ(21.5%),51 women in categoryⅢ(15.0%),45 women in categoryⅣ(13.3%),and 40 women in categoryⅤ(11.8%).The proportion of women with NYHA heart function gradeⅢ-Ⅳwas increased with higher pregnancy risk category(χ^2=190.271,P<0.001).②The incidence of cardiovascular complications,obstetric complications and perinatal complicationswas 13.0%,13.9%and 24.5%respectively.There were significant differences in the incidence of cardiovascular complications(heart failure,respiratory failure,thrombus/embolism,death),fetal complications(abortion in the first and second trimester,perinatal death,preterm delivery,fetal growth restriction)and pregnancy induced hypertension between different risk categories(P<0.05).③ROC curve analysis showed the AUC was 0.866(95%CI 0.802-0.930)for Chinese Medical Association risk classification system and 0.808(95%CI 0.722-0.894)for CARPREGⅡscoring system.Conclusions:The Chinese Medical Association risk classification system is simple.It is easy to perform the classification and individual administration of pregnant women complicated with heart disease.The system has been shown with good predictive value for cardiac complications in pregnancy.