基于实验室指标检测建立预测稽留流产模型的临床价值

Clinical value of establishing a model for predicting missed abortion based on laboratory test indexes

目的研究基于实验室指标检测建立预测稽留流产模型的临床价值。方法选取2015年1月至2020年6月在我院就诊的540例妊娠早期孕妇作为研究对象,根据是否发生稽留流产分组,其中发生稽留流产的为观察组(n=70),未发生稽留流产的为对照组(n=470),比较两组患者的一般情况和临床特征指标。采用多因素Logistic分析预测稽留流产的相关影响因素;建立妊娠早期判断稽留流产的预测模型;以受试者工作曲线(ROC曲线)分析预测模型的判断价值。结果两组患者的年龄及体质量指数(BMI)分布、文化程度、吸烟史、流产史及解脲脲支原体(UU)感染情况比较均有显著性差异(P<0.05);两组患者血清D-二聚体(D-D)、β-HCG、抑制素A、纤维蛋白原(Fib)及妊娠相关血浆蛋白A(PAPP-A)水平比较均有显著性差异(P<0.05);多因素Logistic分析结果显示,年龄[OR=1.365,95%CI(1.095,1.702),P=0.006]、血清D-D[OR=1.434,95%CI(1.079,1.906),P=0.013]是稽留流产的高危因素,文化程度[OR=0.525,95%CI(0.379,0.727),P=0.000]、血清β-HCG[OR=0.397,95%CI(0.184,0.857),P=0.019]、抑制素A[OR=0.413,95%CI(0.285,0.598),P=0.000]及PAPP-A[OR=0.491,95%CI(0.305,0.790),P=0.003]是稽留流产的保护因素。根据多因素分析结果建立预测模型为:Y=0.488+0.311X 1-0.644X 2+0.360X 3-0.924X 4-0.884X 5-0.711X 6(X 1:年龄;X 2:文化程度;X 3:血清D-D;X 4:血清β-HCG;X 5:抑制素A;X 6:PAPP-A);该模型预测稽留流产的ROC曲线下面积(AUC)为0.854[SE=0.071,95%CI(0.751,0.947),P=0.000]。结论基于实验室指标建立的预测稽留流产的模型对判断稽留流产风险具有较高应用价值。

Objective:To explore the clinical value of establishing a model for predicting missed abortion based on laboratory test indexes.Methods:A total of 540 pregnant women in early pregnancy in our hospital from January 2015 to June 2020 were selected as the research objects.According to the occurrence of missed abortion,the women were divided into two groups:the women with missed abortion were in the observation group(n=70)and the women without missed abortion were in control group(n=470).The general conditions and the clinical characteristic indexes of the two groups were compared.The logistic multivariate analysis was used to explore the related factors of missed abortion.The prediction model of missed abortion in early pregnancy was established.The receiver operator characteristic(ROC)was used to analyze the judgment value of the prediction model.Results:There were significant differences in age,body mass index(BMI),education level,smoking history,abortion history and ureaplasma urealyticum(UU)between the two groups(P<0.05).There were significant differences in serum D-Dimer,β-HCG,inhibin A,fibrinogen(Fib)and pregnancy associated plasma protein A(PAPP-A)between the two groups(P<0.05).The logistic multivariate analysis showed that the age[OR=1.365,95%CI(1.095,1.702),P=0.006]and serum D-Dimer[OR=1.434,95%CI(1.079,1.906),P=0.013]were the high risk factors of missed abortions.The education level[OR=0.525,95%CI(0.379,0.727),P=0.000],β-HCG[OR=0.397,95%CI(0.184,0.857),P=0.019],inhibin A[OR=0.413,95%CI(0.285,0.598),P=0.000]and PAPP-A[OR=0.491,95%CI(0.305,0.790),P=0.003]were the protective factors for missed abortion.The prediction model was established as Y=0.488+0.311X_(1)-0.644X_(2)+0.360X_(3)-0.924X_(4)-0.884X_(5)-0.711X_(6)(X_(1):age,X_(2):education level,X_(3):serum D-Dimer,X_(4):serumβ-HCG,X_(5):inhibin A,X_(6):PAPP-A).The area under the ROC curve(AUC)of missed abortion predicted by the model was 0.854[SE=0.071,95%CI(0.751,0.947),P=0.000].Conclusions:The model of predicting missed abortion based on laboratory indexes has high application value in judging the risk of missed abortion.