妊娠期高血压疾病的炎症反应标志物及其产后发生慢性高血压的预测模型研究

Study on the inflammatory response markers of pregnant women with hypertension during pregnancy and the predictive model of postpartum chronic hypertension

目的研究妊娠期高血压疾病(HDP)孕产妇的炎症反应标志物并构建预测产后发生慢性高血压(CH)的Nomogram模型。方法选取2016年1月至2018年1月淮南东方总院妇产科收取的337例进行产前检查及分娩的HDP孕产妇作为研究对象。收集其妊娠24~28周时的中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)及血小板与淋巴细胞比值(PLR)。根据受试者工作特征(ROC)曲线及多元Logistic回归模型结果构建Nomogram模型。结果随访2.5年后,112例发生CH(CH组),225例未发生CH(非CH组)。CH组年龄、体重指数(BMI)、吸烟比例、高血压家族史比例、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、白细胞计数(WBC)、血小板计数(PLT)、中性粒细胞、淋巴细胞、NLR、LMR、PLR高于CH组,差异具有统计学意义(P<0.05)。年龄、BMI、SBP、DBP、MAP、WBC、NLR、LMR、PLR曲线下面积(AUC)分别为0.877、0.719、0.764、0.744、0.686、0.757、0.844、0.826、0.796;最佳截断值分别为30岁、24.5kg/m^(2)、147mmHg、90mmHg、107mmHg、8.24×10^(9)/L、4.13、4.26、141.65。年龄、BMI、高血压家族史、SBP、NLR及LMR是HDP孕产妇产后2.5年发生CH的独立危险因素(P<0.05)。内部验证结果显示C-index为0.877(95%CI:0.710~0.912)。结论本研究构建的Nomogram模型有助于对HDP孕产妇在妊娠中期进行早期的心血管疾病(CVD)风险筛查。

Objective To study inflammatory markers in pregnant women with hypertension during pregnancy(HDP)and design a Nomogram model for predicting the occurrence of chronic hypertension(CH)after delivery.Methods A total of 337 pregnant women with HDP who had undergone antenatal checkups and delivery in Huainan Oriental General Hospital from January 2016 to January 2018 were selected.The neutrophil to lymphocyte ratio(NLR),lymphocyte to mononucleus ratio(NLR)and platelet to lymphocyte ratio(PLR)were collected at 24-28 weeks of pregnancy.The Nomogram model was constructed based on the ROC curve and the results of the multiple Logistic regression model.Results After 2.5 years of follow-up,112 patients developed CH(CH group)and 225 patients did not(non-CH group).Age,BMI,smoking rate,family history rate of hypertension,SBP,DBP,MAP,WBC,PLT,neutrophils,lymphocytes,NLR,LMR and PLR in CH group were higher than those in non-CH group(P<0.05).Age,BMI,SBP,DBP,MAP,WBC,NLR,LMR and PLR area under curve(AUC)were 0.877,0.719,0.764,0.744,0.686,0.757,0.844,0.826 and 0.796,respectively.The best cutoff values were 30 years old,24.5kg/m^(2),147mmHg,90mmHg,107mmHg,8.24×10^(9)/L,4.13,4.26,141.65,respectively.Age,BMI,family history of hypertension,SBP,NLR and LMR were independent risk factors for CH in HDP women 2.5 years after postpartum(P<0.05).Internal verification results showed that C-index was 0.877(95%CI:0.710-0.912).Conclusions The nomogram model constructed in this study is helpful to screen HDP pregnant women for early cardiovascular disease(CVD)risk in the second trimester of pregnancy.