妊娠期高血压疾病风险预测模型建立探讨

Establishment of Risk Prediction Model of Hypertensive Disorders in Pregnancy

目的:探讨妊娠期高血压疾病(HDP)的危险因素,建立HDP风险预测模型。方法:回顾性分析四川省妇幼保健院8771例孕妇的HDP风险因素及早中孕期特异性血清学指标,筛选207例HDP孕妇作为HDP组,4556例孕妇作为对照组。比较两组病例间的风险因素及特异性血清学指标的差异性,建立HDP风险预测模型。结果:(1)两组孕妇的孕前BMI、预产期年龄、产次、β-人绒毛膜促性腺激素(β-hCG)、妊娠相关蛋白(PAPP-A)的差异有统计学意义(P<0.005);而甲胎蛋白(AFP)、抑制素A(Inhibin A)的差异无统计学意义(P>0.05);(2)当联合β-hCG+PAPP-A+孕前BMI+预产期年龄+产次联合建立HDP风险预测模型时,最大约登指数为0.816,对应敏感度为0.875,特异度为0.941,AUC为0.907;联合β-hCG+PAPP-A+AFP+Inhibin A+孕前BMI+预产期年龄+产次联合建立HDP风险预测模型时,其最大约登指数为0.926,对应敏感度为0.926,特异度为1,AUC为0.968。结论:联合β-hCG+PAPP-A+孕前BMI+预产期年龄+产次联合建立的HDP风险预测模型具有较高的预测价值及临床意义;而AFP、Inhibin A作为预测指标联合建立HDP风险预测模型的价值还需进一步认证。

Objective:To explore the risk factors of hypertensive disorders of pergnancy(HDP)and establish a risk prediction model of HDP.Methods:The risk factors of HDP in 8771 pregnant women in Sichuan Maternal and Child Health Hospital were analyzed retrospectively.The specific serological indexes in the first and second trimester were selected.207 pregnant women were selected as the HDP group and 4556 pregnant women were selected as the control group.The differences of risk factors and specific serological indexes between the two groups were compared,and the HDP risk prediction model was established.Results:(1)The differences in pre-pregnancy BMI,expected age,parity,β-hCG,and PAPP-A between the two groups were statistically significant(P<0.005),while the differences in AFP and Inhibin A were not statistically significant(P>0.05).(2)When β-hCG+PAPP-A+pre-pregnancy BMI+expected age+parity werecombined to establish an HDP prediction model,the maximum Youden index was 0.816,the corresponding sensitivity was 0.875,the specificity was 0.941,and the AUC value was 0.907,while combining β-hCG+PAPP-A+AFP+Inhibin A+pre-pregnancy BMI+expected age+parity to establish the HDP prediction model,the maximum Youden index was 0.926,the corresponding sensitivity was 0.926,the specificity was 1,and the AUC value was 0.968.Conclusions:The HDP risk prediction model established by β-hCG+PAPP-A+pre-pregnancy BMI+expected age+parityhas high prediction value and clinical significance.While the value of AFP and Inhibin A as the predictors to jointly establish the HDP risk prediction model still needs be further investigation.