子痫前期孕妇并发肝功能受损危险因素分析及预测模型构建

Risk factors analysis and prediction model construction of liver functionimpairment in preeclampsia pregnant women

目的 分析子痫前期孕妇并发肝功能受损的危险因素并构建预测模型。方法 选择2016年5月至2021年6月在苏州市第九人民医院确诊子痫前期的279例患者作为研究对象,以是否发生肝功能受损分为发生组(72例)和未发生组(207例),比较两组的临床资料,通过Logistic回归分析子痫前期孕妇并发肝功能受损危险因素并构建预测模型。用ROC曲线下面积、灵敏度、特异度评价模型区分度,用拟合优度检验评价模型校准度。然后纳入69例子痫前期孕妇检验预测模型在临床应用的准确率。结果 经Logistic回归分析发现多胎、孕期未规律补钙和维生素D、白蛋白(albumin, Alb)、D-二聚体及凝血酶原时间(prothrombin time, PT)水平异常均是子痫前期并发肝功能受损的危险因素(P<0.05)。根据危险因素得出预测模型方程为:Prob=1/(e^-Y),Y=-28.854^(+)0.514×多胎+1.189×孕期未规律补钙+1.027×孕期未规律补充维生素D+0.685×Alb+0.952×D-二聚体+1.431×PT。该模型的ROC曲线下面积为0.904,灵敏度为88.10%,特异度为84.30%;拟合优度检验的χ2=2.579,P=0.548,模型拟合良好。经临床验证模型的灵敏度为87.50%、特异度为83.02%、准确率为84.06%。结论 子痫前期孕妇并发肝功能受损与多胎、孕期未规律补钙和维生素D、Alb、D-二聚体及PT水平异常相关。以此构建预测模型,能有效评估子痫前期发生肝功能受损的风险。

Objective To analyze the risk factors of liver dysfunction in preeclampsia pregnant women and build a prediction model.Methods A total of 279 patients diagnosed with preeclampsia in the Ninth Peoples Hospital of Suzhou from May 2016 to June 2021 were selected as research objects,and were divided into a developing group(72 cases)and a non-developing group(207 cases)according to whether they had liver function impairment.The clinical data of the two groups were compared,the risk factors of liver function impairment in pregnant women with preeclampsia were analyzed by Logistic regression and the prediction model was constructed.The area under the ROC curve,sensitivity and specificity were used to evaluate the model discrimination,and goodness of fit test was used to evaluate model calibration.Then,69 pregnant women with preeclampsia were included to test the accuracy of the prediction model in clinical application.Results Logistic regression analysis showed that multiple pregnancies,irregular calcium and vitamin D supplementation during pregnancy,albumin(Alb),D-dimer and prothrombin time(PT)indexes all were risk factors for preeclampsia complicated with liver function impairment(P<0.05).According to the risk factors,the prediction model equation was:Prob=1/(e^(-Y)),Y=-28.854^(+)0.514×multiple fetus+1.189×irregular calcium supplementation during pregnancy+1.027×irregular vitamin D supplementation during pregnancy+0.685×Alb+0.952×D-dimer+1.431×PT.The area under the ROC curve of this model was 0.904,the sensitivity was 88.10%,and the specificity was 84.30%.The goodness of fit test was X^(2)=2.579,P=0.548,the model fitted well.The sensitivity,specificity and accuracy of the model were 87.50%,83.02%and 84.06%respectively.Conclusion Liver function impairment in pregnant women with preeclampsia were associated with multiple pregnancies,irregular calcium and vitamin D supplementation during pregnancy,Alb,D-dimer and PT during pregnancy.The prediction model can effectively evaluate the risk of liver function impairment in preeclampsia.