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超声联合磁共振成像检查预测胎盘植入性疾病不良妊娠结局的列线图模型构建 被引量:3

Construction of a Nomogram Model Based on Ultrasonography and MRI for Adverse Pregnancy Outcomes in Patients with Placenta Accreta Spectrum Disorders
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摘要 目的:构建超声评分联合磁共振成像(MRI)征象预测胎盘植入性疾病(PAS)发生不良妊娠结局的列线图模型。方法:回顾性队列研究,纳入2016年1月至2020年11月于北京大学第三医院入院,术前行PAS超声评分并行MRI检查,以剖宫产终止妊娠且临床资料完整的387例孕产妇建立队列,记录术后不良妊娠结局[术中出血量≥1500 ml和(或)子宫切除]发生的情况。分别纳入不同的MRI征象[胎盘内增生血管征象(血窦)、T2相胎盘内黑带、子宫颈受侵、子宫外突、膀胱交界面增生血管],与超声评分相结合,通过留一法内部验证,选取赤池信息准则(AIC)值最低的模型,以列线图呈现。比较所构建模型与仅超声评分预测模型的优劣。结果:单因素分析显示超声评分及5个MRI征象与PAS不良妊娠结局有关(P<0.001);以超声评分联合胎盘内增生血管征象(血窦)、T2相胎盘内黑带及子宫外突4个指标构建模型最佳(AUC 0.88),校准曲线贴合良好,决策曲线显示预测模型具有临床实用性。将构建所得模型与仅超声评分构建模型(AUC 0.86)比较,两模型AUC值差异有统计学意义(P<0.05),净重新分类指数(NRI)和综合判别改善指数(IDI)均>0,所构建模型存在正改善作用。结论:超声评分联合MRI征象构建的列线图模型可有效提供PAS发生不良妊娠结局的预风险参考,模型效能较好。 Objective:To construct a nomogram model based on ultrasonic scores and MRI signs predicting adverse pregnancy outcomes in patients with placenta accreta spectrum disorders.Methods:A retrospective CO hort study was conducted including 387 pregnant wormen admitted to Peking University Third Hospital from Janu-ary 2016 to November 2020.Patients underwent placenta accreta ultrasonic scores and MRI examination before operation,and terminated pregnancy by cesarean section with complete clinical data.The occurrence of adverse pregnancy outcomes including intraoperative blood loss≥1500 ml and(or)having hysterectomy was recorded.Diffterent MRI signs[abnormal intraplacental vascularization(placenta blood sinus),intraplacental black band on T2 weighted imaging,cervical involvement,uterine bulging,vascularization of uterovesical interface]were included and combined with ultrasonic scores.We conducted leave-one-out Cross validation,selected the model with the lowest AIC value and presented in a nomogram model.Compare the pros and cons of the constructed model with the model constructed by only ultrasonic scoring system.Results:Univariate analysis showed that ultrasonic scores and 5 MRI signs were significantly associated with adverse pregnancy outcomes(P<0.001).The model constructed by combining ultrasonic scores with abnormal intraplacental vascularization(placenta blood sinus),intraplacental black band on T2 weighted imaging,and uterine bulging was the best with AUC value of 0.88.The calibration curve fitted well,a nd the decision curve showed that the prediction model has clinical practicability.Compared the constructed model with the model constructed by only ultrasonic scoring system(AUC value 0.86),and P<0.05,which indicating that there was a significant difference in the AUC values of two models,and the calculated NRI and IDI were both>0,indicating that the constructed model had a positive improvement.Conclusions:The nomogram model based on ultrasonic scores and MRI signs could effectively predict the risk of adverse pregnancy outcomes in patients with placenta accreta spectrum disorders,and the model has a good performance.
作者 李泽丽 陈练 石慧峰 赵扬玉 LI Zeli;CHEN Lian;SHI Huifeng(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)
出处 《实用妇产科杂志》 CAS CSCD 北大核心 2023年第4期277-281,共5页 Journal of Practical Obstetrics and Gynecology
基金 国家重点研发计划(编号:2021YFC2701500) 北京市科技新星人才项目(编号:Z211100002121045) 北京大学第三医院临床重点项目(编号:BYSYZD2021042)。
关键词 胎盘植入性疾病 超声 磁共振成像 不良妊娠结局 列线图模型 Placenta accreta spectrum disorders Ultrasonography Magnetic resonance imaging Adverse clinical outcome Nomogram model
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