高龄二胎产妇剖宫产后子宫瘢痕愈合不良的Nomogram预测模型的构建及其应用价值

Construction and application value of Nomogram prediction model for poor healing of uterine scar incision after cesarean section in women of advanced age with second pregnancy

目的 构建高龄二胎产妇剖宫产后子宫瘢痕愈合不良(PHUI)的列线图(Nomogram)预测模型,并探讨其临床应用价值。方法 回顾性分析2019年1月至2021年12月新乡医学院第一附属医院收治的277例高龄二胎剖宫产产妇的临床资料,依据所有产妇的子宫瘢痕愈合情况分为子宫瘢痕愈合良好(GHUI)组204例和PHUI组73例,经单因素分析后采用Logistic回归分析高龄二胎产妇剖宫产后PHUI的影响因素,构建Nomogram预测模型,并采用受试者工作特征曲线(ROC)及曲线下面积(AUC)进行临床应用性验证。结果 经单因素分析结果显示,年龄、孕期增重、贫血、既往剖宫产史、子宫位置、手术时机、术者年资、切口与宫颈内口距离、胎膜早破、羊水污染、术后感染是高龄二胎产妇剖宫产后PHUI的影响因素(P<0.05);经Logistic回归分析结果显示,年龄、贫血、既往剖宫产史、子宫位置、手术时机、切口与宫颈内口距离、胎膜早破、羊水污染、术后感染是高龄二胎产妇剖宫产后PHUI的独立影响因素(P<0.05);根据Logistic回归方程构建高龄二胎产妇剖宫产后PHUI的Nomograms预测模型,经检验,该模型C-index为0.921,校准度为0.873,预测高龄二胎产妇剖宫产后PHUI的AUC为0.868 (95%CI:0.822~0.916),敏感度为84.93%,特异度为70.10%;且经临床验证,该模型预测高龄二胎产妇剖宫产后PHUI的AUC为0.885 (95%CI:0.825~0.949),敏感度为85.29%,特异度为77.66%。结论 基于年龄、贫血、既往剖宫产史、子宫位置、手术时机、切口与宫颈内口距离、胎膜早破、羊水污染、术后感染等临床资料构建高龄二胎产妇剖宫产后PHUI的预测模型具有可行性,且其预测价值高,临床应用性可靠。

Objective To construct a Nomogram prediction model for poor healing of uterine scar incision(PHUI)after cesarean section in women of advanced age with second pregnancy,and to explore its clinical application value.Methods The clinical data of 277 women of advanced age undergoing cesarean section for second-child deliv-ery in the First Affiliated Hospital of Xinxiang Medical University from January 2019 to December 2021 were retrospec-tively analyzed.The patients were divided into two groups according to the healing of uterine scars:good uterine scar healing(GHUI)group(204 cases)and poor uterine scar healing(PHUI)group(73 cases).After univariate analysis,logis-tic regression analysis was used to identify the factors affecting PHUI in elderly women undergoing cesarean section for second-child delivery.A Nomogram prediction model was constructed,and the receiver operating characteristic(ROC)curve and area under the curve(AUC)were used for clinical application validation.Results The results of univariate analysis showed that age,pregnancy weight gain,anemia,previous history of cesarean section,uterine position,surgical timing,operator seniority,distance between incision and internal cervical orifice,premature rupture of membranes,amni-otic fluid contamination,and postoperative infection were the influencing factors of PHUI in women of advanced age with second pregnancy after cesarean section(P<0.05).The results of logistic regression analysis showed that age,ane-mia,previous history of cesarean section,uterine position,surgical timing,distance between incision and internal cervi-cal orifice,premature rupture of membranes,amniotic fluid contamination,and postoperative infection were the indepen-dent influencing factors of PHUI in women of advanced age with second pregnancy after cesarean section(P<0.05).Based on the logistic regression equation,a Nomograms prediction model for PHUI after cesarean section in women of advanced age with second pregnant was constructed,with the model's C-index of 0.921 and the calibration degree of 0.873.The AUC for predicting PHUI after cesarean section in elderly women with second pregnant was 0.868(95%CI:0.822-0.916),with a sensitivity of 84.93%and a specificity of 70.10%.Clinical validation showed that the model's AUC for predicting PHUI after cesarean section in elderly women with second pregnant was 0.885(95%CI:0.825-0.949),with a sensitivity of 85.29%and a specificity of 77.66%.Conclusion It is feasible to construct a predictive model for PHUI in women of advanced age with second pregnancy after cesarean section based on clinical data such as age,ane-mia,previous history of cesarean section,uterine position,surgical timing,distance between incision and internal cervi-cal orifice,premature rupture of membranes,amniotic fluid contamination,and postoperative infection,and the predic-tive value is high and the clinical applicability is reliable.