HDP孕妇产后发生慢性高血压危险因素及其预测模型建立

Risk factors of the postpartum chronic hypertension of women with hypertensive disorder of pregnancy and the prediction model establishment

目的:探讨妊娠期高血压疾病(HDP)孕妇产后发生慢性高血压危险因素及其预测价值。方法:回顾性选取2019年1月-2021年8月在本院产前检查并分娩的HDP患者138例临床资料,根据产后2年是否发生慢性高血压分为为慢性高血压组和非慢性高血压组,采用单因素、多因素分析HDP患者产后发生慢性高血压的影响因素,构建预测模型。结果:138例HDP患者产后2年慢性高血压发病率为32.6%(45例),未发生慢性高血压93例,占比67.4%。单因素分析显示,年龄、妊娠前体质指数(BMI)及妊娠期最高收缩压、中性粒细胞/淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、血小板与淋巴细胞比值(PLR)均与HDP患者产后发生慢性高血压有关(P<0.05)。多因素分析显示,年龄≥35岁(OR=1.743,95%CI 1.072~2.834)、孕期体质指数≥24 kg/m^(2)(OR=1.937,95%CI 1.146~3.275),以及孕期最高收缩压高(OR=1.044,95%CI 1.006~1.083)、NLR高(OR=2.122,95%CI 1.351~3.335)、LMR高(OR=1.048,95%CI 1.022~1.075)、PLR高(OR=1.570,95%CI 1.045~2.358)均为HDP患者产后发生慢性高血压的独立危险因素(P<0.05)。Hosmer-Lemsshow拟合优度检验χ^(2)=9.476,DF=8,P=0.304,模型拟合度良好。受试者工作特征曲线分析,该预测模型的曲线下面积为0.859(95%CI 0.787~0.930,P<0.001),约登指数0.574时,预测敏感度为77.8%,特异度79.6%。结论:HDP患者产后慢性高血压发生率较高,其影响因素包括年龄大、孕前BMI及妊娠期最高收缩压、NLR、LMR、PLR均异常高,据此构建的logistic回归模型预测价值较好。

Objective:To explore the risk factors of the postpartum chronic hypertension of women with hypertensive disorder of pregnancy(HDP),and to analyze the value of the risk factors for the HDP of the women.Methods:The clinical data of 138 pregnant women with HDP who had been antenatal examination and had given birth in the hospital from January 2019 to August 2021 were selected retrospectively.According to whether the chronic hypertension occurred of the women within 2 years after delivery,the women were divided in group A(women with postpartum chronic hypertension)and group B(women without postpartum chronic hypertension).The univariate and multivariate analysis were used to explore the influencing factors of the postpartum chronic hypertension of the women with HDP,and a prediction model was constructed.Results:The incidence of the chronic hypertension of 138 pregnant women with HDP within 2 years after delivery was 32.6%(45 cases),and among them,there were 93 cases in group B,accounting for 67.4%.Univariate analysis showed that the age,and the values of pre-pregnancy body mass index(BMI),maximum systolic blood pressure during pregnancy,neutrophil/lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR)and platelet-to-lymphocyte ratio(PLR)of the women with HDP were all associated with their postpartum chronic hypertension(P<0.05).Multivariate analysis showed that the age≥35years old(OR=1.743,95%CI 1.072-2.834),the body mass index value≥24kg/m^(2)(OR=1.937,95%CI 1.146-3.275),and the highest peak systolic blood pressure during pregnancy(OR=1.044,95%CI 1.006-1.083),the NLR value(OR=2.122,95%CI 1.351-3.335),the LMR value(OR=1.048,95%CI 1.022-1.075)and the PLR value(OR=1.570,95%CI 1.045-2.358)of the women with HDP were the independent risk factors of their postpartum chronic hypertension(P<0.05).Hosmer-Lemsshow goodness of fit test was χ^(2)=9.476,DF=8,P=0.304,suggesting agood fit of the model.Receiver operating characteristic curve analysis showed that the area under the curve of the prediction model for predicting the postpartum chronic hypertension of the women was 0.859(95%CI 0.787-0.930,P<0.001),and when the Youden index was 0.574,the sensitivity and the specificity of the prediction model for predicting the postpartum chronic hypertension of the women were 77.8%and 79.6%.Conclusion:The incidence of the postpartum chronic hypertension of the women with HDP is high,and the influencing factors of which including the age,and the values of pre-pregnancy BMI,maximum systolic blood pressure during pregnancy,NLR,LMR and PLR.The Logistic regression model based on these influencing factors has reliable predictive value for the postpartum chronic hypertension of the women.