子痫前期并发胎儿生长受限的风险预测列线图模型构建与验证

Construction and Verification of Risk Prediction Nomogram Model forPreeclampsia Complicated with Fetal Growth Restriction

目的探讨子痫前期并发胎儿生长受限(FGR)的影响因素,并依此建立列线图预测模型。方法回顾性分析郑州人民医院2018年12月至2022年12月收治的168例子痫前期患者的临床资料,按照2∶1的比例将其分为建模组(112例)和验证组(56例),并根据是否并发FGR将建模组分为并发组(49例)和未并发组(63例)。采用多因素logistic回归分析法分析子痫前期并发FGR的影响因素,并采用R3.4.3软件包绘制列线图模型,采用Bootstrap法进行内部验证;绘制受试者工作特征(ROC)曲线对列线图预测子痫前期并发FGR的效能进行分析,采用决策曲线分析法(DCA)验证模型的临床净获益率。结果并发组发病孕周<34周、羊水过少、收缩压≥160 mmHg、胎儿脐动脉收缩压与舒张压比值(S/D)升高、24 h尿蛋白定量≥2.0 g占比以及血红蛋白(HB)、谷草转氨酸(AST)、血尿酸(UA)、尿素氮(BUN)、肌酐、D-二聚体(D-D)水平高于未并发组(P<0.05),白蛋白、凝血酶原时间(PT)水平低于未并发组(P<0.05);经logistic回归分析可知,发病孕周<34周、羊水过少、S/D比值升高、24 h尿蛋白定量≥2.0 g、BUN和D-D水平升高是子痫前期并发FGR的危险因素(P<0.05),白蛋白是其保护因素(P<0.05)。依据以上影响因素构建子痫前期并发FGR的列线图模型,经Bootstrap法进行内部验证,其一致性指数为0.825,校正曲线和标准曲线拟合度较好;ROC曲线结果显示,建模组列线图预测子痫前期并发FGR的曲线下面积(AUC)、灵敏度、特异度分别为0.862、83.67%、87.30%;验证组列线图预测子痫前期并发FGR的AUC、灵敏度、特异度分别为0.830、80.77%、83.33%;DCA提示列线图模型进行风险评估可获得满意的净收益。结论发病孕周<34周、羊水过少、S/D比值升高、24 h尿蛋白定量≥2.0 g、BUN和D-D水平升高均是子痫前期并发FGR的危险因素,白蛋白是其保护因素,且基于此构建的列线图模型临床应用价值较高,可为临床筛选子痫前期并发FGR高危患者提供参考。

Objective To explore the influencing factors of preeclampsia complicated with fetal growth restriction(FGR),and to establish a nomogram prediction model.Methods The clinical data of 168 patients with preeclampsia admitted to Zhengzhou People’s Hospital from December 2018 to December 2022 were retrospectively analyzed.According to the ratio of 2∶1,they were divided into modeling group(112 cases)and verification group(56 cases).According to whether FGR was complicated,the modeling group was divided into concurrent group(49 cases)and non-concurrent group(63 cases).Multivariate logistic regression analysis was used to analyze the influencing factors of preeclampsia complicated with FGR,and R3.4.3 software package was used to draw the nomogram model,and Bootstrap method was used for internal verification.The receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of the nomogram in predicting preeclampsia complicated with FGR,and the decision curve analysis(DCA)was used to verify the clinical net benefit rate of the model.Results The proportions of gestational age<34 weeks,oligohydramnios,systolic blood pressure≥160 mmHg,fetal umbilical artery systolic blood pressure/diastolic blood pressure ratio(S/D)ratio increased,24 h urine protein quantification≥2.0 g and levels of hemoglobin(HB),aspartate aminotransferase(AST),blood uric acid(UA),blood urea nitrogen(BUN),creatinine,D-dimer(D-D)in the concurrent group were higher than those in the non-concurrent group(P<0.05),albumin level and prothrombin time(PT)were lower than those in the non-concurrent group(P<0.05).Logistic regression analysis showed that gestational age<34 weeks,oligohydramnios,increased S/D ratio,24 h urinary protein quantification≥2.0 g,elevated BUN and D-D levels were risk factors for preeclampsia complicated with FGR(P<0.05),and albumin was its protective factor(P<0.05).Based on the above influencing factors,a nomogram model of preeclampsia complicated with FGR was constructed.The Bootstrap method was used for internal verification,and the consistency index was 0.825,and the calibration curve and standard curve fit was good.ROC curve results showed that the area under the curve(AUC),sensitivity and specificity of the modeling group nomogram for predicting preeclampsia complicated with FGR were 0.862,83.67%and 87.30%,respectively.The AUC,sensitivity and specificity of the validation group nomogram in predicting preeclampsia complicated with FGR were 0.830,80.77%and 83.33%,respectively.DCA suggested that the nomogram model can obtain satisfactory net income for risk assessment.Conclusion The gestational age of onset<34 weeks,oligohydramnios,elevated S/D ratio,24-hour urinary protein quantification≥2.0 g,elevated BUN and D-D levels levels are all risk factors for preeclampsia complicated with FGR,and albumin is a protective factor.The clinical application value of the nomogram model constructed based on this is high,which can provide reference for clinical screening of high-risk patients with preeclampsia complicated with FGR.