妊娠期高血压疾病孕早期风险因素的主成分、聚类及预测价值分析

Principal component analysis,cluster analysis and predictive value of risk factors for hypertensive disorder complicating pregnancy in early pregnancy

目的 评估孕早期孕妇临床特征、血流动力学和循环血管生成蛋白指标对妊娠期高血压疾病(HDCP)的预测价值。方法 选取2022年1-6月于华中科技大学同济医学院武汉市中心医院行产前检查、孕12~13周、血压正常的单胎孕妇共252例为研究对象,剔除失访病例,根据在妊娠期间新发高血压的风险将其分为观察组(136例,新发高血压风险较高)和对照组(103例,新发高血压风险较低)。收集两组孕早期基础信息[体重指数(BMI)、心率(HR)、平均动脉压(MAP)]、血流动力学指标[每搏输出量(SV)、子宫动脉搏动指数(PI)、心输出量(CO)、总外周阻力(TPR)]和循环血管生成蛋白[胎盘生长因子(PLGF)、可溶性fms样酪氨酸激酶-1(sFlt-1)、可溶性内皮糖蛋白(s-Eng)、髓过氧化物酶(MPO)和内皮素(ET)]等,评估上述指标对HDCP的预测价值。结果 观察组BMI、MAP、HR、TPR、PI和s-Eng均高于对照组(P<0.05),观察组SV、CO、PLGF均低于对照组(P<0.05)。主成分分析表明,3个主成分占队列变异性的61%,第一主成分主要受TPR(22%)、s-Eng(16%)和CO(12%)的影响,第二主成分主要受BMI(33%)和MAP(19%)的影响,而MPO(18%)则主要影响第三主成分。对队列进行聚类分析识别出3个组:低风险组(127例)、中风险组(81例)和高风险组(31例)。预测HDCP效果较高的4个变量依次是TPR[曲线下面积(AUC)=0.96]、s-Eng(AUC=0.84)、MAP(AUC=0.92)和PLGF(AUC=0.89)。结论 TPR、s-Eng、MAP和PLGF对孕期发生HDCP有较高的预测价值,确定HDCP发生的风险因素对开发针对性的预防和抗高血压治疗方案具有重要意义。

Objective To evaluate the predictive value of clinical features,hemodynamics and circulating angiogenic protein indicators for hypertensive disorder complicating pregnancy(HDCP)in early pregnancy.Methods A total of 252 single pregnant women with normal blood pressure who underwent prenatal examination at 12-13 weeks of gestation in the Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology from January to June 2022 were selected as the study subjects.The missing cases were divided into observation group(136 cases with high risk of new hypertension)and control group(103 cases with high risk of new hypertension)according to the risk of new hypertension during pregnancy.Basic information[body mass index(BMI),heart rate(HR),mean arterial pressure(MAP)],hemodynamic parameters[stroke output(SV),uterine artery pulse index(PI),cardiac output(CO),total peripheral resistance(TPR)]and circulating angiogenic protein[placental growth factor(PLGF),soluble fms-like tyrosine kinase-1(sFlt-1)]were collected from the two groups in early pregnancy.Results BMI,MAP,HR,TPR,PI and s-Eng in observation group were higher than those in control group(P<0.05),and SV,CO and PLGF in observation group were lower than those in control group(P<0.05).Principal component analysis showed that the three dimensions accounted for 61%of the cohort variability.Dimension 1 was mainly affected by total peripheral resistance(TPR,22%),soluble endoglin(s-Eng,16%)and cardiac output(CO,12%).Dimension 2 was mainly affected by body mass index(BMI,33%)and mean arterial pressure(MAP,19%),while myeloperoxidase(MPO,18%)was mainly affected by dimension 3.TPR[area under the curve(AUC)=0.96],s-Eng(AUC=0.84),MAP(AUC=0.92)and PLGF(AUC=0.89)were the four variables with high predictive effect on hypertensive disease in pregnancy.Conclusion This study is of great significance for identifying high-risk factors for HDCP during pregnancy and developing specific prevention and antihypertensive treatment plans.TPR,s-Eng,MAP and PLGF have high predictive value for HDCP during pregnancy,and determining the risk factors for HDCP is of great significance for developing targeted prevention and antihypertensive treatment.