妊娠合并心脏病患者发生产后抑郁的影响因素分析及列线图构建

Analysis of factors influencing postpartum depression in pregnant patients with heart disease and construction of a nomogram model

目的 探讨妊娠合并心脏病患者发生产后抑郁的影响因素,建立列线图模型量化各因素贡献值,为产后恢复和管理提供指导。方法 选择2021年7月至2023年7月在中国人民解放军北部战区总医院母儿心脏病诊治中心就诊并分娩的105例妊娠合并心脏病患者,根据产后6周爱丁堡产后抑郁量表(EPDS)得分,分为产后抑郁组(EPDS评分>9分,研究组48例)和非产后抑郁组(EPDS评分≤9分,对照组57例)。采用心脏焦虑问卷(CAQ)、欧洲心力衰竭自我护理行为量表(EHFScBS)和自制量表,结合患者的医疗信息,评估其一般资料、心脏病、妊娠及新生儿相关指标,利用单因素及多因素logistic回归分析妊娠合并心脏病患者发生产后抑郁的影响因素,并建立列线图模型。结果 妊娠合并心脏病患者产后抑郁的发生率为45.71%(48/105)。单因素分析显示,新生儿性别、新生儿体重、担心新生儿心脏情况、心脏焦虑问卷特定项目(Q3、Q4、Q13、Q15、Q16)在产后抑郁组与非产后抑郁组之间差异有统计学意义。多因素logistic回归分析显示,女婴、担心新生儿心脏情况、心脏焦虑问卷Q15项目评分高是妊娠合并心脏病患者产后抑郁的独立危险因素(P<0.05)。内部验证结果显示,列线图模型的曲线下面积为0.767(95%CI 0.679~0.856),分辨力良好,校准效果良好。决策曲线分析显示,阈值在0.08~0.68时,列线图模型提供临床净效益。结论 妊娠合并心脏病患者产后抑郁发病率高。新生儿性别为女、担心新生儿心脏情况、心脏焦虑问卷Q15项目评分高是其危险因素,基于此构建的列线图模型能够为临床上针对性管理提供参考。

Objective To investigate the influencing factors of postpartum depression in pregnant women with heart disease,and establish a nomogram model to quantify the contribution of each factor,in order to provide guidance for their postpartum recovery and management.Methods A total of 105 pregnant women with heart disease who visited and delivered at the Maternal and Child Heart Disease Diagnosis and Treatment Center of the Northern Theater Command General Hospital of the People′s Liberation Army from July 2021 to July 2023 were included in the study.According to the scores of the Edinburgh Postnatal Depression Scale(EPDS)at 6 weeks after delivery,they were divided into the postpartum depression group(EPDS score>9 points,n=48)and the no-postpartum depression group(EPDS score≤9 points,n=57).The Cardiac Anxiety Questionnaire(CAQ),European Heart Failure Self-Care Behavior Scale(EHFScBS),and self-made scale were used,combined with the patient′s medical information,to assess their general data,heart disease,pregnancy,and newborn-related indicators.Univariate and multivariate Logistic regression analysis was used to analyze the influencing factors of postpartum depression in pregnant women with heart disease,and a nomogram model was estab-lished.Results The incidence of postpartum depressionin pregnant women with heart disease was 45.71%(48/105).Univariate analysis showed that the gender andweight of the newborn,concern about the heart conditionof the newborn,and specific items of the Cardiac AnxietyQuestionnaire(Q3,Q4,Q13,Q15,Q16)had statistically significant differences between the postpartum depression group and the no-postpartum depression group.MultivariateLogistic regression analysis showed that female infants,concern about the heart condition of the newborn,and high scoreson item Q15 of the Cardiac Anxiety Questionnaire were independent risk factors for postpartum depression in pregnantwomen with heart disease(P<0.05).Internal validation results showed that the area under the curve of the nomogrammodel was 0.767(95%CI:0.679~0.856),with good discrimination and calibration.Decision curve analysis showed thatwhen the threshold was between 0.08 and 0.68,the nomogram model provided clinical net benefits.Conclusions The in-cidence of postpartum depression in pregnant women with heart disease is high,and the risk factors are female newborns,concern about the heart condition of the newborn,and high scores on item Q15 of the Cardiac Anxiety Questionnaire.Thenomogram model constructed on this basis can provide a reference for targeted management in clinical practice.