早孕期基于母体风险因素的子痫前期风险预测模型的效能探讨

Effectiveness of a preeclampsia risk prediction model based on maternal risk factors in the first trimester of pregnancy

目的在本地区人群中探讨早孕期基于母体风险因素的子痫前期风险预测模型的效能。方法该研究为诊断性研究。纳入2019年5月至2022年5月在日照市人民医院行产前检查并且存在子痫前期风险因素的妊娠11~13+6周的孕妇,根据后续是否发生子痫前期及分娩孕周分为早产型子痫前期组、足月型子痫前期组和非子痫前期组。收集入选者的相关临床资料。采用受试者工作特征(ROC)曲线评估不同模型预测子痫前期风险的效能。结果入选孕妇559名,发生子痫前期者78例(14.0%),其中早产型35例(6.3%)(早产型子痫前期组),足月型43例(7.7%)(足月型子痫前期组),未发生子痫前期者481名(86.0%)(非子痫前期组)。早孕期预测早产型子痫前期效能最大的模型是母体风险因素+平均动脉压(MAP)+血清胎盘生长因子(PLGF)+子宫动脉搏动指数(UTPI),曲线下面积(AUC)为0.805,假阳性率为10%时敏感度为56.6%;预测足月型子痫前期、子痫前期效能最大的模型是母体风险因素+MAP+UTPI,AUC均为0.777,假阳性率为10%时敏感度分别为52.6%和53.5%。结论早孕期基于母体风险因素的子痫前期风险预测模型预测本地区人群早产型子痫前期的效能尚可。

Objective To investigate the effectiveness of preeclampsia risk prediction models based on maternal risk factors during the first trimester in a local population.Methods This was a diagnostic study.Pregnant women who underwent prenatal examination in People′s Hospital of Rizhao from May 2019 to May 2022 and had risk factors for preeclampsia were enrolled at 11-13+6 weeks gestation,and were divided into preterm preeclampsia group,term preeclampsia group and non-preeclampsia group according to the occurrence and the gestational week.Baseline clinical data were collected.The effectiveness of different models in predicting preeclampsia risk was evaluated using receiver operating characteristic(ROC)curves.Results Among the 559 pregnant women enrolled,78(14.0%)had preeclampsia,including 35(6.3%)with preterm preeclampsia(preterm preeclampsia group),43(7.7%)with term preeclampsia(term preeclampsia group),and 481(86.0%)without preeclampsia(non-preeclampsia group).The most effective model for predicting preterm preeclampsia in the first trimester was maternal risk factor+mean arterial pressure(MAP)+serum placental growth factor(PLGF)+uterine artery pulse index(UTPI).The area under ROC curve was 0.805,and the sensitivity was 56.6%with a false-positive rate of 10%;the most effective model for predicting term preeclampsia and preeclampsia was maternal risk factor+MAP+UTPI.The area under ROC curve was 0.777,and the sensitivity was 52.6%and 53.5%with a false-positive rate of 10%.Conclusion The combined predicting strategy for preterm preeclampsia based on maternal risk factors in the first trimester maybe effective among our population.