妊娠糖尿病患者合并妊娠高血压的风险预测模型构建

Construction of risk prediction model of gestational diabetes mellitus patients complicated with gestational hypertension

目的探讨妊娠糖尿病(GDM)患者合并妊娠高血压的危险因素,并建立列线图预测模型。方法将294例GDM患者按照2∶1比例分为建模组(196例)和验证组(98例)。根据是否合并妊娠高血压将建模组分为合并高血压组(51例)和未合并高血压组(145例)。分析GDM合并妊娠高血压的影响因素,构建列线图模型并验证。结果孕前超重/肥胖、孕期体质量增长过度、口服葡萄糖耐量试验3项异常、同型半胱氨酸(Hcy)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、胰岛素抵抗(HOMA-IR)、丙二醛(MDA)、合并焦虑/抑郁情绪均是GDM合并妊娠高血压的影响因素(OR=2.776、2.149、5.008、4.586、4.208、4.047、3.473、0.503、3.688、3.317、2.305,P<0.05)。将上述影响因素作为预测指标,构建GDM合并妊娠高血压风险预测列线图模型,建模组和验证组一致性指数分别为0.830、0.827,校准曲线和理想曲线拟合度均较好。受试者工作特征曲线评估模型显示,建模组、验证组曲线下面积分别为0.859、0.850;决策曲线显示,建模组、验证组在风险阈值概率分别为0.02~0.89、0.02~0.85时可获得较高的净获益值。结论孕前超重/肥胖、孕期体质量增长过度、口服葡萄糖耐量试验3项异常、Hcy、TG、TC、LDL、HDL、HOMA-IR、MDA、合并焦虑/抑郁情绪均是GDM合并妊娠高血压的影响因素,据此构建的列线图模型预测效能较好,可指导临床筛选高风险人群。

Objective To investigate the risk factors of gestational diabetes mellitus(GDM)combined with gestational hypertension,and to establish a nomogram prediction model.Methods According to the ratio of 2 to 1,294 GDM patients were divided into modeling group(196 cases)and verification group(98 cases).The modeling group was divided into the hypertensive group(51 cases)and the non-hypertensive group(145 cases).The influential factors of GDM combined with pregnancy-induced hypertension were analyzed,and the nomogram model was established and verified.Results Pre-pregnancy overweight/obesity,excessive weight gain during pregnancy,three abnormalities in oral glucose tolerance test,homocysteine(Hcy),triglyceride(TG),total cholesterol(TC),low density lipoprotein(LDL),high density lipoprotein(HDL),insulin resistance(HOMA-IR),malondialdehyde(MDA)and anxiety/depression were all the influencing factors of GDM combined with gestational hypertension(OR=2.776,2.149,5.008,4.586,4.208,4.047,3.473,0.503,3.688,3.317,2.305,P<0.05).The above influencing factors were used as predictive indicators to construct a nomogram model for predicting the risk of GDM complicated with pregnancy-induced hypertension.The consistency index of the modeling group and the validation group was 0.830 and 0.827,respectively,and the calibration curve and ideal curve fit were good.The receiver operating characteristic curve evaluation model showed that the area under the curve of the modeling group and the validation group were 0.859 and 0.850,respectively;the decision curve showed that the modeling group and the validation group could obtain higher net benefit values when the risk threshold probability was 0.02 to 0.89 and 0.02 to 0.85,respectively.Conclusion Prepregnancy overweight/obesity,excessive body mass gain during pregnancy,abnormalities in three indicators of oral glucose tolerance test,Hcy,TG,TC,LDL,HDL,HOMA-IR,MDA and anxiety/depression are all influencing factors of GDM combined with gestational hypertension.The column-line model constructed based on this analysis has good predictive efficacy and can guide clinical screening of high-risk groups.