HDP临床流行病学特征及相关预测模型构建与预测

Clinical epidemiological characteristics of hypertensive disorders of pregnancy(HDP)of pregnant women and the related model construction and its predictive value for HDP

目的:探究妊娠期高血压疾病(HDP)临床流行病学特征,构建相关预测模型并分析其预测价值。方法:回顾性选取2019年2月-2023年5月在本院诊治的孕中期HDP孕妇102例临床资料为HDP组,健康产妇100例纳入对照组,收集两组临床资料,分析HDP者临床流行病学特征,探究影响HDP发生的危险因素并建立预测模型,探究预测价值。结果:两组年龄、孕前体质指数(BMI)、HDP史、文化程度、高血压家族史、孕前糖尿病史、受孕方式、居住地及孕次等有差异(P<0.05),孕周、产次、职业、糖尿病家族史、乙肝病毒感染、甲状腺功能减退等无差异(P>0.05)。多因素logistic回归分析,高龄、孕前BMI偏高、存在HDP史、文化程度低、人工辅助受孕、居住地在农村、高孕次均是发生HDP风险(P<0.05)。采用ROC曲线对上述结果中存在差异的因素进行预测价值分析,孕妇年龄、孕前BMI、HDP史、文化程度、受孕方式、居住地、孕次预测HDP发生的曲线下面积(AUC)分别为0.707、0.925、0.606、0.569、0.601、0.640、0.735,根据上述多因素logistic回归分析结果及ROC曲线分析结果建立的HDP预测模型,最终纳入年龄、孕前BMI及孕次3个因素,ROC曲线对上述模型的预测价值进行检验,其AUC值为0.948,该模型预测HDP的敏感度92.2%,特异度85.0%。结论:发生HDP孕妇中,多表现为高龄、孕前BMI偏高、存在HDP史、文化程度低、人工辅助受孕、居住地在农村、高孕次等,纳入年龄、孕前BMI及孕次建立的预测HDP模型具有一定临床应用价值。

Objective:To explore the clinical epidemiological characteristics of hypertensive disorders of pregnancy(HDP)of pregnant women,and to construct the related predictive model for HDP,and to study the predictive value of the model for HDP.Methods:102 pregnant women with HDP who had admitted in hospital during the second trimester of pregnancy from February 2019 to May 2023(in study group)were selected in this study retrospectively,and 100 healthy pregnant women were selected in control group.The clinical data of the women in the two groups were collected.The clinical epidemiology characteristics of the women with HDP were analyzed.The risk factors affecting the HDP occurrence of the women were explored,and the prediction model for HDP occurrence of the women based on these risk factors was established,and the predictive value of the model was explored.Results:There were significant differences in the age,the body mass index(BMI)value before pregnancy,the family hypertension history,the history of diabetes before pregnancy,the conception way,the place of residence and the gravidity of the women between the two groups(P<0.05).There were no significant differences in the gestational weeks,the parity,the occupation,the family history of diabetes,the hepatitis B virus infection and the hypothyroidism of the women between the two groups(P>0.05).Multivariate logistic regression analysis showed that the advanced age,the high value of pre-pregnancy BMI,the history of HDP,the low education level,the pregnancy by assisted technology,the residence in rural area,and the high gravidity of the women were all the risk factors of their HDP occurrence(P<0.05).ROC curve was used to analyze the predictive values of these risk factors with differences of the women for their HDP occurrence,which showed that the area under the curve(AUC)of the age,the pre-pregnancy BMI value,the HDP history,the education level,the conception way,the residence and the gravidity of the women for predicting their HDP occurrence were0.707,0.925,0.606,0.569,0.601,0.640,and 0.735,respectively.Based on the results of multivariate logistic regression analysis and ROC curve analysis,the prediction model for HDP was established,and finally including the age,the pre-pregnancy BMI value and the gravidity.ROC curve was used to test the predictive value of this model,and the AUC,the sensitivity and the specificity of this model for predicting the HDP occurrence of the women were 0.948,92.2%and 85.0%,respectively.Conclusion:Among the pregnant women with HDP,their most manifestations are the advanced age,the high value of pre-pregnancy BMI,the previous history of HDP,the low education level,the pregnancy by assisted technology,the residence in rural areas,and the more gravidity,and so on.The Age,the prepregnancy BMI value and the gravidity of the women are included to establish a model for predicting their HDP,and the predictive model has certain clinical application value.