McDonald宫颈环扎术后不良妊娠结局预测模型的建立  

Establishment of prediction model of adverse pregnancy outcomes after McDonald cervical cerclage

作　　者：殷红宇 陈悦[2] Yin Hongyu;Chen Yue(Graduate School of Guangxi Medical University,Nanning 530021;Department of Obstetrics,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021)

机构地区：[1]广西医科大学研究生院,南宁530021 [2]广西医科大学第一附属医院产科,南宁530021

出　　处：《现代妇产科进展》2022年第12期915-920,共6页Progress in Obstetrics and Gynecology

摘　　要：目的:通过分析单胎妊娠宫颈机能不全(CI)患者行McDonald宫颈环扎术后不良妊娠结局的相关危险因素,建立风险预测模型。方法:回顾分析2012年1月至2021年12月于广西医科大学第一附属医院产科行McDonald宫颈环扎术并分娩的CI患者的临床资料,利用logistic回归分析筛选不良妊娠结局的预测变量,R软件绘制列线图,ROC曲线、校准图、决策曲线等评估预测效能及临床价值。内部验证采用1000次Bootstrap重抽样。结果:羊膜囊膨出、术前宫颈长度(CL)<25mm、羊水沉积物(AFS)与不良妊娠结局密切相关。据此建立预测公式:Logit(P)=-0.726+1.775×羊膜囊膨出(否:0,是:1)+1.127×术前CL(CL≥25mm:0,CL<25mm:1)+1.672×AFS(无:0,有:1),进而可视化绘制成Nomogram列线图模型。模型的AUC为0.741,Hosmer-Lemeshow good of fit test(H-L检验)P>0.05,Brier得分0.199,校准图中校准曲线与标准曲线相接近。决策曲线表明当模型的阈概率在32%~88%之间时,其具备一定的临床决策价值。经Bootstrap内部验证后模型校正的AUC为0.736,校准曲线显示一致性较好。结论:该预后模型具备一定的临床价值,能在产前筛选出宫颈环扎术后的高危孕妇,协助产科医师为患者拟定个性化的诊疗措施以改善妊娠结局。Objective:To establish a risk prediction model by analyzing the risk factors associated with adverse pregnancy outcomes after McDonald cervical cerclage in singleton pregnancy patients with cervical incompetence.Methods:Retrospectively collected and analyzed the datas of patients who underwent McDonald cervical cerclage and delivered in the obstetrics department of the First Affiliated Hospital of Guangxi Medical University from January 2012 to December 2021.Logistic regression was used to sceen predictive factors for adverse pregnancy outcomes.The corresponding Nomogram was drawn by R software.The receiver operating characteristic curve、calibration plot、decision curve were used to evaluate the prediction efficiency and clinical utility of the prediction model.Internal validation was performed by using 1000 times Bootstrap resampling.Result:Membranes bulging into the vagina,cervical length<25 mm and sludge were closely related to adverse pregnancy outcomes.The prediction formula was Logit(P)=-0.726+1.775×membranes bulging into the vagina(No:0,Yes:1)+1.127×preoperative CL(CL≥25 mm:0,CL<25 mm:1)+1.672×AFS(No:0,Yes:1).Nomogram model was performed accordingly.The AUC value of the ROC curve was 0.741,the P value of Hosmer-Lemeshow good of fit test was 0.953,and the Brier score was 0.199.The calibration curve of calibration plot was close to the standard curve.The decision curve showed that the model had some clinical value when the threshold probability was between 32%and 88%.The AUC value of Bootstrap was 0.736 after internal verification,and the calibration curve showed good consistency.Conclusions:The prognostic model has certain clinical value,it can screen high-risk pregnant women after cervical cerclage and assist obstetricians to make individualized diagnosis and treatment plans for patients to improve pregnancy outcome.

关 键 词：宫颈环扎术 妊娠结局 宫颈机能不全 预测模型 

分 类 号：R719.9[医药卫生—妇产科学]