基于产前超声指标和妊娠期高血压的列线图模型预测低体质量儿不良结局的价值  

Value of a nomogram model based on prenatal ultrasound indexes and pregnancy-induced-hypertension in predicting adverse outcomes in low birth weight infants

作　　者：姚雨 柳阳 冯梅 刘建新 YAO Yu;LIU Yang;FENG Mei;LIU Jianxin(Department of Ultrasound Medicine,the Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China)

机构地区：[1]华中科技大学同济医学院附属武汉中心医院超声医学科,武汉市430014

出　　处：《临床超声医学杂志》2023年第3期172-176,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨基于产前超声指标和妊娠期高血压(PIH)构建的列线图模型在预测低体质量儿不良结局中的价值。方法选取在我院行产前超声检查且分娩的PIH孕妇102例(PIH组)和正常孕妇121例(对照组),比较两组临床及产前超声检查资料的差异;应用单因素及多因素Logistic回归分析筛选低体质量儿不良结局的影响因素,并建立预测低体质量儿不良结局的列线图模型。采用Bootstrap重抽样法进行内部验证,绘制受试者工作特征(ROC)曲线分析模型的诊断效能;Hosmer-Lemeshow检验并绘制校准曲线评估模型的拟合优度及校准度;决策曲线分析模型的临床获益。结果PIH组检出低体质量儿33例,对照组检出低体质量儿6例,两组低体质量儿占比比较差异有统计学意义(P<0.01)。单因素及多因素Logistic回归分析显示,PIH、晚孕期胎儿体质量、妊娠32周后脐动脉收缩末期峰值流速与舒张末期峰值流速比值均是低体质量儿不良结局的独立影响因素(OR=6.162、0.997、16.712,均P<0.05)。ROC曲线分析显示,列线图模型预测低体质量儿不良结局的曲线下面积为0.852(95%可信区间:0.789~0.914);Hosmer-Lemeshow检验显示,列线图模型预测概率与实际概率比较差异无统计学意义(P=0.788);校准曲线图显示,标准曲线与校准曲线贴合良好(内部验证结果显示C指数为0.841);临床决策曲线图显示该模型的潜在临床获益可观。结论基于产前超声指标和PIH构建的列线图模型在预测低体质量儿不良结局方面有较高的临床应用价值,可指导不良妊娠结局的早期干预。Objective To explore the value of a nomogram model based on prenatal ultrasound indexes and pregnancy-induced-hypertension(PIH)in predicting adverse outcomes in low birth weight infants.Methods A total of 102 pregnant women(PIH group)and 121 cases of normal pregnant women(control group)who underwent prenatal ultrasonography and delivery in our hospital were selected.The clinical and prenatal ultrasonic data of the two groups were retrospectively analyzed,and the influencing factors of adverse outcomes of low birth weight infants were screened by univariate and multivariate Logistic regression,and a nomogram model for predicting adverse outcomes of low birth weight infants was established.Bootstrap resampling was used for internal validation,the receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficiency of the model.Hosmer-Lemeshow test and calibration curves were drawn to assess the goodness of fit and calibration of the model,and decision curves were used to analyze the clinical benefit of the model.Results A total of 33 cases of low birth weight infants were detected in PIH group and 6 cases in control group,the proportion of low birth weight infants was statistically significant(P<0.01).Univariate and multivariate Logistic regression analysis showed that PIH,fetal weight in late pregnancy and S/D of the umbilical artery after 32 weeks of gestation were independent influencing factors for adverse outcomes of low birth weight infants(OR=6.162,0.997,16.712,all P<0.05).ROC curve analysis showed that the area under the curve of the nomogram model for predicting adverse outcomes of low birth weight infants was 0.852(95%confidence interval:0.789~0.914)Hosmer-Lemeshow test showed that there was no significant difference between the predicted probability of the nomogram model and the actual probability(P=0.788).The calibration curve showed that the standard curve fits well with the calibration curve(internal verification results show that the C index was 0.841).The clinical decision curv

关 键 词：超声检查 产前 妊娠期高血压 低体质量儿 列线图 

分 类 号：R445.1[医药卫生—影像医学与核医学]