未足月胎膜早破发生组织学绒毛膜羊膜炎风险评分系统构建  

The establishment of histological chorioamnionitis risk scoring system for preterm premature rupture of membranes

作　　者：李杰[1] 赵卫东[1] Li Jie;Zhao Weidong(Department of Obstetrics and Gynecology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)妇产科,合肥230001

出　　处：《现代妇产科进展》2023年第6期426-429,共4页Progress in Obstetrics and Gynecology

摘　　要：目的:建立未足月胎膜早破发生组织学绒毛膜羊膜炎(HCA)风险评分系统,为临床绒毛膜羊膜炎的早期诊断提供可靠的依据。方法:回顾分析2015年12月至2021年12月于安徽省立医院住院分娩的孕周为28~36+6周且符合本研究纳入排除标准的胎膜早破患者80例,其中未并发HCA者44例(对照组),并发HCA者36例(病例组)。综合孕妇年龄、孕周、孕产次、破膜时间、白细胞计数、中性粒细胞百分比、中性粒细胞及淋巴细胞计数、C-反应蛋白水平、NLR、PCT等指标,采用单因素和多因素逐步logistic回归分析,根据回归分析纳入变量的回归系数和OR值构建logistic评分系统和Additive评分系统,并采用受试者工作特征曲线检验其区分度、Hosmer-Lemeshow检验其校准度来评估预测模型。结果:未足月胎膜早破并发HCA预测模型:Logit P=30.992+0.516*WBC+0.305*NEU+0.675*NLR+0.626*CRP。定义简易logistic评分:WBC(>11.69)5分,NEU比例(>78.6)3分,NLR(>5.97)7分,CRP(>10.82)6分,分值范围0~21分。Logistic评分为8分时,预测发生HCA的敏感度和特异度分别为91.67%、90.91%,AUC为0.95,校正能力Hosmer-Lemeshow拟合优度检验满意(P>0.05)。Additive评分:WBC(>11.69)16分,NEU比例(>78.6)10分,NLR(>5.97)19分,CRP(>10.82)15分,分值范围0~60分。Additive评分为26分时,预测发生HCA的敏感度和特异度分别为86.11%、90.91,AUC为0.935,校正能力Hosmer-Lemeshow拟合优度检验满意(P>0.05)。结论:构建未足月胎膜早破发生组织学绒毛膜羊膜炎简化logistic评分系统和Additive评分系统,有助于对未足月胎膜早破孕妇并发HCA进行早期诊断评估,为临床决策提供依据。Objective:To establish a histological chorioamnionitis(HCA)risk scoring system for preterm premature rupture of membranes(PROM),so as to provide a reliable basis for the early diagnosis of clinical chorioamnionitis.Methods:A retrospective analysis was conducted on 80 patients with premature rupture of the fetal membranes who were hospitalized in Anhui Provincial Hospital for delivery from December 2015 to December 2021 and whose gestational age was 28 to 36+6 weeks and met the inclusion and exclusion criteria of this study.Among them,44 patients had no HCA complications(control group)and 36 patients had HCA complications(case group).Based on pregnant women's age,gestational age,gestational number,membrane rupture time,white blood cell count,neutrophil percentage,neutrophil and lymphocyte count,C-reactive protein level,NLR,PCT and other indicators,The logistic and additive scoring systems were constructed according to the regression coefficients and OR values of the variables included in the regression analysis,and the differentiation and Hosmer-Lemeshow were tested using the subject working characteristic curve The prediction model was evaluated by checking its calibration.Results:The HCA prediction model of premature rupture of preterm membrane was logit P=30.992+0.516*WBC+0.305*NEU+0.675*NLR+0.626*CRP.The simple logistic score was defined as WBC(>11.69)5 points,NEU ratio(>78.6)3 points,NLR(>5.97)7 points,CRP(>10.82)6 points,ranging from 0 to 21 points.When logistic score was 8,the sensitivity and specificity of predicting HCA were 91.67%and 90.91%,respectively,and the AUC was 0.95.The Hosmer-Lemeshow goodness-fit test of correction ability was satisfactory(P>0.05).The additive scores were:WBC(>11.69)16 points,NEU ratio(>78.6)10 points,NLR(>5.97)19 points,CRP(>10.82)15 points,ranging from 0 to 60 points.The sensitivity and specificity of the Additive scored at 26 points showed 86.11%,90.91,0.935,and satisfactory Hosmer-Lemeshow goodness of fit test(P>0.05).Conclusions:The simplified logistic scoring system and A

关 键 词：未足月胎膜早破 绒毛膜羊膜炎 

分 类 号：R71[医药卫生—妇产科学]