平均动脉压、子宫动脉搏动指数联合血清同型半胱氨酸对子痫前期的早期预测价值  

The early predictive value of mean arterial pressure,uterine artery pulse index combined with serum homocysteine for preeclampsia

作　　者：宋清源 周玉霞[1] 彭红梅 金日男[1] SONG Qingyuan;ZHOU Yuxia;PENG Hongme;i JIN Rinan(Department of Obstetrics,People’s Hospital of North Guangdong,Guangdong Province,Shaoguan 512026,China)

机构地区：[1]粤北人民医院产科,广东韶关512026

出　　处：《妇儿健康导刊》2023年第21期23-26,F0003,共5页JOURNAL OF WOMEN AND CHILDREN'S HEALTH GUIDE

基　　金：韶关市科技计划项目(技术开发类)(210802154537456)。

摘　　要：目的探讨平均动脉压(MAP)、子宫动脉搏动指数(UTPI)联合血清同型半胱氨酸(HCY)对子痫前期的早期预测价值。方法选取2021年1月至2022年12月在粤北人民医院建档产检的1278例11周~13周+6单胎孕妇,采集病史及孕早期实验室检查指标,根据是否发生子痫前期分为子痫前期发病组和正常组,对两组孕妇的病史风险因素及实验室指标进行单因素分析,对差异有统计学意义的指标进行多因素logistic回归分析,构建子痫前期预测模型,采用ROC曲线和Hosmer-Lemeshow拟合优度检验评价模型的区分度和准确性。结果观察过程中61例撤出,剩余1217例孕妇中56例发生子痫前期。单因素分析显示,子痫前期发病组与正常组预产期年龄、孕前体重指数、经产妇有子痫前期病史、慢性高血压病史、子痫前期家族史、MAP、UTPI、妊娠相关血浆蛋白A MoM值及HCY比较,差异有统计学意义(P<0.05)。对以上指标行多因素logistic回归分析,MAP、UTPI、血清HCY进入模型,联合预测模型为Logit(P)=-23.466+0.153MAP+0.277HCY+3.225UTPI,联合预测AUC为0.933,敏感度为80.4%,特异性为89.3%,拟合优度检验P=0.070。结论MAP、UTPI、HCY是子痫前期的独立影响因素,其联合预测在子痫前期早期预测方面具有一定的应用价值。Objective To explore the value of mean arterial pressure(MAP),uterine artery pulse index(UTPI)combined with serum homocysteine(HCY)in early prediction of preeclampsia.Methods From January 2021 to December 2022,1278 single pregnant women who were registered in People’s Hospital of North Guangdong at 11-13+6 weeks of gestation were recruited,their medical history and early pregnancy laboratory examination indicators were collected,and they were divided into preeclampsia onset group and normal group according to whether preeclampsia occurred.Univariate analysis was applied to the medical history,risk factors and laboratory indicators of the two groups to find the difference indicators,and multivariate logistic regression analysis was used to construct the prediction model of preeclampsia.ROC curve and Hosmer-Lemeshow goodness of fit test were used to evaluate the differentiation and accuracy of the prediction model.Results A total of 61 cases were withdrawn during the course of the observation and 56 of the remaining 1217 pregnant women developed preeclampsia.Univariate analysis indicated that there were statistical differences in expectant age,pre-pregnancy body mass index,history of preeclampsia,chronic hypertension,family history of preeclampsia,MAP,UTPI,pregnancy associated plasma protein-A MoM value and HCY between the preeclampsia onset group and the normal group(P<0.05).Multivariate logistic regression analysis was performed for the above indicators,MAP,UTPI,and serum HCY were entered into the model,and the combined prediction model was Logit(P)=-23.466+0.153MAP+0.277HCY+3.225UTPI,with a joint prediction AUC of 0.933,sensitivity of 80.4%,specificity of 89.3%,and goodness of fit test P=0.070.Conclusion MAP,UTPI and HCY are independent factors in preeclampsia,and their combined prediction model has certain application value in the early prediction of preeclampsia.

关 键 词：子痫前期 平均动脉压 子宫动脉搏动指数 同型半胱氨酸 危险因素 预测模型 

分 类 号：R714.2[医药卫生—妇产科学]