先兆早期早产孕妇近期分娩的风险预测  

Risk Prediction of Recent Delivery in Pregnant Women with Threatened Early Preterm Labor

作　　者：刘艳清 袁玉红 石琪[2] LIU Yanqing;YUAN Yuhong;SHI Qi(Department of Obstetrics and Gynecology,Suining Central Hospital,Suining Sichuan 629000,China;Department of Obstetrics and Gynecology,Affiliated Hospital of North Sichuan Medical College,Nanchong Sichuan 637000,China)

机构地区：[1]遂宁市中心医院妇产科,四川遂宁629000 [2]川北医学院附属医院妇产科,四川南充637000

出　　处：《实用妇产科杂志》2024年第8期670-675,共6页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探索先兆早期早产(妊娠28~33+6周)孕妇近期(1周内)分娩的Cox比例风险预测模型的建立。方法:收集2021年1月至2022年12月川北医学院附属医院产科收治的293例妊娠28~33+6周先兆早期早产患者的临床资料进行回顾性分析。依据患者自住院后近期(1周内)是否分娩,分为分娩组(n=88)和未分娩组(n=205)。收集人口学资料、专科情况及临床生化指标,比较各观察指标在两组中的差异。采用Cox多因素分析筛选变量,再据此构建Cox比例风险预测模型,计算风险比(HR)。利用C-指数来检验模型的预测能力,绘制列线图可视化展示Cox比例风险预测模型,采用校准曲线来检验模型预测结果与实际情况的一致性。结果:分娩组平均年龄30.2±5.0岁,平均延长妊娠时间61.3±47.5 h。分娩组与未分娩组比较,患者入院时体质量指数(BMI)、产次>1次、患妊娠期糖尿病或糖尿病合并妊娠(GDM/PGDM)、胎方位异常、入院时有规律宫缩、入院时阴道清洁度≥Ⅲ度、入院时白细胞总数≥10×10^(9)/L及入院时子宫颈长度<20 mm的患者比例,差异有统计学意义(P<0.05)。多因素Cox回归分析,入院时BMI>30 kg/m^(2)(HR 2.178,95%CI 1.208~3.928,P=0.010)、产次>1次(HR 3.095,95%CI 1.759~5.447,P<0.001)、入院时有规律宫缩(HR 3.447,95%CI 2.216~5.362,P<0.001)、入院时子宫颈长度<20 mm(HR 3.594,95%CI 2.289~5.646,P<0.001)以及入院时白细胞总数≥10×10^(9)/L(HR 2.124,95%CI 1.352~3.335,P=0.001)是先兆早期早产孕妇近期(1周内)分娩的独立危险因素;将以上5个指标纳入预测模型,其C-指数为0.797(95%CI 0.750~0.844),提示模型的预测能力好。绘制校准图提示模型预测结果与实际结果的一致性较好。结论:入院时BMI>30 kg/m^(2)、产次>1次、入院时有规律宫缩、入院时子宫颈长度<20 mm以及入院时白细胞总数≥10×10^(9)/L的先兆早期早产孕妇易于近期内(1周内)发生早产,基于上述危险因素构建的Cox比�Objective:To explore the establishment of a Cox proportional hazard prediction model for the recent(within a week)delivery of pregnant women with threatened early preterm labor(28-33+6 weeks).Methods:The clinical data of 293 patients with threatened early preterm labor at 28-33+6 weeks admitted to the Department of Obstetrics,Affiliated Hospital of North Sichuan Medical College from January 2021 to December 2022 were retrospectively collected.According to whether the patient gave birth recently(within a week)during hospitalization,they were divided into delivery group(n=88)and non-delivery group(n=205).Demographic data,specialty conditions and clinical biochemical indicators were collected,and the differences of each observation index between the two groups were compared.Cox multivariate analysis was used to screen variables,and then the Cox proportional hazard prediction model was constructed to calculate the hazard ratio(HR).The C-index was used to test the predictive ability of the model,and the nomogram was drawn to visualize the Cox proportional hazard prediction model.The calibration curve was used to test the consistency between the model prediction results and the actual situation.Results:The average age of the delivery group was 30.2±5.0 years old,and the average prolonged pregnancy time was 61.3±47.5 hours.Compared to the group that gave birth and did not give birth,the proportion of patients with body mass index(BMI)at admission,parity>1,gestational diabetes mellitus or diabetic pregnancy combined(GDM/PGDM),abnormal fetal orientation,regular contractions at admission,vaginal cleanliness≥Ⅲ,white blood cell count≥10×10^(9)/L at admission and cervical length<20 mm,the difference was statistically significant(P<0.05).Multivariate Cox regression analysis:BMI>30 kg/m^(2)(HR 2.178,95%CI 1.208-3.928,P=0.010),parity>1(HR 3.095,95%CI 1.759-5.447,P<0.001),regular uterine contraction(HR 3.447,95%CI 2.216-5.362,P<0.001),cervical length<20 mm(HR 3.594,95%CI 2.289-5.646,P<0.001)and white blood cell count≥1

关 键 词：先兆早期早产 分娩 危险因素 比例危险度模型 

分 类 号：R714.21[医药卫生—妇产科学]