重度子痫前期患者发生胎盘早剥的相关因素分析  

Analysis of factors associated with placental abruption in patients with severe preeclampsia

作　　者：王玉婷 张夏兰[1] 黄若玲 李丽贤 陈晓琳 李洲敏 WANG Yuting;ZHANG Xialan;HUANG Ruoling;LI Lixian;CHEN Xiaolin;LI Zhoumin(Department of Obstetrics and Gynecology,The Second Affiliated Hospital of Shantou University Medical College,Shantou 515041,China;Department of Obstetrics,Puning People's Hospital,Puning 515300,China;Department of Medical Administration,Puning People's Hospital,Puning 515300,China;Department of Gynecology,Jieyang People's Hospital,Jieyang 522000,China)

机构地区：[1]汕头大学医学院第二附属医院妇产科,广东汕头515041 [2]普宁市人民医院产科,广东普宁515300 [3]普宁市人民医院医务股,广东普宁515300 [4]揭阳市人民医院妇科,广东揭阳522000

出　　处：《汕头大学医学院学报》2024年第3期142-146,共5页Journal of Shantou University Medical College

摘　　要：目的:探讨重度子痫前期患者发生胎盘早剥的相关因素并构建临床预测模型。方法:选取2014年1月—2023年10月揭阳市人民医院和普宁市人民医院待产分娩的237例重度子痫前期患者为研究对象,按照8∶2的比例随机分为训练集(189例)和验证集(48例)。利用logistic回归分析筛选重度子痫前期患者发生胎盘早剥的相关因素,构建重度子痫前期患者发生胎盘早剥的列线图预测模型。采用Hosmer-Lemeshow (HL)拟合优度检验评估预测模型的拟合度。采用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)评估预测模型的区分度。结果:胎龄(OR=0.36,95% CI:0.16~0.81)、舒张压(OR=3.38,95%CI:1.46~7.84)、白细胞计数(OR=3.95,95% CI:1.72~9.05)、凝血酶原时间(OR=3.07,95% CI:1.32~7.14)、纤维蛋白原(OR=0.24,95% CI:0.10~0.56)、乳酸脱氢酶(OR=5.90,95% CI:2.48~14.06)为重度子痫前期患者发生胎盘早剥的相关因素。训练集HL检验P值=0.960 (>0.05),验证集HL检验P值=0.173 (>0.05),表明该预测模型的拟合度较好。ROC曲线显示该模型预测训练集重度子痫前期患者发生胎盘早剥的AUC为0.89 (95% CI:0.83~0.94),验证集的AUC为0.76 (95% CI:0.62~0.90),表明该模型预测重度子痫前期患者发生胎盘早剥的区分度较高。结论:建立的列线图模型包括胎龄、舒张压、白细胞计数、凝血酶原时间、纤维蛋白原和乳酸脱氢酶,其对重度子痫前期患者发生胎盘早剥具有一定的预测能力。Objective:To investigate the factors associated with the occurrence of placental abruption in patients with severe preeclampsia and to construct a clinical prediction model.Methods:237 patients with severe preeclampsia awaiting labor and delivery in Jieyang People's Hospital and Puning People's Hospital from January 2014 to October 2023 were selected as the study subjects,and were randomly divided into a training set(189 cases)and a validation set(48 cases)according to the ratio of 8:2.Logistic regression analysis was used to screen the factors related to the occurrence of placental abruption in patients with severe preeclampsia,and a nomogram prediction model was constructed for the occurrence of placental abruption in patients with severe preeclampsia.The goodness of fit of the predictive model was assessed using the Hosmer-Lemeshow(HL)goodness-of-fit test.The area under curve(AUC)of the receiver operating characteristic(ROC)was used to assess the discrimination of the predictive model.Results:Gestational age(OR=0.36,95%CI:0.16-0.81),diastolic blood pressure(OR=3.38,95%CI:1.46-7.84),white blood cell count(OR=3.95,95%CI:1.72-9.05),prothrombin time(OR=3.07,95%CI:1.32-7.14),fibrinogen(OR=0.24,95%CI:0.10-0.56),and lactate dehydrogenase(OR=5.90,95%CI:2.48-14.06)were correlates of placental abruption in patients with severe preeclampsia.The P-value of HL test for the training set=0.960(>0.05)and the P-value of HL test for the validation set=0.173(>0.05)indicated that the predictive model had a good fit.The ROC curves showed that the model predicted the occurrence of preterm placental abruption in patients with severe preeclampsia with an AUC of 0.89(95%CI:0.83-0.94)for the training set,and an AUC of 0.76 for the validation set(95%CI:0.62-0.90),indicating that the model had a high discriminatory ability to predict the occurrence of placental abruption in patients with severe preeclampsia.Conclusion:The established nomogram prediction model including gestational age,diastolic blood pressure,white blood cell count,proth

关 键 词：重度子痫前期 胎盘早剥 预测模型 列线图 

分 类 号：R714.2[医药卫生—妇产科学]