胎儿下消化道梗阻孕妇早产的影响因素及预测模型构建  

Analysis of influencing factors of preterm birth in pregnant women with fetal lower gastrointestinal obstruction and construction of prediction model

作　　者：姬若楠 赵晓阳 孙金金 陶玲玲 郭晓珮 董理 李丝雨 罗晓华[1] JI Ruonan;ZHAO Xiaoyang;SUN Jinjin;TAO Lingling;GUO Xiaopei;DONG Li;LI Siyu;LUO Xiaohua(Department of Obstetrics and Gynaecology,Zhengzhou 450052,China;Department of Ultrasound,The Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院妇产科,郑州450052 [2]郑州大学第三附属医院超声科,郑州450052

出　　处：《中国妇产科临床杂志》2025年第2期113-116,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：河南省医学重点学科建设项目-围产医学(2023093)。

摘　　要：目的探讨胎儿下消化道梗阻孕妇早产的影响因素并构建预测模型,旨在改善因早产导致的先天性肠梗阻的不良预后。方法回顾性分析2013年1月至2024年3月于河南省妇幼保健院住院并分娩的140例胎儿下消化道梗阻孕妇的资料,并分为早产组与足月产组。采用单因素和多因素logistic回归分析筛选胎儿下消化道梗阻孕妇早产的影响因素,并构建列线图模型,分析该模型的预测价值。结果胎儿肠管最宽内径与相应孕周平均值之比、羊水过多及首次发现梗阻的孕周为胎儿下消化道梗阻孕妇早产的影响因素(P<0.05),并构建列线图模型,其ROC曲线下面积为0.783(95%CI:0.706~0.860),特异度为92.1%,敏感度为54.7%,提示模型有良好的区分能力。Homer-Lemeshow拟合优度检验显示,模型有良好的校准能力(χ^(2)=10.847,P=0.210)。通过Bootstrap重抽样方法进行的内部验证结果显示,该模型具有较高的准确度。结论胎儿肠管最宽内径与相应孕周平均值之比、羊水过多及首次发现梗阻孕周为胎儿下消化道梗阻孕妇早产的危险因素,基于此构建的胎儿下消化道梗阻孕妇早产的预测模型区分度、校准度及预测效能良好,可以帮助识别早产高风险人群。Objective To investigate the influencing factors of preterm birth in pregnant women with fetal lower gastrointestinal obstruction(FLGO)and to construct a prediction model,aiming to improve the poor prognosis of congenital intestinal obstruction caused by preterm birth.Methods The data of 140 pregnant women with FLGO who were hospitalized and delivered in Henan Maternal and Child Health Hospital from January 2013 to March 2024 were retrospectively analyzed.They were divided into premature delivery group and full-term delivery group.Univariate and multivariate logistic regression analysis were used to screen the influencing factors of preterm birth in pregnant women with FLGO,and a nomogram model was constructed.The predictive value of the model was analyzed.Results The ratio of the maximum intestinal inner diameter to the average value of the corresponding gestational age,polyhydramnios,and time of first detection of obstruction were identified as influencing factors for preterm birth in pregnant women with FLGO(P<0.05).A nomogram model was constructed,and the area under the ROC curve of this model was 0.783(95%CI:0.706-0.860),the specificity wsa 92.1%and the sensitivity wsa 54.7%,indicating good discrimination ability.The Homer-Lemeshow goodness-of-fit test showed that the model had a good calibration ability(χ^(2)=10.847,P=0.210).The Internal validation using the Bootstrap resampling method indicated that the model had high accuracy.Conclusions The predictive model constructed based on these factors has good discrimination,calibration,and predictive performance,which can help identify high-risk groups for preterm birth.

关 键 词：胎儿下消化道梗阻 早产 影响因素 预测模型 列线图 

分 类 号：R714.21[医药卫生—妇产科学]