基于铁代谢构建多囊卵巢综合征合并妊娠期糖尿病的风险预测模型  

Risk prediction model of polycystic ovary syndrome with gestational diabetes based on iron metabolism

作　　者：董跃彦 陈艳红 郑锦霞 王珂[1] 白洁[1] 孙燕[1] Dong Yueyan;Chen Yanhong;Zheng Jinxia;Wang Ke;Bai Jie;Sun Yan(Department of Assisted Reproductive Technology,Obstetrics and Gynecology Hospital of Tongji University,Shanghai 201204,P.R.China)

机构地区：[1]同济大学附属妇产科医院辅助生殖医学科,上海201204

出　　处：《中国计划生育和妇产科》2025年第3期62-66,71,共6页Chinese Journal of Family Planning & Gynecotokology

基　　金：上海市卫生健康委员会课题(项目编号:0204Y0132)。

摘　　要：目的 基于铁代谢构建预测多囊卵巢综合征(PCOS)合并妊娠期糖尿病(GDM)风险的Nomogram模型。方法 选取2021年1月至2023年12月于同济大学附属妇产科医院建档并行常规产检的500例PCOS孕妇作为研究对象,采用整群随机分组法将其分为训练集(n=389)和验证集(n=111)。使用单因素和多因素Logistic回归分析训练集PCOS合并GDM的危险因素,并建立相关Nomogram预测模型。结果 孕前BMI、HbA1c、FBG、Hb、SF和Fe较高是PCOS合并GDM的独立危险因素(P<0.05)。孕前BMI、HbA1c、FBG、Hb、SF和Fe及其联合检测预测PCOS合并GDM的AUC分别为0.684(95%CI:0.627-0.742)、0.715(95%CI:0.659-0.770)、0.700(95%CI:0.641-0.760)、0.608(95%CI:0.544-0.673)、0.679(95%CI:0.619-0.740)、0.576(95%CI:0.515-0.638)、0.858(95%CI:0.819-0.898)。Nomogram模型验证结果显示,在0%~100%预测范围内模型净获益值>0;训练集和验证集的C-index指数分别为0.858(95%CI:0.838-0.878)和0.806(95%CI:0.781-0.832);两集的校准曲线均趋近于理想曲线;两集ROC曲线的AUC分别为0.858(95%CI:0.819-0.898)和0.811(95%CI:0.783-0.837)。结论 孕前BMI、HbA1c、FBG、Hb、SF和Fe与PCOS合并GDM的发病风险显著相关,基于上述危险因素构建的Nomogram模型对PCOS合并GDM的发生风险具有良好的预测价值。Objective To construct a Nomogram model based on iron metabolism for predicting the risk of gestational diabetes mellitus(GDM) in women with polycystic ovary syndrome(PCOS).Methods A total of 500 pregnant women with PCOS who underwent routine prenatal check-ups at the Obstetrics and Gynecology Hospital of Tongji University from January 2021 to December 2023 were selected as the study subjects.They were divided into a training set(n=389) and a validation set(n=111) using cluster randomization.Univariate and multivariate Logistic regression analyses were performed to identify risk factors for GDM in the training set,and a corresponding Nomogram prediction model was established.Results Higher pre-pregnancy BMI,HbA1c,fasting blood glucose(FBG),hemoglobin(Hb),serum ferritin(SF),and iron(Fe) levels were identified as independent risk factors for GDM in PCOS patients(P<0.05).The AUC values for predicting GDM in PCOS using pre-pregnancy BMI,HbA1c,FBG,Hb,SF,and Fe,as well as their combined detection,were 0.684(95% CI:0.627-0.742),0.715(95% CI:0.659-0.770),0.700(95% CI:0.641-0.760),0.608(95% CI:0.544-0.673),0.679(95% CI:0.619-0.740),0.576(95% CI:0.515-0.638),and 0.858(95% CI:0.819-0.898),respectively.The validation results of the nomogram model showed that the net benefit value was >0 within the 0%~100% prediction range.The C-index for the training set and validation set were 0.858(95% CI:0.838-0.878) and 0.806(95% CI:0.781-0.832),respectively.The calibration curves for both sets were close to the ideal curve,and the AUC values of the ROC curves were 0.858(95% CI:0.819-0.898) and 0.811(95% CI:0.783-0.837),respectively.Conclusion Pre-pregnancy BMI,HbA1c,FBG,Hb,SF,and Fe are significantly associated with the risk of GDM in PCOS patients.The nomogram model constructed based on these risk factors has good predictive value for the occurrence of GDM in PCOS.

关 键 词：铁代谢 多囊卵巢综合征 妊娠期糖尿病 NOMOGRAM 

分 类 号：R711.75[医药卫生—妇产科学] R714.256[医药卫生—临床医学]