子痫前期风险评估模型建立与验证

杜文琼; 赵枫; 郭玲玲; 申嘉欣; 王科科; 王颖; 张萍; 冯永亮; 杨海澜; 王素萍; 邬惟为; 张亚玮

doi:10.16462/j.cnki.zhjbkz.2019.08.019

子痫前期风险评估模型建立与验证

doi: 10.16462/j.cnki.zhjbkz.2019.08.019

杜文琼¹,
赵枫¹,
郭玲玲¹,
申嘉欣¹,
王科科¹,
王颖¹,
张萍¹,
冯永亮¹,
杨海澜²,
王素萍¹,
邬惟为^1, ,,
张亚玮^{1, 3, ,}

1.
030001 太原, 山西医科大学公共卫生学院流行病学教研室
2.
030001 太原, 山西医科大学第一医院妇产科
3.
06511 纽黑文, 耶鲁大学公共卫生学院环境健康科学系

基金项目:

国家自然科学基金 81473061

国家自然科学基金 81703314

山西省青年科技研究基金 2013021033-2

详细信息

通讯作者:
张亚玮. E-mail: yawei.zhang@yale.edu

邬惟为. E-mail: wuweiwei2008@sina.com

中图分类号: R714.24
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- 文章访问数: 516
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- PDF下载量: 46
- 被引次数: 0
出版历程
- 收稿日期: 2019-02-20
- 修回日期: 2019-05-10
- 刊出日期: 2019-08-10

Establishment and verification of preeclampsia risk assessment model

1.
Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
2.
Department of Obstetrics and Gynecology, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
3.
Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven 06511, American

Funds:

National Natural Science Foundation of China 81473061

National Natural Science Foundation of China 81703314

Shanxi Youth Science and Technology Research Fund 2013021033-2

More Information

Corresponding author: WU Wei-wei. E-mail: wuweiwei2008@sina.com; ZHANG Ya-wei. E-mail: yawei.zhang@yale.edu

摘要

摘要: 目的分析影响子痫前期发病的危险因素，建立子痫前期风险评估模型，以期早期评估子痫前期的发生风险。方法以山西医科大学第一医院产科于2012年3月-2016年9月分娩的所有产妇为调查对象，进行面对面问卷调查。共收集合格问卷10 319份，排除其他妊娠期相关高血压疾病后，共纳入9 623例，随机抽取其中70%的对象作为训练样本，分析子痫前期的影响因素，建立Logistic回归分析模型，其余30%的对象作为测试样本，验证模型效果。结果用训练样本建立Logistic回归分析模型，Logit P=-2.517-0.696×孕前偏瘦+0.200×孕前超重+0.944×孕前肥胖-1.295×居住在城市-0.409×孕前补充过叶酸+1.323×双胎及多胎妊娠+1.708×既往妊娠期高血压病史。Homer-Lemeshow拟合优度检验P=0.377。模型AUC=0.767（95%CI：0.747~0.786，P < 0.001）。用测试样本进行验证模型，得到模型灵敏度81.68%，特异度75.05%，阳性似然比为3.27，阴性似然比为0.24。测试样本模型AUC=0.771（95%CI：0.763~0.790，P < 0.001）。结论建立了一个纳入可控因素，且简单、高效的子痫前期风险评估模型，模型拟合度好，灵敏度和特异度较高。
- 子痫前期 /
- 叶酸 /
- Logistic回归分析模型 /
- ROC曲线
Abstract: Objective To analyze the risk factors affecting pre-eclampsia, to establish a pre-eclampsia risk assessment model, and to assess the risk of pre-eclampsia early. Methods A face-to-face questionnaire survey was conducted for all women who gave birth in the Department of Obstetrics, the First Hospital of Shanxi Medical University from March 2012 to September 2016. A total of 10 319 qualified questionnaires were collected to exclude 9 623 cases of other hypertensive diseases related to pregnancy. A total of 70% of the subjects were randomly selected as training samples to analyze the influencing factors of pre-eclampsia, and a Logistic regression model was established. The remaining 30% of the objects are used as test samples to verify the effect of the model. Results Logistic regression model was established with training samples. Logit P=-2.517-0.696×Pre-pregnancy lean +0.200×Pre-pregnancy overweight +0.944×Pre-pregnancy obesity -1.995×Residential in city -0.409×Folic acid supplemented before pregnancy +1.323×Twin and multiple pregnancy +1.708×History of previous pregnancy hypertension. Homer-Lemeshow test P=0.377. Model AUC=0.767 (95%CI: 0.747-0.786, P < 0.001). Using the test sample to verify the model, the model sensitivity was 81.68%, the specificity was 75.05%, the positive likelihood ratio was 3.27, and the negative likelihood ratio was 0.24. The test sample model AUC=0.771 (95%CI=0.763-0.790, P < 0.001). Conclusion This study establishes a simple and effective pre-eclampsia risk assessment model with controllable factors. The model has good fit and sensitivity and specificity.
- Preeclampsia /
- Folic acid /
- Risk factors Risk assessment model /
- ROC curve

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图 1 建立子痫前期风险评估模型的ROC曲线

Figure 1. The ROC curve of the preeclampsia risk assessment model

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表 1 训练样本子痫前期影响因素的单因素分析

Table 1. Univariate analysis of preeclampsia influencing factors in training samples[n(%)]

变量	子痫前期	非子痫前期	χ²值	P值
孕妇年龄(岁)			-3.290^c	0.001
< 20	519(82.91)	5 303(86.78)
20~	6(0.96)	68(1.11)
≥35	101(16.13)	740(12.11)
孕前BMI(kg/m²)^a			-11.279^c	< 0.001
< 18.5	337(53.92)	4 142(67.95)
18.5~	52(8.32)	878(14.40)
24~	161(25.76)	860(14.11)
≥28	75(12.00)	216(3.54)
居住地			319.904	< 0.001
农村	327(52.24)	1 250(20.45)
城市	299(47.76)	4 861(79.55)
人均月收入(元)			8.853^c	< 0.001
< 2 000	181(28.91)	937(15.33)
2 000~	402(64.22)	4 357(71.30)
≥5 000	43(6.87)	817(13.37)
文化程度			12.705^c	< 0.001
小学及以下	41(6.55)	158(2.59)
中学	441(70.45)	2 992(48.96)
大专及以上	144(23.00)	2 961(48.45)
孕前健康教育^a			62.832	< 0.001
无	482(77.74)	3 737(61.62)
有	138(22.26)	2 328(38.38)
孕前一年，月经是否规律^a			16.179	< 0.001
否	574(92.73)	5 812(96.13)
是	45(7.27)	234(3.87)
阴道出血^a			0.915^c	0.180
无	563(89.94)	5 405(88.74)
轻微	59(9.42)	639(10.49)
严重	4(0.64)	47(0.77)
孕早期呕吐情况^a			1.243^c	0.107
无	474(75.72)	4 447(72.90)
轻微	124(19.81)	1 376(22.56)
严重	28(4.47)	277(4.54)
激素治疗^a			0.996	0.318
无	594(98.34)	5 774(97.72)
有	10(1.66)	135(2.28)
自然妊娠^a			0.000	0.997
否	22(4.08)	213(4.09)
是	517(95.92)	5 001(95.91)
是否为初产			4.256	0.039
否	334(53.35)	2 996(49.03)
是	292(46.65)	3 115(50.97)
产次			6.123	0.013
≤3	593(94.73)	5 906(96.65)
＞3	33(5.27)	205(3.35)
孕期前三月发热^a			2.101	0.147
无	616(98.88)	5 932(98.05)
有	7(1.12)	118(1.95)
先天性心脏病^a				0.377^b
无	596(99.67)	5 812(99.45)
有	2(0.33)	32(0.55)
其他心脑血管疾病^a				0.639^b
无	596(99.67)	5 824(99.64)
有	2(0.33)	21(0.36)
糖尿病^a				0.534^b
无	602(99.67)	5 862(99.58)
有	2(0.33)	25(0.42)
甲状腺功能亢进^a				0.235^b
无	597(99.83)	5 815(99.52)
有	1(0.17)	28(0.48)
甲状腺功能减低^a			0.640	0.424
无	592(99.00)	5 768(98.60)
有	6(1.00)	82(1.40)
其他内分泌系统疾病^a				0.290^b
无	597(99.83)	5 818(99.57)
有	1(0.17)	25(0.43)
缺铁性贫血^a				0.434^b
无	597(99.83)	5 826(99.67)
有	1(0.17)	19(0.33)
病毒性乙型肝炎^a				0.356^b
无	597(99.83)	5 820(99.62)
有	1(0.17)	22(0.38)
主动吸烟				0.743^b
无	624(99.68)	6 094(99.72)
有	2(0.32)	17(0.28)
被动吸烟			18.454	< 0.001
无	507(80.99)	5 325(87.14)
有	119(19.01)	786(12.86)
孕前经常饮酒				0.255^b
无	626(100.00)	6 097(99.77)
有	0(0.00)	14(0.23)
孕前经常喝茶			0.000	0.985
无	616(98.40)	6 014(98.41)
有	10(1.60)	97(1.59)
孕前补充过维生素B₂			2.950	0.086
无	623(99.52)	6 034(98.74)
有	3(0.48)	77(1.26)
孕前补充过维生素B₁₂			4.580	0.032
无	625(99.84)	6 048(98.97)
有	1(0.16)	63(1.03)
孕前补充过维生素B₆			5.706	0.017
无	624(99.68)	6 020(98.51)
有	2(0.32)	91(1.49)
孕前补充过叶酸			39.602	< 0.001
无	493(78.75)	4 057(66.39)
有	133(21.25)	2 054(33.61)
孕早期补充过维生素B₆			7.830	0.005
无	606(96.81)	5 750(94.09)
有	20(3.19)	361(5.91)
孕早期补充过叶酸			31.171	< 0.001
无	176(28.12)	1 149(18.80)
有	450(71.88)	4 962(81.20)
经常体育活动			6.105	0.014
无	62(9.90)	439(7.18)
有	564(90.10)	5 672(92.82)
孕期增重(Kg)			1.825	0.177
≤10	616(98.40)	6 049(98.99)
＞10	10(1.60)	62(1.01)
本次怀孕胎数			95.840	< 0.001
单胎	561(89.62)	5 939(97.19)
双胎及以上	65(10.38)	172(2.81)
每日吃盐量(g)			3.780	0.052
≤6	541(86.42)	5 097(83.41)
＞6	85(13.58)	1 014(16.59)
母亲(或姐妹)患有妊娠期高血压疾病^a			0.134	0.714
无	614(99.03)	5 997(99.17)
有	6(0.97)	50(0.83)
妊娠期高血压疾病患病史			112.931	< 0.001
无	593(94.73)	6 071(99.35)
有	33(5.27)	40(0.65)
家族高血压、糖尿病或心血管疾病等慢性病史			11.937	0.001
无	462(73.80)	4 870(79.69)
有	164(26.20)	1 241(20.31)
注：^a存在缺失值；^bFisher确切概率法；^c趋势χ²检验。

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表 2 子痫前期影响因素的多因素logistic回归分析

Table 2. Multivariate logistic regression analysis of influencing factors of preeclampsia

参数	β值	S_x	Wald χ²值	P值	OR值(95%CI)
常数	-2.517	0.191	173.919	< 0.001
孕前BMI(kg/m²)
18.5~					1.00
< 18.5	-0.696	0.119	34.504	< 0.001	0.78(0.57~1.06)
< 24~	0.200	0.087	5.298	0.021	1.91(1.54~2.36)
< ≥28	0.944	0.116	65.684	< 0.001	4.02(2.97~5.44)
居住地
< 农村1.00
< 城市	-1.295	0.090	208.306	< 0.001	0.27(0.23~0.33)
孕前补充过叶酸
< 否					1.00
< 是	-0.409	0.106	14.782	< 0.001	0.66(0.54~0.82)
本次怀孕胎数
< 单胎1.00
< 双胎及以上	1.323	0.162	67.081	< 0.001	3.75(2.74~5.15)
妊娠期高血压疾病患病史
< 无					1.00
< 有	1.708	0.260	43.041	< 0.001	5.52(3.31~9.19)

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表 3 子痫前期风险评估模型评价

Table 3. Evaluation of preeclampsia risk assessment model

预测模型	院内诊断		合计
预测模型	患者(%)	非患者(%)	合计
高风险	223(81.68)	652(24.95)	875
低风险	50(18.32)	1 961(75.05)	2 011
合计	273	2 613	2 886

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