摘要
目的基于多普勒超声监测妊娠高血压(HDCP)母体-胎盘循环相关指标并建立预测模型和进行验证。方法选择120例HDCP孕妇(研究组),年龄20~44岁,平均年龄30.17岁;孕周11~13^(+6)周,平均孕周12.14周;孕次1~5次,平均孕次2.32次;产次0~4次,平均产次1.75次。根据HDCP严重程度,研究组可细分为妊娠期高血压组46例、子痫前期组40例和重度子痫前期组34例。选择同期60例健康孕妇(对照组),年龄20~42岁,平均年龄29.52岁;孕周11~13+6周,平均孕周12.25周;孕次1~4次,平均孕次2.40次;产次0~3次,平均产次1.71次。所有研究对象在孕11~13^(+6)周进行超声检查,记录子宫动脉和子宫螺旋动脉的血流参数。采用Logitic回归分析探究HDCP的独立危险因素并建立预测模型,采用受试者工作特性(ROC)曲线判定预测模型的预测价值。再次纳入200例孕妇对模型的预测价值进行验证。结果研究组子宫动脉血流博动指数(PI)、阻力指数(RI)、收缩期峰值流速/舒张末期流速(S/D)值和双侧切迹阳性率均显著高于对照组(1.43±0.38 vs 0.94±0.22、0.69±0.15 vs 0.46±0.08、4.46±0.84 vs 3.96±0.91、40.00%vs 23.33%),差异均有统计学意义(P<0.05)。随着HDCP严重程度增加,PI、RI、S/D值和双侧切迹阳性率升高。研究组和对照组子宫螺旋动脉的PI、RI、S、D、S/D值差异均无统计学意义(P>0.05),仅重度子痫前期组PI和RI显著高于对照组(0.64±0.12 vs0.53±0.09、0.44±0.10 vs 0.35±0.07。P<0.05)。多元Logistic回归分析表明子宫动脉PI、RI和子宫动脉双侧切迹是HDCP的早期独立预测因素(P<0.05),获得预测模型为Logit(P)=1.214×子宫动脉PI+0.984×子宫动脉RI+0.82×子宫动脉双侧切迹。该模型的ROC曲线下面积为0.889[95%可信区间(CI)0.853~0.926],灵敏度和特异度分别为84.17%、80.00%。该模型对验证集孕妇预测的ROC曲线下面积为0.860(95%CI 0.809~0.911),灵敏度和特异度分别为83.33%、89.77%。结论孕早期超声对母体-胎盘血流循环监测可以为HDCP提供预测指标并建立预测模型,该模型对HDCP的早期筛查具有较高的预测价值。
Objective To construct and validate the prediction model based on Doppler ultrasound monitoring of maternalplacental circulation related indicators in pregnancy-induced hypertension(HDCP).Methods A total of 120 pregnant women with HDCP were enrolled as study group,which aged 20-44 years old with mean age of 30.17 years old;gestational week was 11-13^(+6) weeks with mean gestational week of 12.14 weeks;number of pregnancy was 1-5 with mean numbers of 2.32;number of birth was 0-4 with mean numbers of 1.75.According to the severity of HDCP,the study group was divided into 46 cases of gestational hypertension group,40 of preeclampsia group and 34 of severe preeclampsia group.Sixty healthy pregnant women in the same period were enrolled as control group,which aged 20-42 years old with mean age of 29.52 years old;gestational weeks was 11-13+6 weeks with mean gestational week of 12.25 weeks;number of pregnancies was 1-4 with mean numbers of 2.40;number of births was 0-3 with mean numbers of 1.71.All of them performed ultrasound examination at 11-13^(+6) weeks of gestation,and the blood flow parameters of uterine artery and uterine spiral artery were recorded.The Logitic regression analysis was used to explore independent risk factors of HDCP and the prediction model was established.The receiver operating characteristic(ROC)curve was used to determine the predictive value of prediction model.Another 200 pregnant women were included to verify predictive value of the model.Results The pulsation index(PI),resistance index(RI),peak systolic flow rate(S)/end-diastolic velocity(D)value of uterine artery and the positive rate of bilateral notch in study group were statistical significantly higher than those in control group(1.43±0.38 vs 0.94±0.22,0.69±0.15 vs 0.46±0.08,4.46±0.84 vs 3.96±0.91,40.00%vs 23.33%)(P<0.05).With the increased severity of HDCP,PI,RI,S/D values and percentage of bilateral incisions were increased.There was no significant difference in PI,RI,S,D and S/D values of uterine spiral artery between study group and control group(P>0.05),but PI and RI of severe group were significantly higher than those of control group(0.64±0.12 vs 0.53±0.09,0.44±0.10 vs 0.35±0.07.P<0.05).Multivariate Logistic regression analysis showed that PI of uterine artery,RI of uterine artery and bilateral notch of uterine artery were independent predictors of HDCP in the early stage(P<0.05),and the obtained prediction model was Logit(P)=1.214×uterine artery PI+0.984×uterine artery RI+0.82×bilateral incisions of uterine arteries.The area under ROC curve of the model was 0.889[95%confidence interval(CI)0.853-0.926],and sensitivity and specificity were 84.17%and 80.00%,respectively.The area under ROC curve of prediction model for pregnant women in validation set was 0.860(95%CI 0.809-0.911),the sensitivity and specificity were 83.33%and 89.77%,respectively.Conclusion It is demonstrated that ultrasound monitoring of maternal-placental blood circulation in early pregnancy provide predictive indicators for HDCP and construct predictive model,which show high predictive value for early screening of HDCP.
作者
侯雪晶
刘陈
郭丽魁
HOU Xue-jing;LIU Chen;GUO Li-kui(Department of Obstetrics,First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China)
出处
《生物医学工程与临床》
CAS
2023年第5期599-605,共7页
Biomedical Engineering and Clinical Medicine
基金
秦皇岛市科学技术研究与发展计划项目(201902A048)。
关键词
妊娠高血压
超声
母体-胎盘循环
孕早期
受试者工作特性曲线
pregnancy hypertension
ultrasound
maternal placental circulation
early pregnancy
receiver operating characteristic curve
