摘要
目的:通过分析行经阴道McDonald子宫颈环扎术的单胎妊娠孕妇术后孕34周前分娩的影响因素,建立风险预测模型。方法:回顾性分析2019年1月1日至2024年2月29日于中国人民解放军北部战区总医院和平院区妇产科行McDonald子宫颈环扎术的500例单胎妊娠孕妇的临床资料,按7∶3随机划分为训练集350例与验证集150例。对训练集的资料利用单因素联合多因素Logistic回归筛选出影响子宫颈环扎术后孕34周前分娩的预测变量,建立预测模型和评估,并在验证集中进行内部验证。结果:多因素Logistic回归示,术前子宫颈长度(CL)<20 mm、有羊水沉积物(AFS)、阴道乳杆菌缺失、子宫颈扩张>3 cm为子宫颈环扎术后孕34周前分娩的独立危险因素(OR>1,P<0.05),据此构建的Nomogram模型的曲线下面积(AUC)为0.887,模型的一致性良好(H-L检验:P=0.905,Brier得分为0.095)。临床决策曲线示,当阈值在0.10~0.92时,该模型的临床决策价值较高。内部验证后AUC为0.812,预测结果与实际情况之间具有较高的一致性(H-L检验:P=0.859)。结论:基于影响因素构建的经阴道McDonald子宫颈环扎术后孕34周前分娩的列线图模型具有良好的临床应用价值,对筛选出高危孕妇并给予个体化干预具有指导作用。
Objective:To establish a risk prediction model by analyzing the influencing factors of delivery before 34 weeks′gestatior with singleton pregnancies who underwent transcervical McDonald′s cervical cerclage.Methods:Clinical data of 500 pregnant women with singleton pregnancies who underwent McDonald′s cervical cerclage in the Department of Obstetrics and Gynecology,Heping Hospital,General Hospital of the People′s Liberation Army Northern Theater of Operations from January 1,2019 to February 29,2024 were retrospectively analyzed,and were randomly divided into a training set of 350 cases versus a validation set of 150 cases in accordance with a 7∶3 randomization.The data in the training set were screened for predictive variables affecting delivery before 34 weeks′gestation after cervical cerclage using univariate combined multivariate Logistic regression,predictive modeling and assessment were established,and internal validation was performed in the validation set.Results:Preoperative cervical length(CL)<20 mm,amniotic fluid deposits(AFS),absence of Lactobacillus vaginalis,and cervical dilatation>3 cm were independent risk factors for adverse outcomes of labor and delivery before 34 weeks′gestation after cervical cerclage(OR>1,P<0.05),and the Nomogram model constructed on the basis of this was found to have an AUC of 0.887,with a good agreement of the model(H-L test:P=0.905,Brier score of 0.095).The results of the clinical decision curve showed that the clinical decision value of the model was high when the threshold was between 0.10-0.92.The model was internally validated with an AUC of 0.812,and there was a high degree of agreement between the predictions and the actual situation(H-L test:P=0.859).Conclusions:The column-line diagram model constructed on this basis has a high clinical value,which can help us to screen out the high-risk pregnant women and give them individualized interventions in a timely manner.
作者
任雪丽
陈震宇
孙静莉
金珈汐
庄婷婷
潘琪欣
REN Xueli;CHEN Zhenyu;SUN Jingli(China Medical University Postgraduate Joint Cultivation Base,General Hospital of the People′s Liberation Army Northern Theater of Operations,Shenyang Liaoning 110000,China;Department of Obstetrics and Gynecology,Heping Hospital,General Hospital of the People′s Liberation Army Northern Theater of Operations,Shenyang Liaoning 110000,China)
出处
《实用妇产科杂志》
北大核心
2025年第5期406-411,共6页
Journal of Practical Obstetrics and Gynecology
基金
沈阳市科学技术计划(编号:22-321-33-31)。
