摘要
目的:探讨妊娠期高血压疾病(hypertensive disorders of pregnancy,HDP)患者发生胎盘早剥的影响因素,并构建风险预测模型。方法:回顾性分析宁德师范学院附属宁德市医院2020年7月至2025年3月1380例HDP患者的临床资料,根据是否发生胎盘早剥分为胎盘早剥组(25例)与非胎盘早剥组(1355例)。通过电子病历系统收集HDP患者的基线资料,采用多因素Logistic回归筛选HDP患者胎盘早剥发生的独立影响因素,并构建HDP患者胎盘早剥发生的预测模型。利用受试者工作特征(receiver operating characteristic,ROC)曲线评估预测模型对HDP患者发生胎盘早剥的预测效能。结果:单因素分析显示,胎盘早剥组在子痫前期/子痫、早发型疾病(HDP发病孕周<34周)、重度高血压(收缩压≥160 mmHg)、D-二聚体水平及胎儿生长受限等方面的比例或水平均显著高于非胎盘早剥组(P<0.05)。多因素Logistic回归分析进一步确认,上述五项均为胎盘早剥发生的独立危险因素,其OR值分别为3.252(2.184-4.842)、2.892(1.964-4.260)、2.530(1.722-3.716)、3.673(2.453-5.493)和2.179(1.450-3.275)。基于此构建的预测模型曲线下面积(AUC)为0.892(95%CI:0.856~0.928),敏感度为0.825,特异度为0.803。结论:子痫前期/子痫、早发型疾病、重度高血压、D-二聚体升高及胎儿生长受限是HDP患者胎盘早剥发生的关键危险因素,基于上述影响因素构建的HDP患者胎盘早剥发生预测模型具有良好的预测效能,能为临床早期识别高危人群与实施个体化管理提供参考。
Objective:To explore the influence factors of placental abruption in patients with hypertensive disorders of pregnancy(HDP)and construct a risk prediction model.Methods:A retrospective analysis was conducted on the clinical data of 1380 HDP patients in Ningde Municipal Hospital Affiliated to Ningde Normal Universit from July 2020 to March 2025.The patients were divided into placental abruption group(25 cases)and non placental abruption group(1355 cases)based on whether they had concurrent placental abruption.By collecting HDP patient's baseline data through an electronic medical record system,multiple logistic regression was used to screen for independent influenc factors of placental abruption in patients with HDP,and a predictive model for placental abruption in patients with HDP was constructed.Receiver operating characteristic(ROC)curves were used to evaluate the effectiveness of the predictive model for placental abruption in patients with HDP.Results:Univariate analysis revealed that the proportions or levels of preeclampsia/eclampsia,early-onset disease(onset at<34 weeks of gestation),severe hypertension(systolic blood pressure≥160 mmHg),D-dimer levels,and fetal growth restriction in the placental abruption group were significantly higher than those in the non-placental abruption group(p<0.05).Multivariate logistic regression analysis further confirmed that the aforementioned five factors were independent risk factors for the occurrence of placental abruption in patients with HDP,with ORs of 3.252(2.184-4.842),2.892(1.964-4.260),2.530(1.722-3.716),3.673(2.453-5.493)and 2.179(1.450-3.275)respectively.The area under the curve(AUC)of the predictive model constructed based on these factors was 0.892(95%CI:0.856-0.928),with a sensitivity of 0.825 and a specificity of 0.803.Conclusion:Preeclampsia/eclampsia,early-onset disease,severe hypertension,elevated D-dimer,and fetal growth restriction are key risk factors for placental abruption in patients with HDP.The predictive model constructed based on these factors can effectively identify the risk of placental abruption in HDP patients and provide reference for clinical risk stratification and individualized management.
作者
陈月秋
黄水玉
叶思萍
CHEN Yue-qiu;HUANG Shui-yu;YE Si-ping(Department of Obstetrics,Ningde Municipal Hospital Affiliated to Ningde Normal University,Ningde,Fujian,352100,China)
出处
《现代生物医学进展》
2025年第23期3753-3759,共7页
Progress in Modern Biomedicine
关键词
妊娠期高血压疾病
胎盘早剥
影响因素
预测模型
Hypertensive Disorders of Pregnancy
Placental Abruption
Influence Factor
Prediction Model
