摘要
目的:分析孕晚期孕妇出现未足月胎膜早破(PPROM)的有关因素,构建列线图预警模型并进行评价。方法:回顾性选取2024年1月—2025年3月本院收治的110例PPROM孕妇为PPROM组,未发生PPROM的110例正常孕妇为对照组。收集孕妇临床资料,应用最小绝对值收敛和选择算子(LASSO)回归筛选孕晚期孕妇出现PPROM的预测因子,通过多因素logistic回归确定独立危险因素,构建列线图预警模型。使用受试者工作特征(ROC)曲线、校准曲线、决策曲线、临床影响曲线评价列线图模型的区分度、校准度、临床获益、临床匹配度。结果:单因素分析显示,PPROM组合并妊娠期糖尿病、流产数≥2次、胎位异常、腹压增加(性交/咳嗽/外伤史)、生殖道感染占比及中性粒细胞与淋巴细胞比值(NLR)、高迁移率族蛋白B1(HMGB1)水平均高于对照组;LASSO分析筛选变量后经logistic回归分析显示,合并妊娠期糖尿病、生殖道感染、流产次数≥2次、腹压增加(性交/咳嗽/外伤史)、NLR升高、HMGB1升高是孕晚期孕妇出现PPROM的独立危险因素(均P<0.05)。据此构建的列线图模型,ROC曲线、H-L检验、校准曲线、决策曲线、临床影响曲线评估显示其具有良好的预测效能、校准度及临床价值。结论:孕晚期孕妇发生PPROM的影响因素较多,妊娠期糖尿病、生殖道感染、流产次数≥2、腹压增加(性交/咳嗽/外伤史)、NLR及HMGB1升高对其均具有重要影响,据此构建的列线图预警模型具有良好的预测效能与临床价值。
Objective:To analyze the related factors of the preterm premature rupture of membranes(PPROM)of pregnant women during the third trimester of pregnancy,to construct a nomogram warning model,and to evaluate this model.Methods:A total of 110 pregnant women with PPROM admitted to the hospital from January 2024 to March 2025 were selected in study group retrospectively,and 110 normal pregnant women without PPROM during the same period were selected in control group.The clinical data of the pregnant women in the two groups were collected.The least absolute shrinkage and the selection operator(LASSO)regression were applied to screen the predictive factors for PPROM occurrence of the pregnant women during the third trimester of pregnancy.The independent risk factors of the PPROM occurrence of the pregnant women were determined by multivariate logistic regression,and a nomogram early warning model was constructed based on these independent risk factors.Receiver operating characteristic(ROC)curve,calibration curve,decision curve and clinical impact curve were used to evaluate the discrimination,calibration,clinical benefit,and clinical matching degree of the nomogram model.Results:Univariate analysis showed that the proportions of the gestational diabetes mellitus(GDM),≥2 miscarriages,the abnormal fetal position,the increased abdominal pressure due to sexual intercourse,coughing or history of trauma and the reproductive tract infections,the neutrophil-to-lympho cyte ratio(NLR)and the level of high-mobility group box 1(HM GB1)protein of the women in the study group were significantly higher than those of the women in the control group.After the variable selection by LASSO analysis,logistic regression analysis showed that GDM,≥2 miscarriages,the increased abdominal pressure due to sexual intercourse,coughing or history of trauma,and the higher NLR and HM GB1 protein level of the pregnant women were the independent risk factors of their PPROM during the third trimester of pregnancy(all P<0.05).The constructed nomogram model based on these independent risk factors was evaluated by ROC curve,H-L test,calibration curve,decision curve and clinical impact curve,and all of which showed that the nomogram model had good predictive efficacy,calibration degree and clinical value for PPROM of the pregnant women.Conclusion:There are multiple influencing factors of PPROM of the pregnant women during the third trimester of pregnancy.The GDM,≥2 miscarriages,the increased abdominal pressure due to sexual intercourse,coughing or history of trauma,and the higher NLR and HM GB1 protein level of the pregnant women have important impacts on their PPROM,and the constructed nomogram model based on these factors has good predictive efficacy and clinical value for PPROM of the women.
作者
韩香妮
张雅丽
周丽
HAN Xiangni;ZHANG Yali;ZHOU Li(Baoji Maternal and Child Health Care Hospital,Baoji,Shaanxi Province,721000,China)
出处
《中国计划生育学杂志》
2026年第2期403-408,共6页
Chinese Journal of Family Planning
关键词
未足月胎膜早破
孕晚期
危险因素
预警模型
Preterm premature rupture of membranes
Third trimester of pregnancy
Risk factor
Warning model
