妊娠期糖尿病患者发生自发性早产的危险因素和预防措施研究

目的研究影响妊娠期糖尿病(GDM)患者发生自发性早产的危险因素,并通过预测模型研究其预测方案。方法通过随机抽样纳入2016年2月-2019年3月住院治疗的GDM患者,纳入GDM发生自发性早产的患者100例,GDM无自发性早产的患者100例,先对比两组临床基线资料,然后进行单因素及多因素回归分析,计算影响结果的独立危险因素,通过预测模型ROC分析预测价值。结果两组临床基线资料中,妊娠年龄、月经初潮年龄、月经周期紊乱史、自然流产史、糖尿病家族史、孕前体质指数(BMI)、妊娠期感染史等比较,差异均有统计学意义(均P<0.05)。单因素和多因素Logistics回归分析中,月经周期紊乱史、妊娠期感染史两个因素对自发性早产均无影响。妊娠年龄、月经初潮年龄、自然流产史、糖尿病家族史、孕前BMI为影响GDM患者发生自发性早产的独立危险因素。ROC预测模型结果显示,孕前BMI的AUC最高,自然流产史AUC最低为0.645,灵敏度最高为孕前BMI(85%);灵敏度最低为糖尿病家族史(57%);特异度最高为糖尿病家族史(76%),特异度最低为妊娠年龄(46%)。多因素联合做ROC分析可知,AUC=0.873,灵敏度=87%,特异度=73%,95%CI=0.819~0.916。结论妊娠年龄、月经初潮年龄、自然流产史、糖尿病家族史、孕前BMI为影响GDM发生自发性早产的独立危险因素,多因素联合对于预测GDM的发展有着较高的灵敏度及特异度,具有较高的临床价值。

Study on risk factors and preventive measures for spontaneous preterm birth in patients with gestational diabetes

Objective To study the risk factors of spontaneous preterm birth in patients with gestational diabetes mellitus and to study its prediction scheme through predictive model.Methods 100 patients with gestational diabetes mellitus who were hospitalized from February2016 to March 2019 were enrolled in a randomized sample.100 patients with spontaneous preterm birth due to gestational diabetes mellitus and 100 patients with spontaneous preterm labor without gestational diabetes were compared.The clinical baseline data of the two groups were analyzed,and then the univariate and multivariate regression analysis was performed to calculate the independent risk factors affecting the results.The predictive value was analyzed by the predictive model ROC.Results Among the two groups of clinical baseline data,gestational age,menarche age,menstrual cycle disorder history,spontaneous abortion history,family history of diabetes,pre-pregnancy BMI,and pregnancy infection history were statistically significant(P<0.05);Single factors and multivariate logistic regression In the analysis,the history of menstrual cycle disorder and the history of infection during pregnancy have no effect on spontaneous preterm birth;gestational age,menarche age,spontaneous abortion history,family history of diabetes,pre-pregnancy BMI affect spontaneous preterm birth in patients with gestational diabetes Independent risk factors.The results of ROC predictive model showed that the pre-pregnancy BMI had the highest AUC,the spontaneous abortion history AUC had a minimum of 0.645,the highest sensitivity was 85%pre-pregnancy BMI,the lowest sensitivity was 57%of the family history of diabetes,and the highest specificity was 76%of the family history of diabetes.The specificity is at least 46%of the gestational age.Multi-factor combined ROC analysis showed that AUC=0.873,Sensitivity=87%,Specificity=73%,95%CI=0.819~0.916.Conclusion Pregnancy age,menarche age,spontaneous abortion history,family history of diabetes,pre-pregnancy BMI The independent risk factors affecting spontaneous preterm labor in gestational diabetes mellitus,multi-factor combination has high sensitivity and specificity for predicting the development of gestational diabetes,and has high clinical value.