妊娠期高血压疾病患者妊娠结束后三年慢性高血压的Nomogram预测模型构建

背景妊娠期高血压疾病(HDP)对孕妇的危害不仅限于妊娠期,还可增加妊娠结束后慢性高血压(CH)发生风险,而构建HDP患者妊娠结束后CH的Nomogram预测模型有助于早期筛查、识别CH高风险孕妇。目的构建HDP患者妊娠结束后3年CH的Nomogram预测模型。方法选取2015年1月—2017年1月在六安市第二人民医院进行产前检查、分娩的HDP孕妇324例,均于妊娠结束后随访3年。随访期间主动退出22例,因身体原因退出18例,因失去联系或临床数据不完整剔除10例,最终纳入274例,其中妊娠结束后3年发生CH 68例(CH组)、未发生CH 206例(非CH组)。比较两组患者一般资料(包括年龄、受教育程度、初产妇比例、吸烟情况、高血压家族史)、妊娠前临床资料〔包括体质指数(BMI)、腰围、臀围、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、C反应蛋白(CRP)〕、妊娠期临床资料〔包括最高BMI、最高SBP、最高DBP、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)〕、妊娠结束后6周临床资料(包括BMI、最高SBP、最高DBP);绘制ROC曲线以获取连续变量预测HDP患者妊娠结束后3年CH的最佳截断值;采用多因素Logistic回归分析分析HDP患者妊娠结束后3年CH的影响因素,并构建Nomogram预测模型。结果本研究274例HDP患者妊娠结束后3年发生CH 68例,CH发生率为24.8%。两组患者初产妇比例,妊娠前DBP、FBG,妊娠期最高DBP、TG、TC、LDL、HDL,妊娠结束后6周最高DBP比较,差异无统计学意义(P>0.05);CH组患者年龄、吸烟率、有高血压家族史者所占比例,妊娠前BMI、SBP、CRP,妊娠期最高BMI、最高SBP,妊娠结束后6周BMI、最高SBP高于非CH组,本科及以上学历者所占比例低于非CH组,妊娠前腰围、臀围大于非CH组(P<0.05)。ROC曲线显示,年龄,妊娠前BMI、腰围、臀围、SBP、CRP,妊娠期最高BMI、最高SBP,妊娠结束后6周BMI、最高SBP预测HDP患者妊娠结束后3年CH的最佳截断值分别为28岁、23.0 kg/m2、89.2 cm、98.5 cm、129 mm Hg、1.9 mg/L、26.4 kg/m2、142 mm Hg、24.4 kg/m2、130 mm Hg。多因素Logistic回归分析结果显示,年龄>28岁、本科及以上学历、高血压家族史、妊娠前SBP>129 mm Hg、妊娠期最高BMI>26.4 kg/m2、妊娠结束后6周BMI>24.4 kg/m2是HDP患者妊娠结束后3年CH的独立影响因素(P<0.05)。将HDP患者妊娠结束后3年CH的独立影响因素作为指标构建Nomogram预测模型,内部数据验证结果显示,其一致性指数(CI)为0.811〔95%CI(0.688,0.901)〕。结论本研究成功构建了HDP患者妊娠结束后3年CH的Nomogram预测模型,有助于早期筛查CH高风险HDP患者并有针对性地进行干预。

Construction of Nomogram Prediction Model for Chronic Hypertension 3 Years after the End of Pregnancy in Patients with Hypertensive Disorders in Pregnancy

Background The harm of hypertensive disorders in pregnancy(HDP)to pregnant women is not only existing during pregnancy,but also increasing the risk of chronic hypertension(CH)after the end of pregnancy,therefore it is helpful to early screening and identification of high-risk CH pregnant women that construction of Nomogram prediction model for CH after the end of pregnancy in patients HDP.Objective To construct the Nomogram prediction model for CH 3 years after the end of pregnancy in patients with HDP.Methods A total of 324 HDP patients who underwent prenatal examination and delivered in the Second People's Hospital of Liuan were selected from January 2015 to January 2017,all of them were followed up for 3 years from the end of pregnancy.Of the 324 patients,22 cases quit on their own initiative and 18 cases quit due to state of health during follow-up,meanwhile 10 cases were excluded due to loss of contact or incomplete clinical data,thus 274 cases were finally involved,including 68 cases occurred CH(served as CH group)and the 206 cases did not(served as non-CH group)according to the incidence of CH 3 years after the end of pregnancy.General information(including age,educational level,primipara ratio,smoking rate and family history of hypertension),clinical data before pregnancy(including BMI,waistline,hipline,SBP,DBP,FBG and CRP),clinical data during pregnancy(including the highest BMI,SBP and DBP,TG,TC,LDL and HDL)and clinical data 6 weeks after the end of pregnancy(including BMI,the highest SBP and DBP)were compared between the two groups;ROC curve was drawn to find the optimal cut-off value of continuous variables for predicting CH 3 years after the end pregnancy in patients with HDP;multivariate Logistic regression analysis was used to analyze the influencing factors of CH 3 years after the end of pregnancy in patients with HDP,and then Nomogram prediction model was constructed.Results Incidence of CH 3 years after the end pregnancy in patients with HDP was 24.8%(68/274)in this study.There was no statistically significant difference in primipara ratio,DBP and FBG before pregnancy,the highest DBP,TG,TC,LDL and HDL during pregnancy,the highest DBP 6 weeks after pregnancy between the two groups(P>0.05);age,smoking rate,proportion of patients with family history of hypertension,BMI,SBP and CRP before pregnancy,the highest BMI and SBP during pregnancy,BMI and the highest SBP 6 weeks after pregnancy in CH group were statistically significantly higher than those in non-CH group(P<0.05);proportion of patients with university degree and above in CH group was statistically significantly lower than that in non-CH group,while waistline and hipline before pregnancy in CH group were statistically significantly larger than those in non-CH group(P<0.05).ROC curve showed that,the optimal cut-off value of age,BMI,waistline,hipline,SBP and CRP before pregnancy,the highest BMI and SBP during pregnancy,BMI and the highest SBP 6 weeks after pregnancy in predicting CH 3 years after the end pregnancy in patients with HDP was 28 years old,23.0 kg/m2,89.2 cm,98.5 cm,129 mm Hg,1.9 mg/L,26.4 kg/m2,142 mm Hg,24.4 kg/m2 and 130 mm Hg,respectively.Multivariate Logistic regression analysis results showed that,age>28 years old,university degree and above,family history of hypertension,the highest SBP>129 mm Hg before pregnancy,the highest BMI>26.4 kg/m2 during pregnancy and BMI>24.4 kg/m26 weeks after pregnancy were independent influencing factors of CH 3 years after the end of pregnancy in patients with HDP(P<0.05).Nomogram prediction model for CH 3 years after the end pregnancy in patients with HDP involving the above independent influencing factors was constructed,the consistency index(CI)was 0.811〔95%CI(0.688,0.901)according to internal data validation.Conclusion We successfully constructed the Nomogram prediction model for CH 3 years after the end of pregnancy in patients with HDP,which is helpful to screen high-risk CH pregnant women with HDP carry out targeted interventions.