稽留流产孕早期预测模型的构建与验证

目的构建稽留流产(missed abortion,MA)患者在孕早期流产危险因素列线图。方法纳入2017年2月至2019年10月因稽留流产于中国建筑第二工程局职工医院治疗的孕妇125例为研究组,随机纳入同时期正常孕妇126例为对照组,分析两组患者临床基本资料:年龄、环境因素、动物接触史、叶酸使用、文化程度、流产情况、疾病史、激素水平等。采用Logistic回归分析对孕早期发生稽留流产的危险因素进行分析,应用R软件建立孕早期稽留流产预测列线图,并进行验证。结果研究组孕妇年龄、睾酮(testosterone,T)水平高于对照组,而催乳素(prolactin,PRL)、雌二醇(estradiol,E2)、孕酮(progesterone,P)水平低于对照组,差异均有统计学意义(P<0.05);Logistic回归分析提示孕妇年龄(OR=1.809,P=0.003)、吸烟饮酒(OR=78.120、P=0.044)、职业暴露(OR=61.238,P=0.021)、T水平(OR=5.432,P=0.001)是孕早期发生MA的危险因素。PRL(OR=0.376,P=0.003)、E2(OR=0.258,P=0.016)、P(OR=0.396,P=0.005)是孕早期发生MA的保护因素。预测孕早期MA发生的相关危险因素的C-index为0.912(95%CI:0.874-0.943)。结论列线图中孕妇年龄、环境因素、激素水平能较准确的预测孕早期发生MA的风险。

Construction and verification of early prediction model of missed abortion

Objective To construct and verify the risk factor map of patients with missed abortion(MA)in early pregnancy.Methods A total of 125 pregnant women who were treated in Staff Hospital of China Construction Second Engineering Bureau due to MA from February 2017 to October 2019 were included in the study group,while 126 normal pregnant women were randomly selected as the control group.The basic clinical data of the two groups of patients were analyzed:age,environmental factors,animal exposure history,folic acid use,education,abortion,disease history,hormone levels,etc.Logistic regression analysis was used to analyze the risk factors of early pregnancy MA,and R software was used to establish a line chart for the prediction of early pregnancy miscarriage and verified.Results The age and testosterone(T)levels of pregnant women in the study group were significantly higher than those in the control group,while the prolactin(PRL),estradiol(E2),and progesterone(P)levels were lower than those in the control group(P<0.05);Logistic regression analysis indicated that the age of pregnant women(OR=1.809,P=0.003),smoking alcohol consumption(OR=78.120,P=0.044),occupational exposure(OR=61.238,P=0.021),and T level(OR=5.432,P=0.001)were risk factors for the occurrence of MA in early pregnancy.PRL(OR=0.376,P=0.003),E2(OR=0.258,P=0.016),P(OR=0.396,P=0.005)were the protective factors of MA in early pregnancy.The C-index for predicting the risk factors of MA in the first trimester was 0.912(95%CI:0.874-0.943).Conclusion The nomogram constructed by the age,environmental factors,and hormone levels of pregnant women can more accurately predict the risk of MA in early pregnancy.