双胎妊娠极早产的危险因素探讨与风险预测模型构建-东南大学学报医学版

双胎妊娠极早产的危险因素探讨与风险预测模型构建

单位：北京市顺义区医院产科, 北京 101300

分类号：R714.21;R714.23

出版年·卷·期（页码）：2024·43·第六期（890-897）

摘要：

目的:探讨双胎妊娠极早产的危险因素,并构建风险预测模型。方法:回顾性分析2016年6月至2022年12月本院收治的823例双胎妊娠孕妇的临床资料,将其按照2∶1比例分为建模集(n=549)和验证集(n=274)。根据妊娠结局将双胎妊娠孕妇分为极早产组(胎龄＜32周)和非极早产组(胎龄≥32周),采用Logistic回归分析筛选双胎妊娠极早产的危险因素,构建风险预测模型并对该模型进行验证。结果:建模集和验证集的临床资料比较差异无统计学意义(P＞0.05);建模集Logistic回归分析结果显示,单绒毛膜性、妊娠期高血压、胎膜早破、瘢痕子宫、绒毛膜羊膜炎为双胎妊娠极早产的危险因素(P＜0.05)。基于以上5项指标建立双胎妊娠极早产的风险预测模型,校准曲线显示风险预测模型的校准曲线和理想曲线的一致性良好,建模集和验证集的一致性指数分别为0.829(95%CI:0.782~0.873)、0.818(95%CI:0.763~0.856);受试者工作特征曲线显示,该模型预测建模集和验证集极早产发生风险的曲线下面积分别为0.839(95%CI:0.801~0.875)、0.826(95%CI:0.775~0.869);决策曲线显示,双胎妊娠孕妇根据该模型预测极早产发生的净收益较高。结论:基于单绒毛膜性、妊娠期高血压、胎膜早破、瘢痕子宫、绒毛膜羊膜炎构建的双胎妊娠极早产风险预测模型的预测效能及适用性良好,可用于筛查双胎妊娠孕妇中极早产的发生风险。

Objective: To explore the risk factors for extremely premature delivery in twin pregnancies and establish relevant risk prediction model. Methods: The clinical data of 823 pregnant women with twin pregnancies admitted to our hospital from June 2016 to December 2022 were retrospectively analyzed, and they were divided into modeling set(n=549) and validation set(n=274) according to the ratio of 2∶1. Pregnant women with twin pregnancies were divided into extremely premature delivery group(gestational age<32 weeks) and non-extremely premature delivery group(gestational age≥32 weeks) based on pregnancy outcomes. Logistic regression analysis was used to screen for risk factors of extremely premature delivery in twin pregnancies, and the risk prediction model was constructed and validated. Results: There were no statistically significant differences in the comparisons of clinical data between the modeling set and the validation set(P>0.05). The Logistic regression analysis results of the modeling set showed that single chorionic villi, gestational hypertension, premature rupture of membranes, scar uterus and chorioamnionitis were risk factors for extremely premature delivery in twin pregnancies(P<0.05). Based on the above 5 indicators, the risk prediction model for extremely premature delivery of twin pregnancies was established. The calibration curve showed good consistency between the calibration curve and the ideal curve of the risk prediction model, and the consistency index of the modeling set and validation set were 0.829(95%CI:0.782-0.873) and 0.818(95%CI:0.763-0.856), respectively. The receiver operating characteristic curve showed that the area under the curve of the modeling set and the validation set with extremely premature delivery by the model were 0.839(95%CI:0.801-0.875), 0.826(95%CI:0.775-0.869), respectively. The decision curve showed that pregnant women with twin pregnancies had higher net benefit in predicting the occurrence of extremely premature delivery based on this model. Conclusion: The predictive efficacy and applicability of the risk prediction model for extremely premature delivery in twin pregnancies based on single chorionic villi, gestational hypertension, premature rupture of membranes, scar uterus, and chorioamnionitis are good, and it can be used to screen for the risk of extremely premature delivery in pregnant women with twin pregnancies.

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