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| 基于生化检验指标早期预测妊娠期糖尿病的诊断模型建立及验证 |
| 作者：夏莉敏1 吴雨婷1 陆泓年1 2 高蓉1 王婷婷1 |
| 单位：1. 南京医科大学无锡医学中心/无锡市人民医院/南京医科大学附属无锡人民医院 医学检验科, 江苏 无锡 214023; 2. 南京医科大学, 江苏 南京 211166 |
| 关键词：妊娠期糖尿病 诊断模型 预测模型 生化检验指标 |
| 分类号：R714.256 |
| 出版年·卷·期（页码）：2025·44·第一期（105-112） |
| 摘要： |
目的:构建常规生化检验指标对妊娠期糖尿病(gestational diabetes mellitus, GDM)的诊断模型,并外部验证模型诊断性能。方法:选取2020年1月至12月在无锡市人民医院产科进行产前检查并建档的88例GDM孕妇和同期109例正常健康产检孕妇为研究对象作为训练集,同期选择70例GDM合并贫血者及前述109例正常孕妇作为验证集。于孕24~26周检测3组研究对象的空腹血生化、血常规及贫血3项。基于训练集数据,通过单因素分析并综合考虑预测变量测量的可靠性、可及性筛选预测因子,构建诊断模型,并使用bootstrap法进行内部验证;基于验证集数据进行外部验证。采用受试者工作特征曲线下面积(area under curve, AUC)、校准曲线、决策曲线分析(decision curve analysis, DCA)评估模型性能。结果:模型最终纳入年龄、糖化血红蛋白、铁蛋白、前白蛋白、载脂蛋白A1等5个预测因子。模型内、外部验证的AUC分别为0.91(95%CI:0.87~0.95)和0.88(95%CI:0.83~0.93);Brier评分分别为0.118和0.140,校准曲线接近理想曲线;DCA曲线显示模型对临床使用具有净效益和良好的实用性。结论:使用孕期常规生化检验指标可初步构建较好性能的GDM诊断模型,可为采取更严格设计开发GDM诊断模型提供参考。 |
Objective: To construct a diagnostic model of routine biochemical test indicators for gestational diabetes mellitus(GDM) and externally verify the diagnostic performance of the model. Methods:88 cases of GDM from January 2020 to December 2020 and 109 normal healthy pregnant women in the same period were selected as the training set, and 70 cases of GDM with anemia and the aforementioned 109 normal pregnant women were selected as the validation set. At 24-26 weeks of gestation, the fasting blood biochemistry, blood routine and three items of anemia were detected in the three groups of research objects. Based on the training set data, predictive factors were screened through univariate analysis and by comprehensively considering the reliability and accessibility of predictive variable measurement, and then a diagnostic model was constructed. The bootstrap method was used for internal validation; external validation was carried out based on the validation set data. The area under the receiver operating characteristic curve(AUC) and calibration curve, decision curve analysis(DCA) were used to evaluate the performance of the model. Results:The final model included five predictive factors:age, glycated hemoglobin, ferritin, prealbumin, and apolipoprotein A1. The AUCs for internal and external validation of the model were 0.91(95%CI:0.87-0.95) and 0.88(95%CI:0.83-0.93), respectively; the Brier scores were 0.118 and 0.140, respectively, and the calibration curves were close to the ideal curve; the DCA curve indicated that the model had a net benefit for clinical use and good practicality. Conclusion:Using the biochemical indicators of routine examinations during pregnancy can initially construct a GDM diagnostic model with relatively good performance, which can provide a reference for the development of GDM diagnostic models of more stringent designs. |
| 参考文献： |
[1] International Diabetes Federation.IDF Diabetes Atlas[EB/OL]. 9 ed.ISBN:978-2-930229-87-4.https://diabetesatlas.org/en/. |
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