妊娠期高血压疾病单胎妊娠并发胎盘早剥的风险预测

汪文昕; 汪若兰; 方媛媛; 沈清媚; 汪朦; 杨宽英; 范懿隽

doi:10.16766/j.cnki.issn.1674-4152.003638

妊娠期高血压疾病单胎妊娠并发胎盘早剥的风险预测

doi: 10.16766/j.cnki.issn.1674-4152.003638

安徽医科大学第二附属医院妇产科，安徽合肥 230601

基金项目:

安徽省自然科学基金项目 2208085MH205

安徽医科大学第二附属医院临床研究培育计划 2021LCZD05

详细信息

通讯作者:
范懿隽，E-mail：fanyijun96351@163.com

中图分类号: R714.246 R714.43
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出版历程
- 收稿日期: 2023-12-28
- 网络出版日期: 2024-11-19

Risk prediction of placental abruption in singleton pregnancy with hypertensive disorders of pregnancy

Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, China

摘要

摘要: 目的探讨妊娠期高血压疾病(HDP)单胎妊娠患者并发胎盘早剥的危险因素以预测发生风险。方法回顾性分析2014年1月—2022年1月在安徽医科大学第二附属医院妇产科住院诊治且符合纳排标准的1 595例HDP患者临床资料，根据有无并发胎盘早剥分为研究组(发生胎盘早剥，34例)和对照组(未发生胎盘早剥，1 561例)。记录患者人口学特点、临床特点和实验室检测结果，采用单因素和多因素logistic回归模型分析HDP患者并发胎盘早剥的危险因素，并建立ROC曲线评价预测效能。结果 1 595例HDP患者中，34例(2.13%)发生胎盘早剥。研究组血D-二聚体(P=0.005)、血肌酐(P=0.044)、血尿素氮(P=0.043)、谷草转氨酶(P=0.014)水平较高，血小板计数(P=0.012)、纤维蛋白原(P=0.011)水平较低，且发病与HDP分型相关。血D-二聚体水平(P=0.009)、纤维蛋白原水平(P < 0.01)及HDP分型[重度子痫前期(P=0.033)、子痫(P=0.001)]是HDP患者并发胎盘早剥的影响因素。其中，纤维蛋白原预测胎盘早剥的灵敏度最高(55.9%)，D-二聚体特异度最高(84.2%)，D-二聚体与纤维蛋白原联合预测灵敏度(61.8%)高于所有单项指标。HDP分型的AUC最低[0.617(95% CI: 0.515~0.720)]，D-二聚体+纤维蛋白原+HDP分型联合预测的AUC最高[0.735(95% CI: 0.639~0.831)]。结论不同HDP表型对单胎妊娠患者并发胎盘早剥有显著影响，当纤维蛋白原降低、D-二聚体升高时，应高度警惕HDP单胎妊娠患者并发胎盘早剥。
- 妊娠期高血压 /
- 胎盘早剥 /
- 危险因素 /
- D-二聚体 /
- 纤维蛋白原
Abstract: Objective To investigate the risk factors for placental abruption in singleton pregnancy with hypertensive disorders of pregnancy (HDP). Methods The clinical data of 1 595 HDP patients who met the inclusion criteria and were hospitalized in the Department of Obstetrics and Gynecology in the Second Affiliated Hospital of Anhui Medical University, from January 2014 to January 2022, were retrospectively analyzed. According to the occurrence of placental abruption, they were divided into study group (with placental abruption, 34 cases) and control group (without placental abruption, 1 561 cases). Demographic characteristics, clinical characteristics and laboratory test results were recorded. Univariate and multivariate logistic regression models were used to analyze the risk factors of HDP patients with placental abruption, and an ROC curve was constructed to evaluate the predictive efficacy. Results Among 1 595 HDP patients enrolled in this study, 34 were diagnosed with placental abruption (2.13%). Compared with the control group, the study group had higher levels of D-dimer (P=0.005), serum creatinine (P=0.044), blood urea nitrogen (P=0.043) and aspartate aminotransferase (P=0.014), and lower levels of platelet count (P=0.012) and fibrinogen (P=0.011). Serum D-dimer level (P=0.009), fibrinogen level (P < 0.01) and HDP types [severe preeclampsia (P=0.033), eclampsia (P=0.001)] were the influencing factors of placental abruption in HDP patients. Among them, fibrinogen had the highest predictive sensitivity (55.9%) and D-dimer had the highest specificity (84.2%). The sensitivity of the combination of D-dimer and fibrinogen was higher than that of the individual risk factors (61.8%). The AUC of HDP types was the lowest [0.617 (95% CI: 0.515-0.720)], and the AUC of D-dimer+fibrinogen+HDP types was the highest [0.735 (95% CI: 0.639-0.831)]. Conclusion Different types of HDP have a significant impact on placental abruption in singleton pregnancy. If fibrinogen is decreased and D-dimer is increased, placental abruption should be highly suspected in singleton pregnancy with HDP.
- Hypertensive disorders of pregnancy /
- Placental abruption /
- Risk factors /
- D-dimer /
- Fibrinogen

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图 1 D-二聚体、纤维蛋白原、HDP分型单独及联合预测HDP单胎妊娠患者并发胎盘早剥的ROC曲线

Figure 1. ROC curves of D-Dimer, fibrinogen, and HDP subtypes alone and in combination for predicting placental abruption in HDP single pregnancy patients

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表 1 2组HDP单胎妊娠患者临床资料比较

Table 1. Comparison of clinical data of HDP single pregnancy patients in the two groups

项目	研究组(n=34)	对照组(n=1 561)	统计量	P值
年龄(x±s, 岁)	32.00±4.88	30.58±4.77	1.713^a	0.087
孕前BMI(x±s)	21.94±3.69	23.16±3.95	1.787^a	0.074
糖尿病或妊娠期糖尿病[例(%)]	8(23.53)	535(34.27)	1.710^b	0.191
诊断HDP<32周[例(%)]	13(38.24)	439(28.12)	1.676^b	0.196
自然流产病史[例(%)]	2(5.88)	56(3.59)	0.060^b	0.807
收缩压(x±s, mmHg)	160.24±15.27	157.09±17.21	1.058^a	0.290
舒张压(x±s, mmHg)	104.44±11.09	101.62±12.35	1.318^a	0.188
血小板计数(x±s, ×10⁹/L)	166.82±55.62	194.75±63.97	2.524^a	0.012
血肌酐[M(P₂₅, P₇₅), μmol/L]	61(50, 75)	57(49, 66)	-2.016^c	0.044
血尿素氮[M(P₂₅, P₇₅), mmol/L]	4.48(3.45, 5.38)	4.00(3.16, 4.90)	-2.023^c	0.043
尿酸[M(P₂₅, P₇₅), μmol/L]	355.00(301.75, 440.00)	333.00(274.00, 404.00)	-1.716^c	0.086
白蛋白(x±s, g/L)	27.84±5.18	29.19±4.72	1.650^a	0.099
D-二聚体[M(P₂₅, P₇₅), μg/mL]	3.14(1.24, 6.11)	1.74(1.13, 2.60)	-2.820^c	0.005
谷丙转氨酶[M(P₂₅, P₇₅), U/L]	20.00(13.75, 33.75)	19.00(13.00, 28.00)	-0.723^c	0.470
谷草转氨酶[M(P₂₅, P₇₅), U/L]	30.00(18.75, 39.50)	22.00(17.00, 31.00)	-2.456^c	0.014
纤维蛋白原(x±s, g/L)	3.48±1.06	4.25±1.76	2.533^a	0.011
HDP分型[例(%)]			13.425^b	0.008
慢性高血压合并妊娠	3(8.82)	159(10.19)
妊娠期高血压	4(11.76)	300(19.22)
轻度子痫前期	7(20.60)	548(35.10)
重度子痫前期	18(52.94)	546(34.98)
子痫	2(5.88)	8(0.51)
注：1 mmHg=0.133 kPa。^a为t值，^b为χ²值，^c为Z值。

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表 2 HDP单胎妊娠患者并发胎盘早剥的多因素分析

Table 2. Multifactor analysis of placental abruption in HDP single pregnancy patients

变量	B	SE	Waldχ²	P值	OR值	95% CI
D-二聚体	0.048	0.018	6.905	0.009	1.049	1.012~1.087
纤维蛋白原	-0.707	0.194	13.250	< 0.001	0.493	0.337~0.722
重度子痫前期	0.790	0.370	4.559	0.033	2.204	1.067~4.552
子痫	2.759	0.857	10.356	0.001	15.777	2.940~84.659
注：HDP分型以慢性高血压合并妊娠为参照。

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表 3 D-二聚体、纤维蛋白原、HDP分型预测HDP单胎妊娠患者并发胎盘早剥的效能分析

Table 3. Efficacy analysis of D-Dimer, fibrinogen, and HDP subtypes for predicting placental abruption in HDP single pregnancy patients

项目	AUC	95% CI	SE	P值	灵敏度(%)	特异度(%)
D-二聚体	0.641	0.522~0.761	0.061	0.005	50.0	84.2
纤维蛋白原	0.685	0.592~0.777	0.047	< 0.001	55.9	71.1
HDP分型	0.617	0.515~0.720	0.052	0.019	35.5	76.7
D-二聚体+纤维蛋白原	0.705	0.604~0.806	0.052	< 0.001	61.8	77.3
D-二聚体+纤维蛋白原+HDP分型	0.735	0.639~0.831	0.049	< 0.001	14.4	61.5

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