人口学、血常规及血清生化指标预测妊娠期高血压疾病的价值分析

陈鸳鸳; 马建婷

doi:10.16766/j.cnki.issn.1674-4152.003920

人口学、血常规及血清生化指标预测妊娠期高血压疾病的价值分析

doi: 10.16766/j.cnki.issn.1674-4152.003920

陈鸳鸳^{1, 2},
马建婷^{1, 2, ,}

1.
宁波大学附属阳明医院妇产科，浙江余姚 315400
2.
宁波大学医学部，浙江宁波 315000

基金项目:

浙江省医药卫生科技计划项目 2021KY1073

详细信息

通讯作者:
马建婷，E-mail：mjt9977@126.com

中图分类号: R714.246 R446
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出版历程
- 收稿日期: 2024-01-24
- 网络出版日期: 2025-05-14

The value of demography, blood routine and serum biochemical indexes in predicting hypertensive disorder complicating pregnancy

CHEN Yuanyuan^{1, 2},
MA Jianting^{1, 2
, ,}

1.
Department of Gynecology and Obstetrics, the Affiliated Yangming Hospital of Ningbo University, Yuyao, Zhejiang 315400, China

摘要

摘要: 目的回顾性分析孕早期孕妇的人口学特征、血常规及生化指标，探究这些因素在妊娠期高血压疾病(HDP)中的预测价值。方法根据纳排标准选取2018年5月1日—2022年4月30日在宁波大学附属阳明医院定期产检并分娩的孕妇16 112例，按入院顺序将2018年5月1日—2021年4月30日的12 889例孕妇作为观察组，构建模型预测HDP；2021年5月1日—2022年4月30日的3 223例孕妇作为验证组，进行模型验证。调查研究对象人口学特征、孕早期(8~12⁺⁶周)血常规及生化检查数据, 通过logistic回归分析对观察组建立HDP预测模型, 并进行外部验证, 绘制ROC曲线并计算AUC, 分析该模型的临床预测价值。结果观察组共12 889例，其中HDP患者1 196例，占9.28%。多因素回归模型分析显示，年龄、既往病史、BMI、血细胞比容(HCT)、HB、TG、HDL、LDL、TC、ALB均为HDP的影响因素。基于上述各因素构建HDP的联合预测模型，评分阈值1.5分时预测HDP发生的AUC为0.766。结论基于人口学、血常规及生化指标构建的临床模型对妊娠期高血压疾病具有一定的预测价值。
- 妊娠期高血压疾病 /
- 人口学 /
- 血常规 /
- 生化指标 /
- 预测模型
Abstract: Objective The purpose of this study was to investigate the predictive value of demographic characteristics, blood routine, and biochemical parameters in early pregnancy for hypertensive disorders of pregnancy (HDP). Methods A total of 16 112 pregnant women who underwent regular prenatal check-ups and delivered in the Affiliated Yangming Hospital of Ningbo University from May 1, 2018 to April 30, 2022 were selected, and 12 889 cases from May 1, 2018 to April 30, 2021 were selected as the observation group for the construction of the prediction model. A total of 3 223 cases from May 1, 2021 to April 30, 2022 were used as validation groups for external validation of the prediction model. The demographic characteristics, blood routine, and biochemical examination data of all research subjects were investigated in the first trimester (8-12⁺⁶ weeks), and the prediction model of HDP for the observation group was established by logistics regression statistical method, and the model was verified by the validation group, and the ROC curve was obtained and the area under the ROC curve was calculated, and the clinical prediction performance of the prediction model was evaluated. Results A total of 12 889 patients were in the observation group, of which 1 196 were HDP patients, accounting for 9.28%. Multivariate regression model analysis showed that age, medical history, BMI, hematocrit (HCT), HB, TG, HDL, LDL, TC, and ALB were influencing factors of HDP. Based on these factors, a combined prediction model for HDP was constructed, and when the scoring threshold was 1.5, the AUC for predicting the occurrence of HDP was 0.766. Conclusion Clinical models based on demographic, blood routine, and biochemical indicators have certain predictive value for hypertensive diseases in pregnancy.
- Hypertensive disorders of pregnancy /
- Maternal demography /
- Complete blood count /
- Biochemical indicators /
- Predictive models

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图 1 临床模型阈值为1.5分时预测HDP的ROC曲线

Figure 1. ROC curve for predicting HDP at a threshold of 1.5 points for the clinical model

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表 1 不同人口学资料观察组孕妇HDP患病率比较[例(%)]

Table 1. Comparison of the prevalence of HDP in pregnant women with different demographic data in the observation group [cases (%)]

项目	例数	HDP患病情况	χ²值	P值
年龄(岁)			25.740	＜0.001
＜35	10 564	916(8.67)
≥35	2 325	280(12.04)
产次(次)			0.001	0.989
1	7 649	710(9.28)
≥2	5 240	486(9.27)
孕次(次)			0.704	0.703
1	5 003	476(9.51)
2	4 214	390(9.25)
≥3	3 672	330(8.99)
居住地			0.343	0.558
农村	3 892	370(9.51)
城市	8 997	826(9.18)
文化程度			0.936	0.626
大学以上	1 715	170(9.91)
大学	9 952	912(9.16)
大学以下	1 222	114(9.33)
BMI			460.935	＜0.001
＜18.5	2 407	93(3.86)
18.5~23.9	3 701	177(4.78)
24.0~27.9	3 717	370(9.95)
≥28.0	3 064	556(18.15)
既往病史			5.172	0.023
是	11 970	1 130(9.44)
否	919	66(7.18)

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表 2 不同血常规指标观察组孕妇HDP患病率比较[例(%)]

Table 2. Comparison of the prevalence of HDP in pregnant women with different blood routine indicators [cases (%)]

项目	例数	HDP患病情况	χ²值	P值
PLT(×10⁹/L)			1.577	0.455
＜100	1 796	162(9.02)
100~300	4 199	409(9.74)
＞300	6 894	625(9.07)
HB(g/L)			442.149	＜0.001
≥100	4 603	759(16.49)
＜100	8 286	437(5.27)
HCT(%)			65.834	＜0.001
＜37	6 360	712(11.19)
37~48	5 728	399(6.97)
＞48	801	85(10.61)

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表 3 不同生化指标观察组孕妇HDP患病率比较[例(%)]

Table 3. Comparison of the prevalence of HDP in pregnant women with different biochemical indicators in the observation group [cases (%)]

项目	例数	HDP患病情况	χ²值	P值
TC(mmol/L)			171.275	＜0.001
≥5.2	8 463	990(11.70)
＜5.2	4 426	206(4.65)
TG(mmol/L)			352.046	＜0.001
＜0.4	2 958	228(7.71)
0.4~1.8	5 267	247(4.69)
＞1.8	4 664	721(15.46)
HDL(mmol/L)			288.871	＜0.001
＜1.29	3 227	492(15.25)
1.29~1.55	4 331	169(3.90)
＞1.55	5 331	535(10.04)
LDL(mmol/L)			88.401	＜0.001
＜3.12	7 796	572(7.34)
≥3.12	5 093	624(12.25)
ALT(U/L)			0.405	0.524
0~40	7 644	699(9.14)
＞40	5 245	497(9.48)
AST(U/L)			0.042	0.837
0~40	6 912	638(9.23)
＞40	5 977	558(9.34)
D-BIL(μmo/L)			0.003	0.958
＞7.0	6 349	590(9.29)
0~7.0	6 540	606(9.27)
T-BIL(μmol/L)			3.125	0.210
＜3.4	4 329	410(9.47)
3.4~17.1	5 271	506(9.60)
＞17.1	3 289	280(8.51)
UA(μmo/L)			3.331	0.189
＜89	3 369	331(9.82)
89~357	6 838	638(9.33)
＞357	2 682	227(8.46)
ALB(g/L)			60.981	＜0.001
＜35	2 766	178(6.44)
35~50	6 071	536(8.83)
＞50	4 052	482(11.90)

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表 4 变量赋值情况

Table 4. Variable assignment

变量	赋值方法
HDP	未发生=0，发生=1
年龄(岁)	＜35=0，≥35=1
既往病史	否=0，是=1
BMI	＜18.5=0，18.5~23.9=1，24.0~27.9=2，≥28.0=3
HCT(%)	＜0.37=0，0.37~0.48=1，＞0.48=2
HB(g/L)	＜100=0，≥100=1
TG(mmol/L)	＜0.4=0，0.4~1.8=1，＞1.8=2
HDL(mmol/L)	＞1.55=0，1.29~1.55=1，＜1.29=2
LDL(mmol/L)	＜3.12=0，≥3.12=1
TC(mmol/L)	＜5.2=0，≥5.2=1
ALB(g/L)	＜35=0，35~50=1，＞50=2

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表 5 观察组孕妇HDP影响因素的多因素logistic回归分析

Table 5. Multivariate logistic regression analysis of influencing factors of HDP in pregnant women in the observation group

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.765	0.213	12.899	＜0.001	2.149	1.416~3.262
既往病史	0.698	0.198	12.427	＜0.001	2.010	1.363~2.963
BMI	0.701	0.208	11.358	0.001	2.016	1.341~3.030
HCT	0.675	0.221	9.329	0.002	1.964	1.274~3.029
HB	0.705	0.243	8.417	0.004	2.024	1.257~3.259
TG	0.717	0.199	12.982	＜0.001	2.048	1.387~3.025
HDL	-0.847	0.231	13.444	＜0.001	0.429	0.273~0.674
LDL	0.784	0.234	11.225	0.001	2.190	1.385~3.465
TC	0.743	0.228	10.620	0.001	2.102	1.345~3.287
ALB	0.674	0.207	10.602	0.001	1.962	1.308~2.944

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表 6 验证组预测模型各评分阈值评估结果

Table 6. Evaluation results of each score threshold of the prediction model in the validation group

评分阈值	灵敏度(%)	特异度(%)	阳性预测值(%)	阴性预测值(%)	约登指数
0.5	92.1	25.1	5.3	98.4	0.161
1.0	76.6	46.8	6.8	97.8	0.233
1.5	48.9	82.0	11.2	97.2	0.281
2.0	34.0	90.2	14.5	96.6	0.217
2.5	14.2	97.4	20.8	96.0	0.104
3.0	10.1	99.0	32.6	95.8	0.106
3.5	4.5	99.7	40.2	95.5	0.061
4.0	2.3	99.9	43.8	95.3	0.022

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