摘要
背景目前关于残余胆固醇(RC)与孕妇抑郁及妊娠压力关系的研究有限。目的探索RC等因素与妊娠中期孕妇抑郁和妊娠压力的关系,为临床识别和干预提供科学依据。方法选择2020年6月—2024年4月于新疆医科大学第二附属医院产科规律产检的妊娠早期(孕6~13^(+6)周)孕妇为研究对象。采取纵向研究设计,收集孕妇的基线数据和血脂指标,随访至妊娠中期,使用爱丁堡产后抑郁量表(EPDS)和妊娠压力量表(PPS)对孕妇的抑郁和压力情况进行评估。采用多因素Logistic回归分析构建孕妇抑郁和妊娠压力的预测模型。为进一步确定对结局影响最大的因子,采用随机森林(RF)算法再次构建模型,并使用SHAP工具对RF模型结果进行可视化分析。结果本研究随访403例妊娠早期至妊娠中期孕妇,获得有效问卷323份,失访率为19.9%。清洗错误基线数据后,最终纳入279例孕妇。结果显示,孕妇抑郁发生率为38.7%(108/279),妊娠压力发生率为20.8%(58/279)。有抑郁和妊娠压力的孕妇,其RC水平高于无抑郁及无妊娠压力的孕妇(P<0.05)。多因素Logistic回归分析结果显示,本次妊娠方式(OR=0.441,95%CI=0.251~0.775)、吃早餐频率(OR=5.086,95%CI=2.105~12.270)和RC(OR=2.759,95%CI=1.157~6.580)是妊娠中期孕妇抑郁的影响因素(P<0.05);妊娠后是否午休(OR=0.513,95%CI=0.276~0.953)、RC(OR=3.747,95%CI=1.519~9.246)是妊娠中期孕妇妊娠压力的影响因素(P<0.05)。SHAP图显示,RC是影响妊娠中期孕妇抑郁和妊娠压力的最重要因素。结论高水平的RC可能是妊娠中期孕妇发生抑郁和压力事件的危险因素。未来需通过大型队列研究或临床试验进一步验证结果,并阐明其因果关系。
Background Limited research currently exists on the relationship between remnant cholesterol(RC)and maternal depression as well as pregnancy stress.Objective To explore the relationship between factors such as RC and maternal depression and pregnancy stress in the second trimester,providing a scientific foundation for clinical identification and intervention strategies.Methods Pregnant women in early pregnancy(6 to 13^(+6) weeks of gestation)who attended regular prenatal check-ups at the Obstetrics Department of the Second Affiliated Hospital of Xinjiang Medical University from June 2020 to April 2024 were recruited as study participants.A longitudinal study design was adopted to collect baseline data and blood lipid indicators of pregnant women,followed up until the second trimester,and used the Edinburgh Postpartum Depression Scale(EPDS)and Pregnancy Pressure Scale(PPS)to evaluate the depression and stress of pregnant women.Multi-factor Logistic regression analysis was used to construct a prediction model for maternal depression and pregnancy stress.In order to further determine the factors that have the greatest impact on the outcome,the random forest(RF)algorithm was used to build the model again,and the SHAP tool was used to visually analyze the RF model results.Results This study followed 403 pregnant women from the first trimester to the second trimester,with 323 valid responses collected,resulting in a follow-up loss rate of 19.9%.After excluding inaccurate baseline data,279 pregnant women were included in the final analysis.Results indicated that the incidence of depression was 38.7%(108/279),and the incidence of pregnancy stress was 20.8%(58/279).RC levels were significantly higher in pregnant women with depression and pregnancy stress than in those without(P<0.05).Multivariate Logistic regression identified pregnancy planning(OR=0.441,95%CI=0.251-0.775),breakfast frequency(OR=5.086,95%CI=2.105-12.270),and RC(OR=2.759,95%CI=1.157-6.580)as significant factors influencing depression during the second trimester(P<0.05).Additionally,taking a midday rest(OR=0.513,95%CI=0.276-0.953)and RC(OR=3.747,95%CI=1.519-9.246)were significant factors associated with pregnancy stress(P<0.05).The SHAP analysis indicated that RC was the most influential factor affecting maternal depression and pregnancy stress in the second trimester.Conclusion Elevated RC levels may increase the risk of depression and stress-related events in pregnant women during the second trimester.Future research involving larger cohort studies or clinical trials is necessary to confirm these findings and elucidate causal relationships.
作者
陈鸿旭
王登兰
陈媛媛
沈娟娟
宋春
王帆
孔田甜
CHEN Hongxu;WANG Denglan;CHEN Yuanyuan;SHEN Juanjuan;SONG Chun;WANG Fan;KONG Tiantian(School of Public Health,Xinjiang Medical University,Urumqi 830063,China;The Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830063,China;The West China Hospital of Sichuan University,Chengdu 610095,China;Beijing Hui-long-guan Hospital,Beijing 100096,China)
出处
《中国全科医学》
北大核心
2025年第11期1347-1353,共7页
Chinese General Practice
基金
新疆维吾尔自治区自然科学基金面上项目(2023D01C119)
新疆医科大学青年科技拔尖人才项目(XYD2024Q09)。
关键词
妊娠中期
抑郁
妊娠压力
残余胆固醇
SHAP
Pregnancy trimester,second
Depression
Pregnancy stress
Remnant cholesterol
SHAP
