摘要
目的基于三维超声和临床构建早孕期列线图模型预测胎儿生长受限(FGR)。方法回顾性地选取2021年1月至2022年12月早孕期在本院三维能量多普勒超声检查孕妇404例,按照7∶3的比例随机拆分为训练集和内部验证集,依次分为FGR组和非FGR组,在训练集中进行单因素差异性分析和多因素Logistic回归分析,筛选出与FGR相关的独立危险因素构建预测模型,并对模型进行验证。结果训练集经过单因素和多因素Logistic回归分析筛选后,显示高血压、糖尿病、胎盘的体积(PV)、血管化-血流指数(VFI)(P<0.05)是FGR的独立危险预测因素,将4个指标纳入最终模型,选择最小AIC值(309.787)对应的模型:Y=7.9714-0.0994×X1(胎盘体积)-0.4589×X2(血管形成-血流指数)+3.3145×X3(糖尿病,0=否,1=有)+3.8621×X4(高血压,0=否,1=有),以0.500为截值时模型的诊断效能最高,计算出ROC曲线下面积为0.972(95%CI 0.944~1.000),灵敏度为93.1%,特异度为94.9%,内部验证中C统计量为0.941(95%CI 0.860~0.941)。训练集和验证集Hosmer-Lemeshow拟合优度检验的P值分别为:0.224、0.420,均大于0.05,校准曲线显示模型预测曲线与实际曲线拟合良好,用临床决策曲线(DCA)评价模型的临床适用性,显示该模型在0.15~1.00的阈值范围内对判断胎儿发生FGR风险的受益较大。结论本研究基于三维超声和临床因素,得出高血压、糖尿病、PV、VFI是预测FGR的独立危险因素,以此构建的预测模型经过内部验证,可作为早期预测FGR发生风险的可靠参考工具。
Objective Predicting fetal growth restriction based on three-dimensional ultrasound and clinical construction of an early pregnancy nomogram model.Methods A retrospective study of 404 pregnant women who underwent three-dimensional power Doppler ultrasound during early pregnancy in our hospital from January 2021 to December 2022 was conducted,and randomly divided into training set and internal validation set according to a ratio of 7:3,which were successively divided into FGR group and non-FGR group.Univariate difference analysis and multivariate Logistic regression analysis were performed in the training set.Independent risk factors related to FGR were screened out to build a prediction model,and the model was validated.Results After the training set was screened by single-factor and multi-factor logistic regression analysis,it was shown that hypertension,diabetes,PV,and VFI(P<0.05)were independent risk predictors of FGR.Four indicators were included in the final model,and the minimum AIC value(309.787)corresponding model:Y=7.9714-0.0994×X1(placental volume)-0.4589×X2(vascularization-blood flow index)+3.3145×X3(diabetes,0=no,1=yes)+3.8621×X4(hypertension,0=no,1=yes),the diagnostic efficiency of the model is the highest when 0.500 is used as the cutoff value.The calculated area under the ROC curve is 0.972(95%CI 0.944-1.000),the sensitivity is 93.1%,and the specificity is 94.9%,the C statistic in internal validation was 0.941(95%CI 0.860-0.941).The P values of the Hosmer-Lemeshow goodness-of-fit test for the training set and validation set were:0.224 and 0.420,both greater than 0.05.The calibration curve showed that the model prediction curve fit well with the actual curve.The clinical decision curve(DCA)was used to evaluate the model.Clinical applicability shows that this model has greater benefit in determining the risk of fetal FGR within the threshold range of 0.15-1.00.Conclusions Based on three-dimensional ultrasound and clinical factors,this study concluded that hypertension,diabetes,PV,and VFI are independent risk factors for predicting FGR.The prediction model constructed based on this has been internally verified and can be used as a reliable reference tool for early prediction of the risk of FGR.
作者
陈顺姬
张伟娜
吴淑芬
杨舒萍
柯林芳
CHEN Shunji;ZHANG Weina;WU Shufen;YANG Shuping;KE linfang(Department of Ultrasound Medicine,Zhangzhou Hospital Affiliated to Fujian Medical University,Zhangzhou,Fujian 363000,China)
出处
《中国医药指南》
2025年第6期30-34,共5页
Guide of China Medicine
关键词
早孕期
胎儿生长受限
胎盘
三维能量多普勒超声
预测模型
Early pregnancy
Fetal growth restriction
Placenta
Three-dimensional power doppler ultrasound
Prediction model
