基于广西出生队列构建妊娠期高血压疾病预测模型并分析其对妊娠结局的影响

发布时间：2018-01-24 04:10

本文关键词： 妊娠期高血压疾病母亲特征血压预测早产低出生体重儿　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：第一部分妊娠期高血压疾病风险预测模型的构建目的(1)观察本队列人群妊娠期高血压疾病的发生情况。(2)分析本队列人群妊娠期高血压疾病的影响因素。(3)构建本队列人群妊娠期高血压疾病的风险预测模型。方法采用多中心的队列研究方法,在广西南宁、柳州、玉林等6个地区的妇幼保健院招募6203名孕妇,2606人被选择进入本研究。孕妇建卡时进行问卷调查,收集研究对象的人口学特征、生活方式、既往妊娠史、患病情况、用药史、家族史等资料;收集孕妇孕期产检信息(如血压值、尿常规等)。比较孕妇特征及血压值在妊娠期高血压疾病组及正常组的差别,采用logistics回归分析妊娠期高血压疾病的影响因素并建立预测模型,用ROC曲线进行验证,进一步抽取20%本研究人群代入方程验证。结果(1)妊娠期高血压疾病发生率为6.64%(173/2606)。(2)年龄增大,妊娠期高血压疾病的风险略有升高(OR=1.04;95%CI:1.00-1.08),初产妇患妊娠期高血压疾病的风险是经产妇的1.81倍(OR=1.81;95%CI:1.23-2.66),妊娠期前月经不规律患妊娠期高血压疾病的风险是月经规律的1.54倍(OR=1.54;95%CI:1.04-2.26),孕20周前收缩压越高,越易患妊娠期高血压疾病(OR=1.06;95%CI:1.04-1.07)。(3)通过ROC曲线分析,母亲特征预测妊娠期高血压疾病曲线下面积(AUC)为0.62(95%CI:0.58-0.67),约登指数最大时,灵敏度为52.6%,特异度为65.4%。联合孕20周前收缩压预测妊娠期高血压疾病,AUC为0.69(95%CI:0.65-0.73),约登指数最大时,灵敏度为78.4%,特异度为54.5%。结论母亲特征能有一定的预测妊娠期高血压疾病的能力,但是联合孕20周前收缩压后预测灵敏度提高。第二部分妊娠期高血压疾病对妊娠结局的影响目的分析本队列人群妊娠期高血压疾病对早产、出生体重等妊娠结局的影响,进一步说明预防预测的必要性。方法第一部分的研究对象随访至分娩,收集研究对象的分娩孕周、出生体重、产儿结局、分娩方式、阿氏评分、产后出血、是否出生缺陷等分娩信息。比较妊娠期高血压疾病与正常组妊娠结局发生率的差别,采用logistics回归分析妊娠期高血压疾病对妊娠结局的影响。结果妊娠期高血压疾病孕妇血压明显升高组,早产及低出生体重的发病风险增加(RR=2.69,95%CI:1.10-6.48;RR=2.81,95%CI:1.08-7.34)。暂未发现妊娠期高血压疾病与分娩方式、阿氏评分、产后出血、死胎、畸形有关。结论血压明显升高的妊娠期高血压疾病与早产、低出生体重儿有关,血压明显升高者应提高警惕,孕期应加强血压的监测。
[Abstract]:Part I: risk prediction model for hypertensive disorder complicating pregnancy objective 1) to observe the occurrence of hypertensive disorder complicating pregnancy in this cohort. The risk prediction model of hypertensive disorder complicating pregnancy in this cohort was established by analyzing the influencing factors of hypertensive disorder complicating pregnancy in this cohort. Methods A multicenter cohort method was used to study the risk of hypertensive disorder complicating pregnancy in this cohort. In Nanning, Liuzhou, Yulin and other six regions, 6203 pregnant women were recruited in the MCH hospital. 2606 pregnant women were selected to participate in this study. The demographic characteristics, lifestyle, pregnancy history, illness, medication history and family history of the subjects were collected. To collect pregnant women's prenatal examination information (such as blood pressure value, urine routine, etc.) to compare the difference of maternal characteristics and blood pressure value between gestational hypertension disorder group and normal group. Logistics regression analysis was used to analyze the influencing factors of hypertensive disorder complicating pregnancy and a prediction model was established. The results were verified by ROC curve. Results the incidence of hypertensive disorder complicating pregnancy was 6.64% and 173% 2606%. 2) the age was higher. The risk of hypertensive disorder complicating pregnancy was slightly higher than that of OR1.04; 95 CI: 1.00-1.080.The risk of hypertensive disorder complicating pregnancy in primipara was 1.81 times higher than that in puerpera. 95 CI: 1.23-2.66, the risk of premenstrual disorder is 1.54 times higher than that of menstrual cycle. 95 CI: 1.04-2.26, the higher the systolic blood pressure before 20 weeks of pregnancy, the more likely to develop hypertensive disorder complicating pregnancy. 95 CI: 1.04-1.077.3.The analysis of the ROC curve. The maternal characteristics predicted the area under the curve of hypertensive disorder complicating pregnancy (AUC) was 0.622% 95 CI: 0.58-0.67%, and the sensitivity was 52.6% when the Yorden index was the largest. The specificity was 65.4. The AUC of hypertensive disorder complicating pregnancy was 0.6995 CI: 0.65-0.73, which was predicted by systolic blood pressure before 20 weeks of pregnancy, when the Yorden index was the highest. The sensitivity was 78.4 and the specificity was 54.5.Conclusion Maternal characteristics can be used to predict hypertensive disorder complicating pregnancy. However, the predictive sensitivity of hypertensive disorder complicating pregnancy before 20 weeks of pregnancy was improved. Part 2: effect of hypertensive disorder complicating pregnancy on pregnancy outcome objective to analyze the effect of hypertension complicating pregnancy on premature delivery in this cohort. The effect of birth weight and other pregnancy outcome, further explain the necessity of prevention and prediction. Methods the first part of the study subjects followed up to childbirth, collect the study subjects of pregnancy weeks, birth weight, the outcome of infants. To compare the incidence rate of pregnancy outcome between hypertensive disorder complicating pregnancy and normal group, such as delivery mode, Ars score, postpartum hemorrhage, birth defect and so on. Logistics regression analysis was used to analyze the effect of hypertensive disorder complicating pregnancy on the outcome of pregnancy. The risk of preterm birth and low birth weight increased with RRX 2.69 / 95 CI: 1.10-6.48; RRR 2.81% 95 CI: 1.08-7.34. No hypertensive disorder complicating pregnancy and delivery mode, A's score, postpartum hemorrhage, stillbirth were found. Conclusion hypertensive disorder complicating with high blood pressure is related to preterm birth and low birth weight infant. Those with high blood pressure should be on alert and blood pressure monitoring should be strengthened during pregnancy.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.246

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