摘要
目的：分析剖宫产后女性发生剖宫产瘢痕妊娠（CSP）的危险因素，并建立个体化预测其发生风险列线图模型。方法：回顾性分析2015年1月至2022年9月在本院行剖宫产后再次妊娠的1 566例孕妇的临床资料，其中发生CSP者236例（CSP组），未发生CSP者1 330例（非CSP组）。将研究对象随机分为建模组（70%）与验证组（30%）。采用多因素logistic回归分析方法分析CSP的影响因素，并绘制列线图。用验证组数据进行验证，受试者工作特征（ROC）曲线判断模型预测能力；绘制校准图以判断模型校准能力。结果：CSP组和非CSP组孕次、产次、流产次数、剖宫产次数、孕早期阴道流血和子宫位置比较，差异均有统计学意义（均P< 0.05）。多因素logistic 回归分析显示，产次≥3 次（OR=2.056，95%CI：1.032～3.947）、产次2 次（OR=6.795，95%CI：4.689～9.905）、流产次数≥2 次（OR=2.582，95%CI：1.848～3.619）和有孕早期阴道流血（OR=10.722，95%CI：7.675～15.125）均为CSP的独立危险因素，子宫后屈（OR=0.479，95%CI：0.319～0.706）为CSP的独立保护因素（均P< 0.05）。ROC曲线下面积（AUC）为0.854；校准图其模型校准曲线趋近于标准曲线，Brier评分为0.089。结论：产次≥2次、流产≥2次、孕早期阴道流血和子宫后屈均为CSP的影响因素；基于列线图预测CSP发生具有可行性，为临床制定干预决策有参考意义。
Abstract
Objective:To analyze the risk factors of cesarean scar pregnancy(CSP)in women after cesarean section and establish an individualized nomogram model for predicting its occurrence risk.Methods:Clinical data of 1, 566 pregnant women who underwent cesarean section in our hospital from January 2015 to September 2022 and subsequently became pregnant again were retrospectively analyzed, including 236 cases with CSP (CSP group)and 1, 330 cases without CSP(non-CSP group).The research subjects were randomly divided into the modeling group(70%)and the validation group(30%).Multivariate logistic regression analysis was used to analyze the influencing factors of CSP, and the nomogram was drawn.The receiver operating characteristic (ROC) curve was used to determine the prediction ability of the model and the calibration plot was drawn to evaluate the calibration ability of the model.Results:There were significant differences in pregnancy times, parity times, abortion times, cesarean section times, vaginal bleeding in early pregnancy and uterine position between CSP group and non-CSP group (all P< 0.05).Multivariate logistic regression analysis showed that parity ≥3 times (OR=2.056, 95% CI: 1.032-3.947), parity=2 times (OR=6.795, 95% CI: 4.689-9.905), abortion ≥2 times (OR=2.582, 95% CI: 1.848-3.619), and vaginal bleeding in early pregnancy (OR=10.722, 95% CI: 7.675-15.125) were independent risk factors for CSP; retroflexion of uterus(OR=0.479, 95%CI:0.319-0.706)was an independent protective factor for CSP(all P< 0.05).The area under the ROC curve (AUC) was 0.854; the calibration curve of the model was close to the standard curve, and the Brier score was 0.089.Conclusion:Parity ≥2 times, abortion ≥2 times, vaginal bleeding in early pregnancy and retroflexion of uterus are the influencing factors of CSP.It is feasible to predict the occurrence of CSP based on the nomogram, and it has reference significance for clinical intervention decision-making.
百度学术
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