妊娠合并颅脑疾病影响因素分析及诺莫图预测模型构建

Analysis of the influencing factors of pregnancy complicated with craniocerebral diseases and construction of the Nomogram prediction model

  • 摘要: 目的:探讨妊娠合并颅脑疾病的影响危险因素,并构建预测诺莫图模型。方法:选取2020年6月至2023年7月首都医科大学附属北京天坛医院收治的230例妊娠孕产妇的临床资料,根据孕产妇是否发生颅脑疾病分为颅脑疾病组(n=48)和非颅脑疾病组(n=182),采用logistic回归分析妊娠合并颅脑疾病的独立影响因素,将其纳入构建诺莫图预测模型,采用R软件中一致性指数(C-index)、受试者工作特征(ROC)曲线及校准曲线评价妊娠合并颅脑疾病的诺莫图模型效能。结果:两组年龄、孕周、孕次、剖宫产史、流产史、脑卒中史、血红蛋白(Hb)、血小板计数(PLT)、活化部分凝血酶时间(APTT)、凝血酶原时间(PT)、低密度脂蛋白(LDL-C)比较,差异均无统计学意义(均P>0.05)。颅脑疾病组高血压史、分娩次数、孕酮高于非颅脑疾病组,白细胞计数(WBC)、纤维原蛋白(FIB)低于非颅脑疾病组(P<0.05);经logistics回归分析显示高血压史、分娩次数、WBC、FIB均是妊娠合并颅脑疾病的独立危险因素(OR>1,P<0.05);ROC曲线结果显示,高血压史、分娩次数、WBC、FIB的ROC曲线下面积(AUC)均>0.700。基于以上影响因素建立诺莫图风险模型,校准曲线C-index值为0.769,ROC曲线建模组和验证组的AUC分别为0.897和0.872。结论:基于妊娠合并颅脑疾病的独立危险因素构建的诺莫图预测模型,能直观地预测妊娠合并颅脑疾病的危险影响因素。

     

    Abstract: Objective: To explore the risk factors of pregnancy complicated with craniocerebral diseases and construct a predictive Nomogram model. Methods: The clinical data of 230 pregnant women and parturients who were admitted to Beijing Tiantan Hospital affiliated to Capital Medical University from June 2020 to July 2023were included in the study. According to the presence or absence of craniocerebral disease, they were divided into two groups: craniocerebral disease group (n=48) and non-craniocerebral disease group (n=182). Logistic regression was used to analyze the independent influencing factors of pregnancy complicated with craniocerebral diseases, and they were included in the construction of a Nomogram prediction model, and the concordance index(C-index), receiver operating characteristic(ROC) curve and calibration curve in R software were used to evaluate the efficacy of Nomogram model for pregnancy complicated with craniocerebral diseases. Results: There were no significant differences in age, gestational week, gestational frequency, cesarean section history, miscarriage history, stroke history, hemoglobin(Hb), platelet count(PLT), activated partial thrombin time(APTT), prothrombin time(PT), and low-density lipoprotein(LDL-C) between the two groups (all P>0.05). The history of hypertension, number of deliveries, and progesterone in the craniocerebral disease group were higher than those in the non-craniocerebral disease group, while the white blood cell count(WBC) and fibrinogen(FIB) were lower than those in the non-craniocerebral disease group (P<0.05). Logistic regression analysis showed that history of hypertension, number of deliveries, WBC, and FIB were all independent risk factors for pregnancy complicated with craniocerebral diseases(OR>1, P<0.05); the results of ROC curves showed that the history of hyper-tension, number of deliveries, WBC, and area under the ROC curve(AUC) value of FIB were all greater than 0.700. Based on the above influencing factors, a Nomogram risk model was established. The calibration curve Cindex value was 0.769 and the AUC values of the ROC curve modeling group and validation group were 0.897and 0.872, respectively. Conclusion: The Nomogram prediction model based on the independent risk factors of pregnancy complicated with craniocerebral diseases can intuitively predict the risk factors of pregnancy complicated with craniocerebral diseases.

     

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