目的:联合母体因素和平均动脉压(MAP)评估英国胎儿医学基金会(FMF)算法对子痫前期(PE)的预测效能.方法:收集 2021 年 8 月至 2021 年 12 月于北部战区总医院妇产科门诊行NT彩超(孕11～13+6周)及住院孕妇1847 例的临床资料,查阅并计算NT时平均动脉压(MAP),通过FMF网站公开免费的PE风险计算器计算风险值.按妊娠结局是否患有PE分为未发病组、早发型PE组、晚发型PE组、早产型PE组、足月型PE组、全部PE组.绘制受试者工作特征曲线(ROC曲线),分别计算在固定假阳性率分别为5%、10%、15%、20%下该模型对PE及其不同亚型的灵敏度.与实际观测结果及我国《妊娠期高血压疾病诊治指南(2020)》、《ACOG指南(2018)》所建议的筛查结果进行比较,评价该模型的预测效能.结果:1847 例妊娠孕妇中发生PE者112 例(6.1%),其中早发型29 例(1.6%),晚发型 83 例(4.4%),早产型PE 35 例(1.9%),足月型PE 77 例(4.1%).母体因素+MAP 较单一母体因素对 PE 的预测效果更好,ROC 曲线下面积(AUC)为0.847,固定假阳性率分别为5%、10%、15%、20%下的灵敏度分别为45.50%、61.60%、70.50%、78.60%.其中对早产型PE的预测效能最佳,AUC为0.881,固定假阳性率分别为 5%、10%、15%、20%下的灵敏度分别为 51.40%、62.90%、74.30%、80.00%.根据我国《妊娠期高血压疾病诊治指南(2020)》、《ACOG指南(2018)》预测PE的灵敏度分别为 8.04%(9/112)、56.25%(63/112).在相同人群下,联合母体因素及MAP预测全部PE及早产型PE的灵敏度分别为 77.68%(87/112)、85.71%(30/35),较各大指南对PE的预测效果明显升高.结论:联合母体因素和MAP应用FMF竞争风险模型对PE患病有较好的预测效能,且对早产型PE的预测效能最好,优于单一母体因素及各大指南.在资源欠缺的地区或医院可选择联合母体因素和MAP来预测PE.
Objective:To evaluate the efficacy of the Fetal Medicine Foundation(FMF)algorithm in predicting preeclampsia in a local population by combining maternal fac-tors and mean arterial pressure.Methods:Baseline clinical data were collected from pregnant women who underwent NT ultrasound(11～13+6 weeks of gestation)or hospitalized in the Northern Theater General Hospital from August 2021 to the end of December 2021.Calculate mean arterial pressure(MAP)at NT,Calculate the risk value using the publicly available free preeclampsia risk calculator on the FMF website.The pregnancy outcomes were categorized ac-cording to whether or not they had preeclampsia into the no disease group,early-onset pre-eclampsia group,late-onset preeclampsia group,preterm-type preeclampsia group,full-term-type preeclampsia group,and all preeclampsia group.Statistical methods were used to compare the differences in baseline information between the groups.The ROC curves were plotted,and the sensitivity of the model for preeclampsia and its different subtypes was calculated at fixed false-positive rates of 5%,10%,15%,and 20%,respectively.The predictive efficacy of the model was evaluated by comparing the results with the actual observations and the screening results recommended by the《Guidelines for the Diagnosis and Treatment of Hypertensive Diseases in Pregnancy(2020)》and the《ACOG guidelines(2018)》in China.Results:A total of 1847 pregnancies were included in this study for analysis.A total of 112(6.1%)developed pre-eclampsia,including 29(1.6%)pregnant women with early-onset preeclampsia,83(4.4%)pregnant women with late-onset preeclampsia,35(1.9%)pregnant women with preterm-type preeclampsia,and 77(4.1%)pregnant women with full-term-type preeclampsia.Maternal fac-tor+MAP was a better predictor of preeclampsia than single maternal factor,with an area under the ROC curve(AUC)of 0.847,and sensitivities of 45.50%,61.60%,70.50%,and 78.60%at fixed false-positive rates of 5%,10%,15%,and 20%,respectively.The best prediction of preterm preeclampsia was achieved with an AUC of 0.881,and the sensitivities were 51.40%,62.90%,74.30%,and 80.00%at a fixed false positive rate of 5%,10%,15%,and 20%,re-spectively.The sensitivity of predicting preeclampsia according to China's"Guidelines for the diagnosis and treatment of hypertensive disorders in pregnancy(2020)"and ACOG guidelines(2018)was 8.04%(9/112)and 56.25%(63/112),respectively.In the same population,the sensitivity of combined maternal factors and MAP in all preeclampsia and preterm preeclampsia was 77.68%(87/112)and 85.71%(30/35),respectively.Its prediction of preeclampsia was significantly higher than that of major guidelines.Conclusion:The FMF competing risk model combined with maternal factors and MAP has better predictive efficacy for the prevalence of preeclampsia in the local population,and has the best predictive efficacy for preterm preeclamp-sia,which is better than the single maternal factor and the major guidelines.The combination of maternal factors and MAP can be chosen to predict preeclampsia in resource-poor areas or hos-pitals.
李彩曦;陈震宇;刘文竹;张婷;刘婷艾;陈晓明;施红颖
锦州医科大学中国人民解放军北部战区总医院研究生培养基地,沈阳 110003中国人民解放军北部战区总医院妇产科,沈阳 110003
临床医学
子痫前期;预测模型;竞争风险模型;英国胎儿基金会算法;平均动脉压
Preeclampsia;Prediction model;Competing risks model;FMF;MAP
《现代妇产科进展》 2024 (006)
410-416,426 / 8
10.13283/j.cnki.xdfckjz.2024.06.032
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