作者：卢雪莲，叶小兰，郭丽

单位：

237000 安徽省六安市第二人民医院；通信作者：叶小兰，E-mail：yexl3382@163.com

关键词：

高血压，妊娠性；妊娠期高血压疾病；高血压；Nomogram 模型；预测

Keywords：

Hypertension，pregnancy-induced；Hypertensive disorders in pregnancy；Hypertension；Nomogrammodel；Forecasting

CLC：

R 714.246　R 544.1

DOI：

DOI：10.3969/j.issn.1008-5971.2020.04.014

Funds：

摘要：

背景　妊娠期高血压疾病（HDP）对孕妇的危害不仅限于妊娠期，还可增加妊娠结束后慢性高血压（CH）发生风险，而构建 HDP 患者妊娠结束后 CH 的 Nomogram 预测模型有助于早期筛查、识别 CH 高风险孕妇。目的　构建 HDP 患者妊娠结束后 3 年 CH 的 Nomogram 预测模型。方法　选取 2015 年 1 月—2017 年 1 月在六安市第二人民医院进行产前检查、分娩的 HDP 孕妇 324 例，均于妊娠结束后随访 3 年。随访期间主动退出 22 例，因身体原因退出 18例，因失去联系或临床数据不完整剔除 10 例，最终纳入 274 例，其中妊娠结束后 3 年发生 CH 68 例（CH 组）、未发生 CH 206 例（非 CH 组）。比较两组患者一般资料（包括年龄、受教育程度、初产妇比例、吸烟情况、高血压家族史）、妊娠前临床资料〔包括体质指数（BMI）、腰围、臀围、收缩压（SBP）、舒张压（DBP）、空腹血糖（FBG）、C 反应蛋白（CRP）〕、妊娠期临床资料〔包括最高 BMI、最高 SBP、最高 DBP、三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）〕、妊娠结束后 6 周临床资料（包括 BMI、最高 SBP、最高 DBP）；绘制 ROC 曲线以获取连续变量预测 HDP 患者妊娠结束后 3 年 CH 的最佳截断值；采用多因素 Logistic 回归分析分析 HDP 患者妊娠结束后 3 年 CH 的影响因素，并构建 Nomogram 预测模型。结果　本研究 274 例 HDP 患者妊娠结束后 3 年发生 CH 68 例，CH 发生率为 24.8%。两组患者初产妇比例，妊娠前 DBP、FBG，妊娠期最高 DBP、TG、TC、LDL、HDL，妊娠结束后 6 周最高 DBP 比较，差异无统计学意义（P>0.05）；CH 组患者年龄、吸烟率、有高血压家族史者所占比例，妊娠前 BMI、SBP、CRP，妊娠期最高 BMI、最高 SBP，妊娠结束后 6 周 BMI、最高 SBP 高于非 CH组，本科及以上学历者所占比例低于非 CH 组，妊娠前腰围、臀围大于非 CH 组（P<0.05）。ROC 曲线显示，年龄，妊娠前 BMI、腰围、臀围、SBP、CRP，妊娠期最高 BMI、最高 SBP，妊娠结束后 6 周 BMI、最高 SBP 预测 HDP 患者妊娠结束后 3 年 CH 的最佳截断值分别为 28 岁、23.0 kg/m 2 、89.2 cm、98.5 cm、129 mm Hg、1.9 mg/L、26.4 kg/m 2 、142 mm Hg、24.4 kg/m 2 、130 mm Hg。多因素 Logistic 回归分析结果显示，年龄 >28 岁、本科及以上学历、高血压家族史、妊娠前 SBP>129 mm Hg、妊娠期最高 BMI>26.4 kg/m 2 、妊娠结束后 6 周 BMI>24.4 kg/m 2 是 HDP 患者妊娠结束后 3年 CH 的独立影响因素（P<0.05）。将 HDP 患者妊娠结束后 3 年 CH 的独立影响因素作为指标构建 Nomogram 预测模型，内部数据验证结果显示，其一致性指数（CI）为 0.811〔95%CI（0.688，0.901）〕。结论　本研究成功构建了 HDP 患者妊娠结束后 3 年 CH 的 Nomogram 预测模型，有助于早期筛查 CH 高风险 HDP 患者并有针对性地进行干预。

Abstract：

Background　The harm of hypertensive disorders in pregnancy（HDP）to pregnant women is not onlyexisting during pregnancy，but also increasing the risk of chronic hypertension（CH）after the end of pregnancy，therefore itis helpful to early screening and identification of high-risk CH pregnant women that construction of Nomogram prediction modelfor CH after the end of pregnancy in patients HDP. Objective　To construct the Nomogram prediction model for CH 3 years afterthe end of pregnancy in patients with HDP. Methods　A total of 324 HDP patients who underwent prenatal examination anddelivered in the Second People's Hospital of Liuan were selected from January 2015 to January 2017，all of them were followedup for 3 years from the end of pregnancy. Of the 324 patients，22 cases quit on their own initiative and 18 cases quit due to stateof health during follow-up，meanwhile 10 cases were excluded due to loss of contact or incomplete clinical data，thus 274 caseswere finally involved，including 68 cases occurred CH（served as CH group）and the 206 cases did not（served as non-CHgroup）according to the incidence of CH 3 years after the end of pregnancy. General information（including age，educationallevel，primipara ratio，smoking rate and family history of hypertension），clinical data before pregnancy（including BMI，waistline，hipline，SBP，DBP，FBG and CRP)，clinical data during pregnancy(including the highest BMI，SBP and DBP，TG，TC，LDL and HDL) and clinical data 6 weeks after the end of pregnancy（including BMI，the highest SBP and DBP）were compared between the two groups；ROC curve was drawn to find the optimal cut-off value of continuous variables forpredicting CH 3 years after the end pregnancy in patients with HDP；multivariate Logistic regression analysis was used to analyzethe influencing factors of CH 3 years after the end of pregnancy in patients with HDP，and then Nomogram prediction model wasconstructed. Results　Incidence of CH 3 years after the end pregnancy in patients with HDP was 24.8%（68/274）in this study.There was no statistically significant difference in primipara ratio，DBP and FBG before pregnancy，the highest DBP，TG，TC，LDL and HDL during pregnancy，the highest DBP 6 weeks after pregnancy between the two groups（P>0.05）；age，smoking rate，proportion of patients with family history of hypertension，BMI，SBP and CRP before pregnancy，the highestBMI and SBP during pregnancy，BMI and the highest SBP 6 weeks after pregnancy in CH group were statistically significantlyhigher than those in non-CH group（P<0.05）；proportion of patients with university degree and above in CH group wasstatistically significantly lower than that in non-CH group，while waistline and hipline before pregnancy in CH group werestatistically significantly larger than those in non-CH group（P<0.05）. ROC curve showed that，the optimal cut-off value ofage，BMI，waistline，hipline，SBP and CRP before pregnancy，the highest BMI and SBP during pregnancy，BMI and thehighest SBP 6 weeks after pregnancy in predicting CH 3 years after the end pregnancy in patients with HDP was 28 years old，23.0 kg/m 2 ，89.2 cm，98.5 cm，129 mm Hg，1.9 mg/L，26.4 kg/m 2 ，142 mm Hg，24.4 kg/m 2 and 130 mm Hg，respectively.Multivariate Logistic regression analysis results showed that，age>28 years old，university degree and above，family history ofhypertension，the highest SBP>129 mm Hg before pregnancy，the highest BMI>26.4 kg/m 2 during pregnancy and BMI>24.4kg/m 2 6 weeks after pregnancy were independent influencing factors of CH 3 years after the end of pregnancy in patients withHDP（P<0.05）. Nomogram prediction model for CH 3 years after the end pregnancy in patients with HDP involving the aboveindependent influencing factors was constructed，the consistency index（CI）was 0.811〔95%CI（0.688，0.901）accordingto internal data validation. Conclusion　We successfully constructed the Nomogram prediction model for CH 3 years after theend of pregnancy in patients with HDP，which is helpful to screen high-risk CH pregnant women with HDP carry out targetedinterventions.

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