孕妇发生妊娠期肝内胆汁淤积症的风险列线图模型的建立研究

Establishment of a nomogram model for predicting risk of intrahepatic cholestasis in pregnant women during pregnancy

  • 摘要:
      目的  建立孕妇发生妊娠期肝内胆汁淤积症(ICP)的风险列线图模型并验证其评估效果。
      方法  将575例孕妇依据简单随机化方式分为建模组(n=460)与验证组(n=115), 采用Logistic回归分析确定ICP发生的危险因素,应用R软件获得列线图风险预测模型,并评估风险预测模型预测效能。
      结果  乙肝病毒感染、妊娠期高血压、低硒摄入量、ICP家族史、孕激素保胎治疗、高尿酸血症为孕妇ICP发生的危险因素(P < 0.05); 列线图预测ICP发生风险的曲线下面积(AUC)与C指数均为0.840(95%CI: 0.764~0.916)。Calibration校准曲线表明,列线图预测ICP的发生风险与实际诊断发生风险一致性优异; 验证组中,列线图预测ICP发生风险的AUC与C指数均为0.801(95%CI: 0.711~0.892)。Calibration校准曲线表明,预测ICP发生风险与实际诊断发生风险一致性优异。
      结论  构建列线图可以个性化预测ICP的发生风险,有助于鉴别ICP的高风险人群,并制订合适干预措施。

     

    Abstract:
      Objective  To establish a nomogram model for predicting the risk of intrahepatic cholestasis of pregnancy (ICP), and verify its efficiency.
      Methods  A total of 575 pregnant women were enrolled and were divided into modeling group (n=460) and verification group (n=115) according to simple randomization method. Logistic regression analysis was performed to determine the risk factors for ICP. A nomogram model was established using R software, and its predictive performance was evaluated.
      Results  Hepatitis B virus infection, gestational hypertension, low selenium intake, family history of ICP, fetal protection treatment with progesterone and hyperuricemia were risk factors of ICP (P < 0.05). The area under the curve (AUC) value and C index of the nomogram for predicting the risk of ICP were both 0.840 (95%CI, 0.764 to 0.916). The calibration curve showed that predictive results of the nomogram were highly consistent with the results of actual diagnosis. In the verification group, the AUC value and C index of the nomogram for predicting the risk of ICP both were 0.801(95%CI, 0.711 to 0.892). The calibration curve showed that predictive results of the nomogram were highly consistent with the results of actual diagnosis.
      Conclusion  Establishing anomogram can help to predict the risk of ICP, which is conducive to screening high-risk groups of ICP and formulating appropriate intervention measures.

     

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