产妇产后慢性腰背痛发生风险的预测列线图模型构建

Construction of nomogram model for predicting risk of maternal postpartum chronic low back pain

  • 摘要:
    目的 构建产妇产后慢性腰背痛的预测模型并验证其预测效果。
    方法 选取进行分娩的孕妇450例为研究对象, 按照7∶3比例分为建模组(315例)及验证组(135例)。根据产后有无慢性腰背痛发生,将建模组分为疼痛组(n=105)和无疼痛组(n=210)。采用单因素和多因素Logistic回归分析筛选影响产妇产后慢性腰背痛发生的危险因素,并绘制预测产妇产后慢性腰背痛发生风险的列线图模型。
    结果 315例孕妇中,出现产后慢性腰背痛105例,发生率为33.33%。多因素Logistic回归分析显示,胎儿体质量≥4 kg(OR=2.585)、生育次数≥3次(OR=6.144)、分娩方式为剖腹产(OR=2.015)、产妇为婴儿主要护理者(OR=2.390)、有妊娠期腰背痛史(OR=1.942)、有椎管内麻醉(OR=2.223)为影响产后慢性腰背痛发生的独立危险因素(P < 0.05)。基于以上危险因素建立预测产妇产后慢性腰背痛发生风险的列线图模型,并进行内外部验证,结果表明模型预测产后慢性腰背痛发生风险与实际发生风险基本一致; 受试者工作特征(ROC)曲线分析结果显示,建模组和验证组中预测模型预测产后慢性腰背痛的曲线下面积分别为0.803(95%CI: 0.754~0.845)、0.802(95%CI: 0.725~0.866), 表明预测模型具有良好的预测能力。
    结论 胎儿体质量≥4 kg、生育次数≥3次、分娩方式为剖腹产、产妇为婴儿主要护理者、有妊娠期腰背痛史、有椎管内麻醉为影响产妇产后慢性腰背痛发生的危险因素。基于以上危险因素构建的预测模型可准确评估产妇产后慢性腰背痛发生的风险,区分度及有效性均较好。

     

    Abstract:
    Objective To construct a predictive model for postpartum chronic low back pain and verify its prediction effect.
    Methods A total of 450 pregnant women who gave birth were selected as research objects and divided into modeling group (315 cases) and verification group (135 cases) on the basis of a ratio of 7 to 3. According to the occurrence of chronic low back pain after delivery, the modeling group was divided into pain group (n=105) and no pain group (n=210). Single factor and multiple factor Logistic regression analysis were used to screen the risk factors affecting the occurrence of postpartum chronic low back pain, and a nomogram model was drawn to predict the risk of postpartum chronic low back pain.
    Results Among the 15 pregnant women, 105 had chronic low back pain after delivery, and the incidence was 33.33%. Multivariate Logistic regression analysis showed that fetal body weight ≥4 kg (OR=2.585), the number of births ≥3 times (OR=6.144), mode of delivery was caesarean section (OR=2.015), the mother as the main caregiver of the baby (OR=2.390), a history of low back pain during pregnancy (OR=1.942) and had spinal anesthesia (OR=2.223) were independent risk factors for postpartum chronic low back pain (P < 0.05). Based on the above risk factors, a nomogram model was established to predict the risk of postpartum chronic low back pain, and the internal and external verification was carried out. The results showed that the predicted risk of postpartum chronic low back pain was basically consistent with the actual risk; receiver operating characteristic (ROC) curve analysis results showed that the area under the curve of the predictive models in the modeling group and the verification group to predict postpartum chronic low back pain was 0.803 (95%CI, 0.754 to 0.845) and 0.802 (95%CI, 0.725 to 0.866), respectively, indicating that the prediction model had good prediction ability.
    Conclusion Fetal body weight ≥4 kg, the number of births ≥3 times, delivery mode of caesarean section, the mother being the primary caregiver of the baby, history of low back pain during pregnancy and intraspinal anesthesia are risk factors affecting the occurrence of postpartum chronic low back pain. The prediction model based on the above risk factors can accurately evaluate the risk of chronic low back pain in postpartum women, with good differentiation and effectiveness.

     

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