| 刘文竹,陈震宇,李彩曦,等.联合母体危险因素、平均动脉压及子宫动脉搏动指数对子痫前期筛查性能的价值[J].安徽医药,2026,30(5):1023-1029. |
| 联合母体危险因素、平均动脉压及子宫动脉搏动指数对子痫前期筛查性能的价值 |
| Evaluation of the screening performance of maternal risk factors, mean arterial pressure, and uterine artery pulsatility index for preeclampsia |
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| DOI：10.3969/j.issn.1009-6469.2026.05.035 |
| 中文关键词: 子痫前期 预测 外部验证 平均动脉压 子宫动脉搏动指数 |
| 英文关键词: Preeclampsia Prediction External validation Mean arterial pressure Uterine artery pulsatility index |
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| 中文摘要: |
| 目的将母体因素、平均动脉压(MAP)、子宫动脉搏动指数( UtA-PI)代入英国胎儿医学会( FMF)竞争风险模型，评价此模型对本地区孕妇子痫前期预测的价值。方法选取 2021年 6月至 2023年 3月在中国人民解放军北部战区总医院进行 NT检查的孕 11~13+6周的孕妇，共 2 849例。按照标准方案测量平均动脉压( MAP)和子宫动脉搏动指数( UtA-PI)运用 FMF公开的风险计算器分别计算出单独母体因素、母体因素 +MAP、母体因素 +MAP+UtA-PI预测子痫前期的风险。参与者，被分为正常组、早产型和足月型子痫前期组，计数指标采用 χ2检验或 Fisher确切概率法，两组间比较采用 Bonferroni法进行校正，三组间比较采用 Kruskal-Wallis H检验。受试者操作特征曲线( ROC曲线)评估筛查效能，分别计算假阳性率为 5%、10%和 15%时对应的子痫前期、早产型和足月型子痫前期预测的灵敏度，并与我国妊娠期高血压疾病诊治指南( 2020)、美国妇产科医师协会(ACOG)、英国国家健康和临床改进研究所( NICE)建议的筛查方法进行比较。结果 2 894例妊娠孕妇中发生子痫前期 139例(4.8%)其中早产型子痫前期 28例( 1.0%)和足月型子痫前期 111例( 3.8%)。早产型子痫前期妊娠病人 MAP MoM和 UtA-PI MoM数均显著高于正常组。母体因素 +MAP+UtA-PI预测效能优于单独母体因素的预测方法，与母体因素 +MAP预测结果差异不大。在固定假阳性率为 10%对早产型和足月型子痫前期的检出率分别为 66.7%、61.3%。FMF预测模型对子痫前期高风险筛查人群比例为 6.1%，灵敏度为 61.9%。我国妊娠期高血压疾病诊治指南、 ACOG、NICE、FMF指南筛查子痫前期高风险人群比例分别为 2.6%、13.5%、3.2%、7.4%，灵敏度分别为 5.8%、15.1%、3.6%、37.4%。结论利用母体因素 +MAP、母体因素 值，+MAP+UtA-PI能有效地筛查出子痫前期，尤其对早产型子痫前期筛查效能最佳，值得推广。 |
| 英文摘要: |
| Objective To evaluate the value of the Fetal Medicine Foundation (FMF) competition risk model in predicting preeclamp.sia in pregnant women in this region by incorporating maternal factors, mean arterial pressure (MAP), and uterine artery pulsatility in.dex (UtA-PI).Methods The study included a total of 2,849 pregnant women who underwent NT examination at the General Hospitalof the Northern Theater Command from June 2021 to March 2023, at 11-13+6 weeks days of gestation. MAP and UtA-PI were measured according to standard protocols. The risk of predicting preeclampsia was calculated using the FMF public risk calculator based on ma.ternal factors alone, maternal factors+MAP, and maternal factors+MAP+UtA-PI. Participants were divided into normal, preterm, and term preeclampsia groups. The chi-square test or Fisher's exact test was used for categorical variables, while the Kruskal-Wallis H test was used for comparisons between groups with independent samples. Bonferroni correction was applied for pairwise comparisons. Thereceiver operating characteristic curve(ROC curve) was used to evaluate screening performance, with sensitivity for predicting pre.eclampsia, preterm preeclampsia, and term preeclampsia calculated at false positive rates of 5%, 10%, and 15%. These results werecompared with screening methods recommended by the Chinese guidelines for the diagnosis and treatment of hypertensive disorders inpregnancy (2020), the American college of obstetricians and gynecologists (ACOG), and the National institute for health and care excel. lence (NICE) in the UK.Results Among the 2,849 pregnant women, there were 139 cases of preeclampsia (4.8%), with 28 cases of early-onset preeclampsia (1.0%) and 111 cases of late-onset preeclampsia (3.8%). The values of MAP MoM and UtA-PI MoM in preg. nant women with early-onset preeclampsia were significantly higher than those in the normal group. The predictive efficiency of mater. nal factors+MAP+UtA-PI was better than that of using maternal factors alone, with little difference compared to using maternal factors+MAP. At a fixed false positive rate of 10%, the detection rates for early-onset and late-onset preeclampsia were 66.7% and 61.3%, re. spectively. The FMF predictive model identified 6.1% of the high-risk population for preeclampsia, with a sensitivity of 61.9%. In Chi. na, the screening rates for high-risk populations for preeclampsia in the guidelines for the diagnosis and treatment of hypertension inpregnancy, ACOG, NICE, and FMF were 2.6%, 13.5%, 3.2%, and 7.4%, respectively, with sensitivities of 5.8%, 15.1%, 3.6%, and37.4%, respectively. Conclusion Using maternal factors+MAP, and maternal factors+MAP+UtA-PI can effectively screen for pre. eclampsia, especially for early-onset preeclampsia, showing the highest screening efficiency and is worth promoting. |
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