[1]匡梦华,卢 聪,匡梦娇.孕早期基于多因素回归分析构建妊娠期糖尿病预测模型及验证[J].现代检验医学杂志,2024,39(01):158-161+204.[doi:10.3969/j.issn.1671-7414.2024.01.029]
　KUANG Menghua,LU Cong,KUANG Mengjiao.Construction and Validation of Prediction Model of Gestational Diabetes Mellitus Based on Multivariate Regression Analysis in the First Trimester of Pregnancy[J].Journal of Modern Laboratory Medicine,2024,39(01):158-161+204.[doi:10.3969/j.issn.1671-7414.2024.01.029]
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孕早期基于多因素回归分析构建妊娠期糖尿病预测模型及验证()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第39卷
期数:
2024年01期
页码:
158-161+204
栏目:
检验与临床
出版日期:
2024-01-15

文章信息/Info

Title:
Construction and Validation of Prediction Model of Gestational Diabetes Mellitus Based on Multivariate Regression Analysis in the First Trimester of Pregnancy
文章编号:
1671-7414（2024）01-158-05
作者:
匡梦华1; 卢 聪1; 匡梦娇2
（1. 上海市第一人民医院妇产科，上海 201600；2. 同济大学附属东方医院检验科，上海 200123）
Author(s):
KUANG Menghua1;  LU Cong1;  KUANG Mengjiao2
（1. Department of Obstetrics and Gynaecology, the First People’s Hospital of Shanghai, Shanghai 201600, China；2. Department of Clinical Laboratory, Shanghai East Hospital, Tongji University, Shanghai 200123, China）
关键词:
妊娠期糖尿病; 预测模型; 孕早期
分类号:
R446；R714.256
DOI:
10.3969/j.issn.1671-7414.2024.01.029
文献标志码:
A
摘要:
目的　探讨孕早期（12 ～ 13+6 周）妊娠期糖尿病（gestational diabetes mellitus，GDM）发生的危险因素，构建预测模型并验证。方法　选取2020 年1 ～ 12 月在上海市第一人民医院定期产检并分娩的单胎孕妇433 例，根据孕24 ～ 28 周75 g 葡萄糖耐量试验结果分为GDM 组（n=188）与非GDM 组（n=245）。采用电化学发光法检测孕早期血清生化指标，离子交换高效液相色谱法测定糖化血红蛋白。采用Logistic 回归分析筛选GDM 的危险因素并构建预测模型，绘制受试者工作特征（ROC）曲线分析模型对GDM 的预测价值。选取2021 年1 ～ 6 月在上海市第一人民医院产检的95 例孕妇对模型效能进行验证。结果　与非GDM 组比较，GDM 组孕妇的孕前身体质量指数（body mass index，BMI）（23.41±11.17 kg/m2 vs 21.18±2.88 kg/m2），γ- 谷氨酰转肽酶（gamma-glutamyl transpeptidase，γ-GGT）（16.61±10.62 U/L vs 14.00±8.35 U/L）， 三酰甘油（triacylglycerol，TG）（1.90±0.58 mmol/L vs 1.57±0.55 mmol/L），糖化血红蛋白（glycosylated hemoglobinAlc ，HbAlc）（5.25%±0.47% vs 5.07%±0.34%），空腹血糖（fastingblood glucose ，FBG）（4.68±0.47 mmol/L vs 4.36±0.36 mmol/L），LDL/HDL（1.53±0.49 vs 1.41±0.50），TG/HDL（2.93±0.59 vs 2.71±0.58）和TC/HDL（1.19±0.49 vs 0.95±0.45）水平升高，高密度脂蛋白- 胆固醇（high densitylipoprotein-cholesterol, HDL-C）（1.69±0.39 mmol/L vs 1.77±0.41 mmol/L）水平降低，差异均有统计学意义（t=2.613，2.818，5.874，4.582，17.701，2.458，3.815，5.310，-2.187，均P<0.05）。Logistic 回归分析显示，孕前BMI，FBG，HbAlc，TG 和TC/HDL 均为预测GDM 的独立危险因素（Waldχ2=4.48 ～ 35.549，均P<0.05），根据筛选出的危险因素建立的预测模型如下：Logit(P) =-20.562+0.085（BMI）+1.921（FBG）+1.57（HbAlc）+2.248（TG）-2.302（TC/HDL）。该模型预测GDM 的曲线下面积为0.800（95%CI：0.757 ～ 0.842），最佳截断值为0.352，敏感度和特异度分别为80.00%，66.00%。通过95 例孕妇对模型进行验证，发现该模型的敏感度、特异度和准确度分别为84.50%，91.00%和85.30%。结论　孕早期（12~13+6 周）通过BMI 联合FBG，HbAlc，TG 和TC/HDL 构建的预测模型对于GDM 有较高的预测价值。
Abstract:
Objective　To explore the risk factors of gestational diabetes mellitus (GDM) in the first trimester (12 ～ 13+6 weeks) of pregnancy, build a prediction model and verify it. Methods　433 singleton pregnant women delivered in the First People’s Hospital of Shanghai from January 2020 to December 2020 were selected. They were divided into GDM group （n=188） pregnant women and non-GDM group（n=245） pregnant women according to a 75g glucose tolerance test results at 24 ～ 28 weeks of gestation. The electrochemiluminescence method measured serum biochemical indexes in early pregnancy, and glycosylated hemoglobinAlc was measured by ion exchange high- performance liquid chromatography. Using logistic regression analysis to screen the risk factors of GDM and construct a predictive model, draw the subject’s work characteristic curve to analyze the model’s predictive value. Ninety-five pregnant women who underwent prenatal examinations at Shanghai First People’s Hospital from January 2021 to June 2021 were selected to validate the model’s effectiveness. Results　Compared with the non-GDM group, the level of body mass index (BMI) (23.41±11.17 kg/m2 vs 21.18±2.88 kg/m2), gamma-glutamyl transpeptidase (γ-GGT) (16.61±10.62 U/L vs 14.00±8.35 U/L)，triacylglycerol (TG) (1.90±0.58 mmol/L vs 1.57±0.55 mmol/L)，glycosylated hemoglobinAlc (HbAlc ) (5.25%±0.47 % vs 5.07±0.34 %), fasting blood glucose (FBG) (4.68±0.47 mmol/L vs 4.36±0.36 mmol/L), LDL/HDL (1.53±0.49 vs 1.41±0.50), TG/HDL (2.93±0.59 vs 2.71±0.58), and TC/HDL (1.19±0.49 vs 0.95±0.45) in GDM group was increased, and the level of highdensity lipoprotein-cholesterol(HDL) (1.69±0.39 mmol/L vs 1.77±0.41 mmol/L) was decreased, the differences were statistically significant (t=2.613, 2.818, 5.874, 4.582, 17.701, 2.458, 3.815, 5.310, -2.187, all P<0.05). Logistic regression analysis showed that pre-pregnancy BMI，FBG，HbAlc，TG， and TC/HDL were all independent risk factors for predicting gestational diabetes (Waldχ2=4.48 ～ 35.549, all P<0.05). The prediction model constructed based on the selected risk factors was as follows: Logit(P) =-20.562+0.085 (BMI)+1.921 (FBG)+1.57 (HbAlc)+2.248 (TG)-2.302 (TC/HDL). The model predicts that the area under the curve of GDM was 0.800 (95%CI:0.757 ～ 0.842)，the optimal cutoff value was 0.352, and the sensitivity and specificity were 80.00% and 66.00%, respectively. Ninety-five pregnant women validated the model, and its sensitivity, specificity, and accuracy were 84.50%, 91.00%, and 85.30%, respectively. Conclusion　The prediction model constructed by BMI combined with FBG, HbAlc, TG and TC/ HDL in the first trimester (12~13+6 weeks) of pregnancy has a high predictive value for GDM.

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备注/Memo

备注/Memo:
作者简介：匡梦华（1989-），女，硕士研究生，医师，研究方向：妊娠期糖尿病，E-mail：kuangmenghua@outlook.com。
通讯作者：匡梦娇（1994-），女，硕士研究生，技师，研究方向：妊娠期糖尿病，E-mail：mjiao1994@163.com。
更新日期/Last Update: 2024-01-15