本文關(guān)鍵詞： 妊娠期高血壓疾病 母親特征 血壓 預(yù)測 早產(chǎn) 低出生體重兒　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：第一部分妊娠期高血壓疾病風(fēng)險預(yù)測模型的構(gòu)建目的(1)觀察本隊列人群妊娠期高血壓疾病的發(fā)生情況。(2)分析本隊列人群妊娠期高血壓疾病的影響因素。(3)構(gòu)建本隊列人群妊娠期高血壓疾病的風(fēng)險預(yù)測模型。方法采用多中心的隊列研究方法,在廣西南寧、柳州、玉林等6個地區(qū)的婦幼保健院招募6203名孕婦,2606人被選擇進(jìn)入本研究。孕婦建卡時進(jìn)行問卷調(diào)查,收集研究對象的人口學(xué)特征、生活方式、既往妊娠史、患病情況、用藥史、家族史等資料;收集孕婦孕期產(chǎn)檢信息(如血壓值、尿常規(guī)等)。比較孕婦特征及血壓值在妊娠期高血壓疾病組及正常組的差別,采用logistics回歸分析妊娠期高血壓疾病的影響因素并建立預(yù)測模型,用ROC曲線進(jìn)行驗證,進(jìn)一步抽取20%本研究人群代入方程驗證。結(jié)果(1)妊娠期高血壓疾病發(fā)生率為6.64%(173/2606)。(2)年齡增大,妊娠期高血壓疾病的風(fēng)險略有升高(OR=1.04;95%CI:1.00-1.08),初產(chǎn)婦患妊娠期高血壓疾病的風(fēng)險是經(jīng)產(chǎn)婦的1.81倍(OR=1.81;95%CI:1.23-2.66),妊娠期前月經(jīng)不規(guī)律患妊娠期高血壓疾病的風(fēng)險是月經(jīng)規(guī)律的1.54倍(OR=1.54;95%CI:1.04-2.26),孕20周前收縮壓越高,越易患妊娠期高血壓疾病(OR=1.06;95%CI:1.04-1.07)。(3)通過ROC曲線分析,母親特征預(yù)測妊娠期高血壓疾病曲線下面積(AUC)為0.62(95%CI:0.58-0.67),約登指數(shù)最大時,靈敏度為52.6%,特異度為65.4%。聯(lián)合孕20周前收縮壓預(yù)測妊娠期高血壓疾病,AUC為0.69(95%CI:0.65-0.73),約登指數(shù)最大時,靈敏度為78.4%,特異度為54.5%。結(jié)論母親特征能有一定的預(yù)測妊娠期高血壓疾病的能力,但是聯(lián)合孕20周前收縮壓后預(yù)測靈敏度提高。第二部分妊娠期高血壓疾病對妊娠結(jié)局的影響目的分析本隊列人群妊娠期高血壓疾病對早產(chǎn)、出生體重等妊娠結(jié)局的影響,進(jìn)一步說明預(yù)防預(yù)測的必要性。方法第一部分的研究對象隨訪至分娩,收集研究對象的分娩孕周、出生體重、產(chǎn)兒結(jié)局、分娩方式、阿氏評分、產(chǎn)后出血、是否出生缺陷等分娩信息。比較妊娠期高血壓疾病與正常組妊娠結(jié)局發(fā)生率的差別,采用logistics回歸分析妊娠期高血壓疾病對妊娠結(jié)局的影響。結(jié)果妊娠期高血壓疾病孕婦血壓明顯升高組,早產(chǎn)及低出生體重的發(fā)病風(fēng)險增加(RR=2.69,95%CI:1.10-6.48;RR=2.81,95%CI:1.08-7.34)。暫未發(fā)現(xiàn)妊娠期高血壓疾病與分娩方式、阿氏評分、產(chǎn)后出血、死胎、畸形有關(guān)。結(jié)論血壓明顯升高的妊娠期高血壓疾病與早產(chǎn)、低出生體重兒有關(guān),血壓明顯升高者應(yīng)提高警惕,孕期應(yīng)加強血壓的監(jiān)測。
[Abstract]:Part I: risk prediction model for hypertensive disorder complicating pregnancy objective 1) to observe the occurrence of hypertensive disorder complicating pregnancy in this cohort. The risk prediction model of hypertensive disorder complicating pregnancy in this cohort was established by analyzing the influencing factors of hypertensive disorder complicating pregnancy in this cohort. Methods A multicenter cohort method was used to study the risk of hypertensive disorder complicating pregnancy in this cohort. In Nanning, Liuzhou, Yulin and other six regions, 6203 pregnant women were recruited in the MCH hospital. 2606 pregnant women were selected to participate in this study. The demographic characteristics, lifestyle, pregnancy history, illness, medication history and family history of the subjects were collected. To collect pregnant women's prenatal examination information (such as blood pressure value, urine routine, etc.) to compare the difference of maternal characteristics and blood pressure value between gestational hypertension disorder group and normal group. Logistics regression analysis was used to analyze the influencing factors of hypertensive disorder complicating pregnancy and a prediction model was established. The results were verified by ROC curve. Results the incidence of hypertensive disorder complicating pregnancy was 6.64% and 173% 2606%. 2) the age was higher. The risk of hypertensive disorder complicating pregnancy was slightly higher than that of OR1.04; 95 CI: 1.00-1.080.The risk of hypertensive disorder complicating pregnancy in primipara was 1.81 times higher than that in puerpera. 95 CI: 1.23-2.66, the risk of premenstrual disorder is 1.54 times higher than that of menstrual cycle. 95 CI: 1.04-2.26, the higher the systolic blood pressure before 20 weeks of pregnancy, the more likely to develop hypertensive disorder complicating pregnancy. 95 CI: 1.04-1.077.3.The analysis of the ROC curve. The maternal characteristics predicted the area under the curve of hypertensive disorder complicating pregnancy (AUC) was 0.622% 95 CI: 0.58-0.67%, and the sensitivity was 52.6% when the Yorden index was the largest. The specificity was 65.4. The AUC of hypertensive disorder complicating pregnancy was 0.6995 CI: 0.65-0.73, which was predicted by systolic blood pressure before 20 weeks of pregnancy, when the Yorden index was the highest. The sensitivity was 78.4 and the specificity was 54.5.Conclusion Maternal characteristics can be used to predict hypertensive disorder complicating pregnancy. However, the predictive sensitivity of hypertensive disorder complicating pregnancy before 20 weeks of pregnancy was improved. Part 2: effect of hypertensive disorder complicating pregnancy on pregnancy outcome objective to analyze the effect of hypertension complicating pregnancy on premature delivery in this cohort. The effect of birth weight and other pregnancy outcome, further explain the necessity of prevention and prediction. Methods the first part of the study subjects followed up to childbirth, collect the study subjects of pregnancy weeks, birth weight, the outcome of infants. To compare the incidence rate of pregnancy outcome between hypertensive disorder complicating pregnancy and normal group, such as delivery mode, Ars score, postpartum hemorrhage, birth defect and so on. Logistics regression analysis was used to analyze the effect of hypertensive disorder complicating pregnancy on the outcome of pregnancy. The risk of preterm birth and low birth weight increased with RRX 2.69 / 95 CI: 1.10-6.48; RRR 2.81% 95 CI: 1.08-7.34. No hypertensive disorder complicating pregnancy and delivery mode, A's score, postpartum hemorrhage, stillbirth were found. Conclusion hypertensive disorder complicating with high blood pressure is related to preterm birth and low birth weight infant. Those with high blood pressure should be on alert and blood pressure monitoring should be strengthened during pregnancy.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.246

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本文編號：1459139