基于危险因素和常规实验室指标的子痫前期风险预测模型研究
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国家自然科学基金面上项目(62071007)


Risk prediction model for preeclampsia based on risk factors and routine laboratory indicators
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    摘要:

    目的 通过对妊娠妇女6~10周的一般资料、危险因素和常规实验室指标水平进行数据分析,构建妊娠早期子痫前期(PE)预测模型,比较Logistic回归模型和极端梯度提升(XGBoost)模型的预测能力。方法 回顾性分析2015年1月至2020年8月北京大学第三医院925例PE患者和7 613例正常对照组的一般资料、PE发病危险因素和27项常规实验室指标(妊娠6~10周),包括血脂、肝肾功能、凝血、血细胞计数等指标,采用Mann-Whitney U检验、Logistic回归、XGBoost等统计学方法进行数据分析,分别建立预测模型,绘制 ROC曲线抗磷脂综合征,计算曲线下面积(AUCROC)、敏感性、特异性;并用XGBoost绘制特征重要性条形图。结果 两组孕妇是否有糖尿病、SLE、抗磷脂综合征、肾病、子痫或PE史以及是否为初产妇的比例差异均有统计学意义(P均<0.05)。27个常规实验室指标中,两组除Plt/Lym的水平差异无统计学意义(P均>0.05)外,其他所有指标差异均有统计学意义(P均<0.05)。仅纳入危险因素(7项)建立Logistic回归模型,AUCROC为0.621(95%CI:0.601~0.640),敏感性为34.8%,特异性为81.5%;纳入危险因素和实验室指标(6项危险因素+14项实验室指标)建立Logistic模型,AUCROC为0.752(95%CI:0.735~0.769),敏感性为64.2%,特异性为76.0%;建立XGBoost模型,AUCROC为0.867(95%CI:0.839~0.896),敏感性为73.0%,特异性为82.3%。采用XGBoost模型进行PE发病早期预测的能力最优。XGBoost筛选出重要性排在前三的指标依次为TG、Lp(a)、C1q。结论 单独使用临床危险因素预测PE的效能不高,PE发病危险因素结合常规实验室指标进行妊娠早期预测PE发病风险的效果更优, 而XGBoost模型早期预测PE发病的性能优于Logistic回归模型。TG、Lp(a)、C1q是早期预测PE发病的重要变量。

    Abstract:

    Objective To construct the prediction model of preeclampsia (PE) in early pregnancy by analyzing the general data, risk factors and routine laboratory indicators of pregnant women for 6-10 weeks, and compare the prediction ability of Logistic regression model and eXtreme Gradient Boosting (XGBoost) model. Methods The general data, risk factors of PE and 27 routine laboratory indicators such as blood lipids, liver and kidney function, blood coagulation, blood cell count and etc. during 6 and 10 weeks of gestation from 925 PE patients and 7 613 normal controls in Peking University Third Hospital from January 2015 to August 2020 were retrospectively analyzed by the statistical methods such as Mann-Whitney U test, Logistic regression and XGBoost. And then, the prediction model was constructed, the receiver operating characteristic curve (ROC) was drawn, and the area under the ROC curve (AUCROC), sensitivity and specificity were calculated. The feature importance bar chart was drawn with XGBoost. Results There were significant differences in the proportions of diabetes, SLE, antiphospholipid sysdrome, renal diseases, whether there was a history of eclampsia or PE and primipara between the two groups (P<0.05). Among the 27 routine laboratory indicators, there were significant differences in all other indicators except Plt/Lym between the two groups (P<0.05). The AUC (0.621, 95%CI=0.601-0.640, sensitivity=34.8%, specificity=81.5%) of Logistic regression model established based on 7 risk factors was lower than that (AUC=0.752, 95%CI=0.735-0.769, sensitivity=64.2%, specificity=76.0%) of combined Logistic model based on 6 risk factors and 14 laboratory indicators and that (AUC=0.867, 95%CI=0.839-0.896, sensitivity=73.0%, specificity=82.3%) of XGBoost model, indicating that XGBoost model had the best ability to predict the early onset of PE. The top three indicators of importance screened by XGBoost were TG, Lp(a) and C1q. Conclusion The efficacy of using risk factors combined with routine laboratory indicators to predict PE in early pregnancy is better than that of using clinical risk factors alone, and XGBoost model in early predicting the risk of PE is better than the Logistic regression model. TG, Lp(a) and C1q are important variables for early prediction of PE.

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邓兴宇,杨楠,薛宇廷,张华,贾珂珂.基于危险因素和常规实验室指标的子痫前期风险预测模型研究[J].临床检验杂志,2021,(8):566-572

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  • 收稿日期:2021-05-10
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  • 在线发布日期: 2021-10-09
  • 出版日期: 2021-08-29
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