瘢痕子宫患者产后出血的预测模型构建-现代医学

瘢痕子宫患者产后出血的预测模型构建

单位：首都医科大学附属北京同仁医院妇产科, 北京 100021

分类号：R714.46+1

出版年·卷·期（页码）：2025·53·第五期（810-815）

摘要：

目的： 探讨瘢痕子宫患者产后出血的影响因素，构建预测模型。方法： 回顾性选取2022年3月至2024年3年出现产后出血的瘢痕子宫患者80例为产后出血组，选取同期未发生产后出血的瘢痕子宫患者160例为无产后出血组。收集瘢痕子宫患者临床资料，Logistic回归分析瘢痕子宫患者产后出血的影响因素，据此构建回归预测模型，并绘制受试者工作特征(ROC)曲线、校准曲线评估该模型的预测效能、校准度。结果： Logistic回归分析显示，胎盘植入(OR=26.962，95%CI 5.548～131.031，P＜0.001)、子宫前壁下段肌层厚度(OR=0.087，95%CI 0.030～0.255，P＜0.001)、产前纤维蛋白原(FIB)(OR=0.241，95%CI 0.108～0.538，P＝0.001)、产前转化生长因子-β1(TGF-β1)(OR=0.908，95%CI 0.878～0.938，P＜0.001)、新生儿体质量(OR=3.270，95%CI 1.545～6.925，P＝0.002)是瘢痕子宫患者产后出血的影响因素。根据上述影响因素构建预测模型，ROC曲线发现该模型预测瘢痕子宫患者产后出血的曲线下面积(AUC)为0.949，校准曲线显示瘢痕子宫患者产后出血的回归预测模型校准度较高。结论： 胎盘植入、子宫前壁下段肌层厚度、产前FIB水平、产前TGF-β1水平、新生儿体质量均可影响瘢痕子宫患者产后出血的发生，据此构建的回归预测模型具有良好的预测价值，可为临床预防性策略制定提供参考，以降低产后出血风险。

Objective: To explore the influencing factors of postpartum hemorrhage in patients with scar uterus, and to establish a prediction model. Methods: 80 patients with scarred uterus with postpartum hemorrhage from March 2022 to March 2024 were retrospectively selected as the postpartum hemorrhage group, and 160 patients with scarred uterus without postpartum hemorrhage were selected as the group without postpartum hemorrhage during the same period. Clinical data of patients with scarred uterus were collected, and the influencing factors of postpartum hemorrhage in patients with scarred uterus were analyzed by Logistic regression. Regression prediction model was built accordingly, and receiver operating characteristic(ROC) curve, calibration curve were drawn to evaluate the prediction efficiency, calibration degree of the model. Results: Logistic regression analysis showed placenta accreta(OR=26.962, 95%CI 5.548-131.031, P<0.001), inferior anterior uterine wall muscle thickness(OR=0.087, 95%CI 0.030-0.255, P＜0.001), prenatal fibrinogen(FIB)(OR=0.241, 95%CI 0.108-0.538，P=0.001), prenatal transforming growth foctor-β1(TGF-β1)(OR=0.908, 95%CI 0.878-0.938, P<0.001), newborn body mass(OR=3.270, 95%CI 1.545-6.925, P=0.002) were the influencing factors of postpartum hemorrhage in patients with scarred uterus. Regression prediction model was constructed according to the above influencing factors. The ROC curve found that the area under curve(AUC) of this model to predict postpartum hemorrhage in patients with scarred uterus was 0.949, and calibration curve show that the nomogram prediction model of postpartum hemorrhage in patients with scarred uterus had high calibration degree. Conclusion: Placenta implantation, muscular thickness of inferior anterior uterine wall, prenatal FIB level, prenatal TGF-β1 level and newborn body mass can all affect the occurrence of postpartum hemorrhage in patients with scarred uterus. The regression prediction model constructed on this basis has good predictive value, and can provide references for the formulation of clinical preventive strategies to reduce the risk of postpartum hemorrhage.

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