基于阴道微环境变化构建妊娠期女性足月与未足月胎膜早破的风险列线图模型

Construction of a risk nomogram model for full-term and preterm premature rupture of membranes in pregnant women based on changes in vaginal microenvironment

摘要

目的 分析影响妊娠期女性足月与未足月胎膜早破的因素,并建立基于阴道微环境变化的列线图模型。方法 回顾性选取2022年4月至2024年5月在我院进行产前检查的182例妊娠期女性,根据孕妇是否发生胎膜早破分为胎膜早破组(n=60)与健康孕妇组(n=122).收集孕产妇临床资料并检测阴道微环境指标.通过多因素Logistic回归分析妊娠期女性胎膜早破的影响因素,进一步建立妊娠期女性胎膜早破列线图模型,绘制受试者工作特征(ROC)曲线、校准曲线及临床决策曲线(DCA)验证并分析其临床实用性。结果 与健康孕妇组相比,胎膜早破组孕产妇多次宫腔操作史及妊娠期糖尿病的占比更高(χ²值分别为4.000、7.139,均P<0.05),肿瘤坏死因子α(TNF-α)、中性粒细胞计数(NEU)水平均明显升高(t值分别为14.459、4.981,均P<0.05);与健康孕妇组对比,胎膜早破组孕妇阴道pH值水平更高(t值为9.147,P<0.05),大肠埃希菌、粪肠球菌、肺炎克雷伯菌、加德纳菌、铜绿假单胞菌及唾液酸酶阳性占比均明显升高(χ²值范围在21.174~59.234之间,P<0.05),乳酸杆菌占比降低(χ²值为95.210,P<0.05);多因素Logistic分析结果显示,妊娠期糖尿病(OR=4.145,95%CI:1.470~11.693)、多次宫腔操作史(OR=2.184,95%CI:1.458~3.271)、TNF-α(OR=2.555,95%CI:1.381~4.726)、NEU(OR=3.130,95%CI:1.361~7.199)、阴道微环境(OR=2.373,95%CI:1.267~4.442)均为妊娠期女性胎膜早破的独立影响因素(均P<0.05);基于筛选出的独立影响因素建立预测妊娠期女性胎膜早破的列线图模型,ROC曲线显示AUC为0.828(95%CI:0.746~0.869);经拟合优度检验得χ²=6.271(P>0.05);DCA曲线表示列线图模型具有较高的临床实用性。结论 妊娠糖尿病、多次宫腔操作史、TNF-α、NEU、阴道微环境均为妊娠期女性发生胎膜早破的影响因素,基于影响因素建立列线图预测模型具有较高的校准度及预测价值.

Abstract

Objective To analyze factors affecting full-term and preterm premature rupture of membranes (PROM) in pregnant women,and construct a nomogram model based on changes in vaginal microenvironment. Methods 182 pregnant women who received prenatal examination in our hospital from April 2022 to May 2024 were retrospectively selected.According to whether the pregnant woman experienced PROM,they were divided into PROM group (n=60) and non-PROM group (n=122).The clinical data of the pregnant and parturient women were collected,and their vaginal microenvironment indexes were tested.Multivariate Logistic regression analysis was used to analyze influencing factors of POM in pregnant women.And then a nomogram model was established,receiver operating characteristic (ROC) curve,calibration curve and decision curve (DCA) were drawn to verify and analyze their clinical practicality. Results Compared with the non-PROM group,the proportions of the pregnant women with frequent uterine cavity operation histories and gestational diabetes mellitus (GDM) in the PROM group were higher (χ²=4.000 and 7.139 respectively,both P<0.05),and the levels of tumor necrosis factor-α (TNF-α),neutrophil count (NEU) were significantly higher (t=14.459 and 4.981 respectively,both P<0.05).Furthermore,the pH value in the vagina of the pregnant women in the PROM group was higher than that in the non-PROM group (t=9.147,P<0.05),and the positive rates of Escherichia coli,Enterococcus faecalis,Klebsiella pneumoniae,Gardnerella,Pseudomonas aeruginosa and sialidase in the vagina of the pregnant women in the PROM group were significantly higher than those in the non-PROM group (χ²=21.174-59.234,all P<0.05),while the positive rate of lactobacilli in the vagina was lower (χ²=95.210,P<0.05).Multivariate Logistic analysis showed that GDM (OR=4.145,95%CI:1.470-11.693),frequent uterine cavity operations (OR=2.184,95%CI:1.458-3.271),TNF-α (OR=2.555,95%CI:1.381-4.726),NEU (OR=3.130,95%CI:1.361-7.199) and vaginal microenvironment (OR=2.373,95%CI:1.267-4.442) were independent influencing factors for PROM in pregnancy (all P<0.05).The area under the curve (AUC) of the ROC curve for the risk predictive nomogram model of PROM constructed on independent influencing factors for PROM in pregnancy was 0.828 (95%CI:0.746-0.869),suggesting that the nomogram model had good discrimination.The goodness of fit test shown that the chi squared value was 6.271 and the P value >0.05,demonstrating that the calibration curve tended towards an ideal curve with high accuracy,and the DCA curve analysis revealed that the nomogram model had high clinical practicality. Conclusion GDM,frequent uterine cavity operations,TNF-α,NEU,and vaginal microenvironment are the influencing factors of PROM in pregnant women.The nomogram prediction model based on the influencing factors has high calibration and good predictive value.

关键词

阴道微环境 / 妊娠期 / 胎膜早破 / 风险列线图模型

Key words

vaginal microenvironment / pregnancy / premature rupture of membranes / risk nomogram model

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基金资助

山东省优秀中青年科学家科研奖励基金(BS2022SW0239)