基于母体特征和病史的双胎妊娠子痫前期筛查的竞争风险模型。
Competing-risks model in screening for pre-eclampsia in twin pregnancy by maternal characteristics and medical history.
机构信息
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK.
Institute of Health Research, University of Exeter, Exeter, UK.
出版信息
Ultrasound Obstet Gynecol. 2017 Oct;50(4):501-506. doi: 10.1002/uog.17529. Epub 2017 Aug 23.
OBJECTIVE
A survival-time regression model for gestational age at delivery with pre-eclampsia (PE) in singleton pregnancy, using maternal demographic characteristics and medical history, was reported previously. The objective of this study was to extend this model to dichorionic (DC) and monochorionic (MC) twin pregnancy.
METHODS
The study population included 1789 DC and 430 MC twin pregnancies and 93 297 singleton pregnancies. A survival-time model for gestational age at delivery with PE was developed from variables of maternal characteristics and medical history. The risk of PE with delivery < 37 weeks and < 42 weeks in twin pregnancies was determined and compared with that in singleton pregnancies.
RESULTS
In singleton pregnancies comprising women of Caucasian racial origin, mean weight of 69 kg at 12 weeks' gestation, mean height of 164 cm, nulliparous, with spontaneous conception, no family history of PE and no history of diabetes mellitus, systemic lupus erythematosus or antiphospholipid syndrome, the mean of the Gaussian distribution of gestational age at delivery with PE was 55 weeks. In DC twins with PE, mean gestational age at delivery was shifted to the left by 8.2 (95% CI, 7.2-9.1) weeks and in MC twins it was shifted to the left by 10.0 (95% CI, 8.5-11.4) weeks. The risk of delivery with PE occurring at, or before, a specified gestational age is given by the area under the fitted distribution curve. For a reference population with the above characteristics, the estimated risk of PE < 37 weeks' gestation, assuming no other cause of delivery, was 0.6% for singletons, 9.0% for DC twins and 14.2% for MC twins; the respective values for PE < 42 weeks were 3.6%, 27.0% and 36.5%.
CONCLUSIONS
A model based on maternal characteristics and medical history has been developed for estimation of patient-specific risks for PE in DC and MC twin pregnancy. Such estimation of the a-priori risk for PE is an essential first step in the use of Bayes' theorem to combine maternal factors with biomarkers for the continuing development of more effective methods of screening for the disease. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
目的
此前曾报道过一种基于单胎妊娠子痫前期（PE）的产妇人口统计学特征和病史的生存时间回归模型，用于预测分娩时的胎龄。本研究的目的是将该模型扩展到双绒毛膜（DC）和单绒毛膜（MC）双胎妊娠。
方法
研究人群包括 1789 例 DC 双胎妊娠和 430 例 MC 双胎妊娠及 93297 例单胎妊娠。从产妇特征和病史变量中建立了一个预测 PE 时分娩时胎龄的生存时间模型。确定了双胎妊娠中 PE 分娩<37 周和<42 周的风险，并与单胎妊娠进行了比较。
结果
在白人种族的单胎妊娠妇女中，12 周时的平均体重为 69kg，平均身高为 164cm，初产妇，自然受孕，无 PE 家族史，无糖尿病、系统性红斑狼疮或抗磷脂综合征病史，PE 时的分娩时胎龄的高斯分布的平均值为 55 周。在患有 PE 的 DC 双胞胎中，分娩时胎龄向左移动了 8.2（95%CI，7.2-9.1）周，而在 MC 双胞胎中，分娩时胎龄向左移动了 10.0（95%CI，8.5-11.4）周。特定胎龄时发生 PE 的风险是通过拟合分布曲线下的面积来表示的。对于具有上述特征的参考人群，假设没有其他分娩原因，PE<37 周的估计风险为单胎妊娠 0.6%，DC 双胞胎妊娠 9.0%，MC 双胞胎妊娠 14.2%；PE<42 周的相应值分别为 3.6%、27.0%和 36.5%。
结论
我们已经建立了一种基于产妇特征和病史的模型，用于估计 DC 和 MC 双胎妊娠中 PE 的患者特异性风险。对 PE 发生的预先风险的这种估计是使用贝叶斯定理将产妇因素与生物标志物相结合以继续开发更有效的疾病筛查方法的必要的第一步。版权所有 ©2017 ISUOG。由 John Wiley & Sons Ltd 出版。
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