河北医科大学学报 ›› 2025, Vol. 46 ›› Issue (3): 323-328.doi: 10.3969/j.issn.1007-3205.2025.03.013

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妊娠期糖尿病患者胎儿生长受限的风险模型构建及验证

  

  1. 南京医科大学常州医学中心，常州市妇幼保健院产科，江苏 常州 213000

  • 出版日期:2025-03-25 发布日期:2025-03-27
  • 作者简介:丁爱萍（1987-），女，江苏盐城人，江苏省常州市妇幼保健院副主任医师，医学硕士，从事产科疾病诊治研究。

  • 基金资助:
    江苏省卫健委科研课题面上项目(M2020094)；南京医科大学常州医学中心临床研究项目（CMCC202205）

Construction and validation of risk model for fetal growth restriction in patients with gestational diabetes

  1. Deparment of Obstetrical Changzhou Maternity and Child Health Care Hospital, Changzhou Medical 
    Center, Nanjing Medical University, Jiangsu Province, Changzhou 213000, China
  • Online:2025-03-25 Published:2025-03-27

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摘要： 目的 探讨妊娠期糖尿病患者胎儿生长受限的风险因素，构建并验证风险预测模型。
方法 回顾性分析2018年12月—2023年12月于常州市妇幼保健院分娩的256例妊娠期糖尿病产妇的病历资料，按照8∶2比例分为训练集（204例）和验证集（52例）。根据是否发生胎儿生长受限分为异常组和正常组，筛查妊娠期糖尿病患者胎儿生长受限的风险因素，构建并验证风险预测模型。
结果 204例妊娠期糖尿病患者中宫内生长受限胎儿22例，发生率为10.78%（22/204）。异常组糖化血红蛋白（glycated hemoglobin A1c,HbA1c）、脐动脉收缩期最大血流峰值（systolic peak velocity，S）/舒张期最小血流峰值（diastolic peak velocity，D）、脐动脉阻力指数（resistance index，RI）、可溶性血管内皮生长因子受体1（soluble vascular endothelial growth factor receptor-1，sVEGFR-1）高于正常组（P＜0.05），肱动脉血流介导的血管舒张功能（flow-mediated dilation，FMD）低于正常组（P＜0.05）。HbA1c（OR=3.601，95%CI：1.511~8.578）、S/D（OR=3.307，95%CI：1.388~7.879）、RI（OR=3.714，95%CI：1.558~8.848）、sVEGFR-1（OR=3.425，95%CI：1.437~8.159）、FMD（OR=0.212，95%CI：0.089~0.506）是妊娠期糖尿病患者发生胎儿生长受限的风险因素（P＜0.05）。风险模型预测训练集妊娠期糖尿病患者发生胎儿生长受限的敏感度为0.823（95%CI：0.729~0.908），特异度为0.826（95%CI：0.751~0.916），曲线下面积为0.884（95%CI：0.819~0.945）。风险模型预测验证集妊娠期糖尿病患者发生胎儿生长受限的敏感度为0.731（95%CI：0.643~0.861），特异度为0.825（95%CI：0.712~0.907），曲线下面积为0.818（95%CI：0.726~0.913）。
结论 HbA1c、S/D、RI、sVEGFR-1、FMD水平变化与妊娠期糖尿病患者发生胎儿生长受限有关，构建风险预测模型有助于早期甄别胎儿生长受限风险。


关键词: 糖尿病,妊娠, 胎儿生长受限, 影响因素, 风险预测模型

Abstract: Objective To explore the risk factors of fetal growth restriction (FGR) in patients with gestational diabetes, and to construct and validate the risk prediction model. 
Methods The medical records of 256 pregnant women with gestational diabetes who delivered in Changzhou Maternal and Child Health Hospital from December 2018 to December 2023 were retrospectively analyzed, and were divided into training set (n=204) and validation set (n=52) according to an 8〖DK〗∶2 ratio. According to restriction of FGR, they were divided into abnormal group and normal group, the risk factors of FGR in patients with gestational diabetes were screened, and the risk prediction model was constructed and verified. 
Results Among 204 patients with gestational diabetes, 22 had intrauterine growth restriction (IUGR), with an incidence of 10.78% (22/204). The glycated hemoglobin A1c (HbA1c), systolic peak velocity (S)/diastolic peak velocity (D), resistance index (RI), and soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) of the abnormal group were higher than those of the normal group (P＜0.05), and the flow mediated dilation (FMD) of the brachial artery was lower than that of the normal group (P＜0.05). HbA1c (OR=3.601, 95%CI: 1.511-8.578), S/D (OR=3.307, 95%CI: 1.388-7.879), RI (OR=3.714, 95%CI: 1.558-8.848), sVEGFR-1 (OR=3.425, 95%CI: 1.437-8.159), FMD (OR=0.212, 95%CI: 0.089-0.506) were risk factors for FGR in patients with gestational diabetes (P＜0.05). The sensitivity of the risk model to predict the occurrence of FGR in diabetic patients during pregnancy in the training set was 0.823 (95%CI: 0.729-0.908), the specificity was 0.826 (95%CI: 0.751-0.916), and the area under the curve (AUC) was 0.884 (95%CI: 0.819-0.945). The sensitivity, specificity, and AUC of the risk model for predicting the occurrence of FGR in pregnant women with diabetes were 0.731 (95%CI: 0.643-0.861), 0.825 (95%CI: 0.712-0.907), and 0.818 (95%CI: 0.726-0.913) respectively. 
Conclusion The changes of HbA1c, S/D, RI, sVEGFR-1 and FMD levels are related to the occurrence of FGR in patients with gestational diabetes. Constructing a risk prediction model is helpful to identify the risk of FGR at an early stage. 


Key words: diabetes, gestational, fetal growth restriction, influencing factor, risk prediction model

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