目的:比较三种不同的孕早期筛查数学模型对先兆子痫(PE)的预测性能,将产妇危险因素与平均动脉压(MAP)相结合,子宫动脉搏动指数(UtA-PI)和血清胎盘生长因子(PlGF),和两个风险评分系统,基于NICE和ACOG的建议。
方法:这是一项前瞻性队列研究,于2017年9月至2019年12月在西班牙五个不同地区的八个胎儿医学单位进行。邀请所有在妊娠110至136周进行常规超声检查的单胎妊娠和非畸形活胎孕妇参加研究。记录产妇特征和病史,并测量MAP,UtA-PI,血清PlGF和妊娠相关血浆蛋白A(PAPP-A)转换为中位数(MoM)的倍数。期限风险,根据FMF竞争风险模型计算早产PE(<37周妊娠)和早期PE(<34周妊娠),Crovetto等人。,Logistic回归模型,和Serra等人。,高斯模型。还进行了基于NICE和ACOG指南的患者分类。我们在固定的10%筛查阳性率(SPR)下,用95%置信区间(CI)估计检出率(DR),以及早产儿PE的接收器工作特征曲线下面积(AUROC),早期PE,和所有PE的三个数学模型。对于评分系统,我们计算了DR和SPR。还评估了风险校准。
结果:研究人群包括10,110例单胎妊娠,包括32例(0.3%)发展为早期PE,72例(0.7%)发生早产PE,230例(2.3%)发生任何PE。在固定的10%SPR下,FMF,Crovetto等人。,和Serra等人。,检测到82.7%(95%CI,69.6至95.8%),73.8%(95%CI,58.7至88.9%),早期PE的79.8%(95%CI,66.1至93.5%);72.7%(95%CI,62.9至82.6%),69.2%(95%CI,58.8至79.6%),早产PE的74.1%(95%CI,64.2至83.9%)和55.1%(95%CI,48.8至61.4%),47.1%(95%CI,40.6至53.5%),和所有PE的53.9%(95%CI,47.4至60.4%),分别。预测病例和观察病例之间的最佳相关性是通过FMF模型实现的,AUROC为0.911(95%CI,0.879至0.943),斜率为0.983(95%CI,0.846-1.120),截距为0.154(95%CI,-0.091至0.397)。NICE标准在11%SPR时确定了46.7%(95%CI,35.3%至58.0%)的早产PE,ACOG标准在33.8%SPR时确定了65.9%(95%CI,55.4%至76.4%)的早产PE。
结论:通过将母体因素与MAP相结合的数学模型,可以实现筛查早产PE的最佳性能,UtA-PI和PlGF,与NICE或ACOG标准等风险评分系统相比。虽然所有三种算法在总体预测方面都显示出相似的结果,FMF模型在个体水平上表现最佳。本文受版权保护。保留所有权利。
OBJECTIVE: To compare the predictive performance of three different mathematical models for first-trimester screening of pre-eclampsia (PE), which combine maternal risk factors with mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF), and two risk-scoring systems.
METHODS: This was a prospective cohort
study performed in eight fetal medicine units in five different regions of Spain between September 2017 and December 2019. All pregnant women with singleton pregnancy and a non-malformed live fetus attending their routine ultrasound examination at 11 + 0 to 13 + 6 weeks\' gestation were invited to participate in the
study. Maternal characteristics and medical history were recorded and measurements of MAP, UtA-PI, serum PlGF and pregnancy-associated plasma protein-A (PAPP-A) were converted into multiples of the median (MoM). Risks for term PE, preterm PE (< 37 weeks\' gestation) and early PE (< 34 weeks\' gestation) were calculated according to the FMF competing-risks model, the Crovetto et al. logistic regression model and the Serra et al. Gaussian model. PE classification was also performed based on the recommendations of the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG). We estimated detection rates (DR) with their 95% CIs at a fixed 10% screen-positive rate (SPR), as well as the area under the receiver-operating-characteristics curve (AUC) for preterm PE, early PE and all PE for the three mathematical models. For the scoring systems, we calculated DR and SPR. Risk calibration was also assessed.
RESULTS: The
study population comprised 10 110 singleton pregnancies, including 32 (0.3%) that developed early PE, 72 (0.7%) that developed preterm PE and 230 (2.3%) with any PE. At a fixed 10% SPR, the FMF, Crovetto et al. and Serra et al. models detected 82.7% (95% CI, 69.6-95.8%), 73.8% (95% CI, 58.7-88.9%) and 79.8% (95% CI, 66.1-93.5%) of early PE; 72.7% (95% CI, 62.9-82.6%), 69.2% (95% CI, 58.8-79.6%) and 74.1% (95% CI, 64.2-83.9%) of preterm PE; and 55.1% (95% CI, 48.8-61.4%), 47.1% (95% CI, 40.6-53.5%) and 53.9% (95% CI, 47.4-60.4%) of all PE, respectively. The best correlation between predicted and observed cases was achieved by the FMF model, with an AUC of 0.911 (95% CI, 0.879-0.943), a slope of 0.983 (95% CI, 0.846-1.120) and an intercept of 0.154 (95% CI, -0.091 to 0.397). The NICE criteria identified 46.7% (95% CI, 35.3-58.0%) of preterm PE at 11% SPR and ACOG criteria identified 65.9% (95% CI, 55.4-76.4%) of preterm PE at 33.8% SPR.
CONCLUSIONS: The best performance of screening for preterm PE is achieved by mathematical models that combine maternal factors with MAP, UtA-PI and PlGF, as compared to risk-scoring systems such as those of NICE and ACOG. While all three algorithms show similar results in terms of overall prediction, the FMF model showed the best performance at an individual level. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.