实用临床医药杂志2026，Vol.30Issue(4)：104-110,7.DOI:10.7619/jcmp.20256987
基于超声造影联合胎盘生长因子的早发型子痫前期预警模型构建与评估
Construction and evaluation of an early-onset preeclampsia prediction model based on contrast-enhanced ultrasound combined with placental growth factor
摘要
Abstract
Objective To construct an early-onset preeclampsia(EOSP)prediction model based on contrast-enhanced ultrasound combined with placental growth factor(PlGF)and evaluate its efficacy.Methods Eighty-six patients with EOSP were selected as case group(strictly defined as those who first presented with symptoms and were diagnosed at a gestational age of less than 34 weeks and had not reached the state of emergency termination of pregnancy at the time of examination).An-other 100 healthy late-pregnancy pregnant women during the same period were selected as control group.Pregnant women in both groups underwent placental contrast-enhanced ultrasound examination to obtain perfusion parameters such as arrival time(AT),time to peak(TTP),peak intensity(PI),and area under the curve(AUC).Enzyme-linked immunosorbent assay(ELISA)was used to detect serum PlGF levels.Univariate and multivariate logistic regression analyses were used to screen inde-pendent influencing factors,and two combined prediction models were constructed(Model 1:only included potential early indicators TTP,PI,and PlGF;Model 2:included all variables with statisti-cally significant differences).Model performance was evaluated using receiver operating characteris-tic(ROC)curves,calibration curves,the Hosmer-Lemeshow test,and Bootstrap internal validation(1 000 repeated samplings).The clinical utility of the models was verified through decision curve a-nalysis(DC A).Results The median time interval from examination to diagnosis in the case group was 4.2(2.8,5.6)weeks.The systolic and diastolic blood pressures of pregnant women in the case group were higher than those in the control group,while the fetal biparietal diameter,femoral length,and placental thickness were smaller than those in the control group;the AT and TTP were longer,and the PI and AUC were lower in the case group compared with the control group;the serum PlGF level in the case group was also lower than that in the control group,and all differences above were statistically significant(P＜0.05).The formula for Model 1 was Logit(P)=-4.218+0.758 × TTP-0.888 × PI-0.954 × PlGF.After Bootstrap internal validation,the AUC of Model 1 was 0.897(95％CI,0.852 to 0.932),and the AUC of Model 2 after validation was 0.903(95％CI,0.860 to 0.938),with no significant difference between the two(P=0.621).Model 1 had good cal-ibration(Hosmer-Lemeshow test:x2=6.325,P=0.619).Using a predicted probability of 0.35 as the cut-off value,the sensitivity was 87.2％,and the specificity was 89.0％.DCA showed that when the risk threshold was between 0.15 and 0.80,the clinical net benefit of Model 1 was significantly higher than that of the"full-intervention"or"no-intervention"strategies.Conclusion The predic-tion model(Model 1)based on placental perfusion parameters(TTP,PI)from contrast-enhanced ultrasound combined with serum PlGF has good discrimination,calibration,and clinical utility.It can effectively provide early warning before the clinical symptoms of EOSP appear,with better effi-cacy than single indicators,and the early-warning time window is up to 4.2 weeks,providing a reli-able basis for early screening,risk stratification,and clinical intervention of EOSP.关键词
早发型子痫前期/超声造影/胎盘生长因子/预警模型/胎盘灌注/风险分层/Logistic回归分析/决策曲线分析Key words
early-onset preeclampsia/contrast-enhanced ultrasound/placental growth factor/prediction model/placental perfusion/risk stratification/logistic regression analysis/decision curve analysis分类
医药卫生引用本文复制引用
纪莉,王超..基于超声造影联合胎盘生长因子的早发型子痫前期预警模型构建与评估[J].实用临床医药杂志,2026,30(4):104-110,7.基金项目
国家自然科学基金项目(82110379) （82110379）
陕西省科技计划项目(2024JC-YBMS-674) （2024JC-YBMS-674）
