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Article(id=1241522766499861226, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202308111, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1691424000000, receivedDateStr=2023-08-08, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931693911, onlineDateStr=2026-03-19, pubDate=1704816000000, pubDateStr=2024-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931693911, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931693911, creator=13701087609, updateTime=1773931693911, updator=13701087609, issue=Issue{id=1241522764012647140, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931693318, creator=13701087609, updateTime=1773931808852, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523248643494379, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523248643494380, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=60, endPage=64, ext={EN=ArticleExt(id=1241522766902514414, articleId=1241522766499861226, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the incidence and influencing factors of gestational hypertension in hospitalized parturient from 2016 to 2022, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the incidence of gestational hypertension in hospital delivery of obstetrics and gynecology from 2016 to 2022, understand its characteristics and changes, to explore the influencing factors of gestational hypertension, and to construct a predictive model of gestational hypertension, to provide basis for clinical prediction of gestational hypertension.

Methods

A total of 101 583 medical records of hospitalized parturient in a hospital of gynecology and obstetrics and children in Sichuan Province from 2016 to 2022 were collected. The χ2 test was used for univariate analysis, logistic regression analysis was used to establish the prediction model of influencing factors, and ROC curve was used to evaluate the discrimination of the prediction model.

Results

The incidence of gestational hypertension in hospital delivery of obstetrics and gynecology from 2016 to 2022 was 0.053. The results of logistic regression model showed that older age (OR=1.392, 95%CI: 1.243-1.559), local household registration (OR=0.760, 95%CI: 0.689-0.839), hypothyroidism (OR=1.443, 95%CI: 1.160-1.794), intrahepatic cholestasis of pregnancy (ICP) (OR=1.874, 95%CI: 1.570-2.237), and diabetes mellitus (OR=1.367, 95%CI: 1.230-1.519), multipara (OR=0.693, 95%CI: 0.623-0.770), multiple births (OR=2.443, 95%CI: 2.135-2.795), family history of hypertension (OR=3.347,95%CI: 2.666-4.203), and in vitro fertilization-embryo transfer (IVF-ET) assisted reproduction (OR=1.821, 95%CI: 1.594-2.080) were the influencing factors of gestational hypertension. The area under the ROC curve constructed by the predictive model of gestational hypertension was AUC=0.655 (95%CI: 0.645-0.665).

Conclusion

The risk factors of gestational hypertension are older age, hypothyroidism, ICP, diabetes, multiple births, family history of hypertension, and IVF-ET assisted reproduction. The protective factors of gestational hypertension are local household registration and multipara. The predictive model of gestationall hypertension established in this study has good discrimination ability and has certain predictive value.

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目的

分析2016—2022年妇产科住院分娩产妇的妊娠期高血压疾病的发生率，了解其特点和变化情况，探讨产妇高血压发生情况的影响因素，构建妊娠期高血压疾病的预测模型，为临床预测妊娠期高血压疾病提供依据。

方法

收集四川省某三甲妇产儿童专科医院2016—2022年医院住院分娩产妇的病历资料共101 583份，采用χ2检验进行单因素分析，采用logistic回归分析建立影响因素预测模型，应用ROC曲线评价预测模型的区分度。

结果

2016—2022年妇产科住院分娩产妇的妊娠期高血压疾病发生率为0.053，logistic回归模型的结果显示，高龄（OR=1.392，95%CI：1.243～1.559）、本地户籍（OR=0.760，95%CI：0.689～0.839）、甲状腺功能减退（OR=1.443，95%CI：1.160～1.794）、ICP（OR=1.874，95%CI：1.570～2.237）、糖尿病（OR=1.367，95%CI：1.230～1.519）、经产妇（OR=0.693，95%CI：0.623～0.770）、多胎（OR=2.443，95%CI：2.135～2.795）、高血压家族史（OR=3.347，95%CI：2.666～4.203）和IVF-ET辅助生殖（OR=1.821，95%CI：1.594～2.080）是妊娠期高血压疾病的影响因素，妊娠高血压预测模型构建的ROC曲线下面积为AUC=0.655（95%CI：0.645～0.665）。

结论

妊娠高血压的危险因素为高龄、甲状腺功能减退、ICP、糖尿病、多胎、高血压家族史、IVF-ET辅助生殖。妊娠高血压的保护因素为本地户籍和经产妇。本研究建立的妊娠期高血压疾病预测模型区分能力较好，具有一定的预测价值。

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李吉杰，E-mail:
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唐雨欣（1990—），女，硕士，主管技师，研究方向：流行病与卫生统计学

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Incidence of gestational hypertension from 2016 to 2022 ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）产妇数妊娠期高血压疾病妊娠期高血压慢性高血压子痫前期重度子痫前期子痫
201611 755586（4.99）175（1.49）135（1.15）78（0.66）190（1.62）8（0.07）
20179 961575（5.77）140（1.41）138（1.39）122（1.22）170（1.71）5（0.05）
201811 663699（5.99）221（1.89）156（1.34）151（1.29）168（1.44）3（0.03）
201915 167867（5.72）251（1.65）156（1.03）257（1.69）198（1.31）5（0.03）
202015 070673（4.47）177（1.17）96（0.64）185（1.23）212（1.41）3（0.02）
202117 237916（5.31）238（1.38）130（0.75）300（1.74）247（1.43）1（0.01）
202220 7301 060（5.11）280（1.35）140（0.68）347（1.67）291（1.40）2（0.01）
χ2值45.55130.64284.94686.5529.60915.227
P值<0.001<0.001<0.001<0.0010.1420.019
χ2趋势值4.3236.01361.18555.1393.91113.268
P趋势值0.0380.014<0.001<0.0010.048<0.001
), ArticleFig(id=1241677625580646485, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522766499861226, language=CN, label=表1, caption=

2016—2022年妊娠期高血压疾病发生情况［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
年份（年）产妇数妊娠期高血压疾病妊娠期高血压慢性高血压子痫前期重度子痫前期子痫
201611 755586（4.99）175（1.49）135（1.15）78（0.66）190（1.62）8（0.07）
20179 961575（5.77）140（1.41）138（1.39）122（1.22）170（1.71）5（0.05）
201811 663699（5.99）221（1.89）156（1.34）151（1.29）168（1.44）3（0.03）
201915 167867（5.72）251（1.65）156（1.03）257（1.69）198（1.31）5（0.03）
202015 070673（4.47）177（1.17）96（0.64）185（1.23）212（1.41）3（0.02）
202117 237916（5.31）238（1.38）130（0.75）300（1.74）247（1.43）1（0.01）
202220 7301 060（5.11）280（1.35）140（0.68）347（1.67）291（1.40）2（0.01）
χ2值45.55130.64284.94686.5529.60915.227
P值<0.001<0.001<0.001<0.0010.1420.019
χ2趋势值4.3236.01361.18555.1393.91113.268
P趋势值0.0380.014<0.001<0.0010.048<0.001
), ArticleFig(id=1241677625719058524, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522766499861226, language=EN, label=Table 2, caption=

Univariate analysis of gestational hypertension

, figureFileSmall=null, figureFileBig=null, tableContent=
变量高血压相关疾病［n（%）］χ2值P值
是否
高龄是1 243(55.57)994(44.43)
否3 182(48.12)3 431(51.88)37.092<0.001
已婚是4 358(49.95)4 367(50.05)
否67(53.60)58(46.40)0.6570.418
初中以上文化是2 600(49.56)2 646(50.44)
否1 825(50.64)1 779(49.36)0.9900.320
孕期参加工作是1 714(47.74)1 876(52.26)
否2 711(51.54)2 549(48.46)12.300<0.001
本地户籍是3 006(47.65)3 303(52.35)
否1 419(55.84)1 122(44.16)48.696<0.001
甲减是613(74.67)208(25.33)
否3 812(47.48)4 217(52.52)220.216<0.001
ICP是490(69.50)215(30.50)
否3 935(48.31)4 210(51.69)116.554<0.001
糖尿病是1 228(57.84)895(42.16)
否3 197(47.52)3 530(52.48)68.716<0.001
经产妇是1 261(45.41)1 516(54.59)
否3 164(52.1)2 909(47.9)34.123<0.001
多胎是1 111(72.38)424(27.62)
否3 314(45.3)4 001(54.7)371.992<0.001
流产次数≥2次是1 010(52.39)918(47.61)
否3 415(49.34)3 507(50.66)5.6130.018
高血压家族史是631(78.97)168(21.03)
否3 794(47.12)4 257(52.88)294.923<0.001
IVFET辅助生殖是1 128(70.90)463(29.10)
否3 297(45.42)3 962(54.58)338.875<0.001
前置胎盘是136(47.06)153(52.94)
否4 289(50.10)4 272(49.9)1.0340.309
甲亢是37(49.33)38(50.67)
否4 388(50.01)4 387(49.99)0.0130.908
血型A1 404(50.50)1 376(49.50)
B1 035(47.87)1 127(52.13)
O1 601(51.36)1 516(48.64)
AB385(48.67)406(51.33)7.0720.070
BMI≥24 kg/m2是920(50.36)907(49.64)
否3 505(49.91)3 518(50.09)0.1170.733
), ArticleFig(id=1241677625882636382, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522766499861226, language=CN, label=表2, caption=

妊娠期高血压疾病单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量高血压相关疾病［n（%）］χ2值P值
是否
高龄是1 243(55.57)994(44.43)
否3 182(48.12)3 431(51.88)37.092<0.001
已婚是4 358(49.95)4 367(50.05)
否67(53.60)58(46.40)0.6570.418
初中以上文化是2 600(49.56)2 646(50.44)
否1 825(50.64)1 779(49.36)0.9900.320
孕期参加工作是1 714(47.74)1 876(52.26)
否2 711(51.54)2 549(48.46)12.300<0.001
本地户籍是3 006(47.65)3 303(52.35)
否1 419(55.84)1 122(44.16)48.696<0.001
甲减是613(74.67)208(25.33)
否3 812(47.48)4 217(52.52)220.216<0.001
ICP是490(69.50)215(30.50)
否3 935(48.31)4 210(51.69)116.554<0.001
糖尿病是1 228(57.84)895(42.16)
否3 197(47.52)3 530(52.48)68.716<0.001
经产妇是1 261(45.41)1 516(54.59)
否3 164(52.1)2 909(47.9)34.123<0.001
多胎是1 111(72.38)424(27.62)
否3 314(45.3)4 001(54.7)371.992<0.001
流产次数≥2次是1 010(52.39)918(47.61)
否3 415(49.34)3 507(50.66)5.6130.018
高血压家族史是631(78.97)168(21.03)
否3 794(47.12)4 257(52.88)294.923<0.001
IVFET辅助生殖是1 128(70.90)463(29.10)
否3 297(45.42)3 962(54.58)338.875<0.001
前置胎盘是136(47.06)153(52.94)
否4 289(50.10)4 272(49.9)1.0340.309
甲亢是37(49.33)38(50.67)
否4 388(50.01)4 387(49.99)0.0130.908
血型A1 404(50.50)1 376(49.50)
B1 035(47.87)1 127(52.13)
O1 601(51.36)1 516(48.64)
AB385(48.67)406(51.33)7.0720.070
BMI≥24 kg/m2是920(50.36)907(49.64)
否3 505(49.91)3 518(50.09)0.1170.733
), ArticleFig(id=1241677626025242726, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522766499861226, language=EN, label=Table 3, caption=

Logistic regression analysis of the influencing factors of gestational hypertension

, figureFileSmall=null, figureFileBig=null, tableContent=
变量B χ2值P值OR值（95%CI）
高龄0.3310.05832.841<0.0011.392（1.243～1.559）
本地户籍-0.2740.05029.637<0.0010.760（0.689～0.839）
甲状腺功能减退0.3670.11110.8820.0011.443（1.160～1.794）
ICP0.6280.09048.337<0.0011.874（1.570～2.237）
糖尿病0.3120.05433.684<0.0011.367（1.230～1.519）
经产妇-0.3670.05446.304<0.0010.693（0.623～0.770）
多胎0.8930.069168.858<0.0012.443（2.135～2.795）
高血压家族史1.2080.116108.164<0.0013.347（2.666～4.203）
IVFET辅助生殖0.5990.06877.745<0.0011.821（1.594～2.080）
常数项-0.2320.05318.845<0.001
), ArticleFig(id=1241677626146877546, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522766499861226, language=CN, label=表3, caption=

妊娠期高血压疾病影响因素的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量B χ2值P值OR值（95%CI）
高龄0.3310.05832.841<0.0011.392（1.243～1.559）
本地户籍-0.2740.05029.637<0.0010.760（0.689～0.839）
甲状腺功能减退0.3670.11110.8820.0011.443（1.160～1.794）
ICP0.6280.09048.337<0.0011.874（1.570～2.237）
糖尿病0.3120.05433.684<0.0011.367（1.230～1.519）
经产妇-0.3670.05446.304<0.0010.693（0.623～0.770）
多胎0.8930.069168.858<0.0012.443（2.135～2.795）
高血压家族史1.2080.116108.164<0.0013.347（2.666～4.203）
IVFET辅助生殖0.5990.06877.745<0.0011.821（1.594～2.080）
常数项-0.2320.05318.845<0.001
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2016—2022年住院产妇妊娠期高血压疾病发生情况及影响因素分析
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唐雨欣 1 , 李黎 1 , 罗会强 2 , 李吉杰 1
现代预防医学 | 儿少卫生与妇幼保健 2024,51(1): 60-64
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现代预防医学 | 儿少卫生与妇幼保健 2024, 51(1): 60-64
2016—2022年住院产妇妊娠期高血压疾病发生情况及影响因素分析
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唐雨欣1, 李黎1, 罗会强2, 李吉杰1
作者信息
  • 1.四川大学华西第二医院病案管理部，出生缺陷及相关妇儿疾病教育部重点实验室，四川 成都 610041
  • 2.四川大学华西医院

    • 唐雨欣（1990—），女，硕士，主管技师，研究方向：流行病与卫生统计学

通讯作者:

李吉杰，E-mail:
Analysis of the incidence and influencing factors of gestational hypertension in hospitalized parturient from 2016 to 2022
Yu-xin TANG1, Li LI1, Hui-qiang LUO2, Ji-jie LI1
Affiliations
  • West China Second Hospital of Sichuan University, Chengdu, Sichuan 610041 , China
出版时间: 2024-01-10 doi: 10.20043/j.cnki.MPM.202308111
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摘要
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目的

分析2016—2022年妇产科住院分娩产妇的妊娠期高血压疾病的发生率，了解其特点和变化情况，探讨产妇高血压发生情况的影响因素，构建妊娠期高血压疾病的预测模型，为临床预测妊娠期高血压疾病提供依据。

方法

收集四川省某三甲妇产儿童专科医院2016—2022年医院住院分娩产妇的病历资料共101 583份，采用χ2检验进行单因素分析，采用logistic回归分析建立影响因素预测模型，应用ROC曲线评价预测模型的区分度。

结果

2016—2022年妇产科住院分娩产妇的妊娠期高血压疾病发生率为0.053，logistic回归模型的结果显示，高龄（OR=1.392，95%CI：1.243～1.559）、本地户籍（OR=0.760，95%CI：0.689～0.839）、甲状腺功能减退（OR=1.443，95%CI：1.160～1.794）、ICP（OR=1.874，95%CI：1.570～2.237）、糖尿病（OR=1.367，95%CI：1.230～1.519）、经产妇（OR=0.693，95%CI：0.623～0.770）、多胎（OR=2.443，95%CI：2.135～2.795）、高血压家族史（OR=3.347，95%CI：2.666～4.203）和IVF-ET辅助生殖（OR=1.821，95%CI：1.594～2.080）是妊娠期高血压疾病的影响因素，妊娠高血压预测模型构建的ROC曲线下面积为AUC=0.655（95%CI：0.645～0.665）。

结论

妊娠高血压的危险因素为高龄、甲状腺功能减退、ICP、糖尿病、多胎、高血压家族史、IVF-ET辅助生殖。妊娠高血压的保护因素为本地户籍和经产妇。本研究建立的妊娠期高血压疾病预测模型区分能力较好，具有一定的预测价值。

妊娠期高血压  /  住院  /  影响因素  /  预测模型
Objective

To analyze the incidence of gestational hypertension in hospital delivery of obstetrics and gynecology from 2016 to 2022, understand its characteristics and changes, to explore the influencing factors of gestational hypertension, and to construct a predictive model of gestational hypertension, to provide basis for clinical prediction of gestational hypertension.

Methods

A total of 101 583 medical records of hospitalized parturient in a hospital of gynecology and obstetrics and children in Sichuan Province from 2016 to 2022 were collected. The χ2 test was used for univariate analysis, logistic regression analysis was used to establish the prediction model of influencing factors, and ROC curve was used to evaluate the discrimination of the prediction model.

Results

The incidence of gestational hypertension in hospital delivery of obstetrics and gynecology from 2016 to 2022 was 0.053. The results of logistic regression model showed that older age (OR=1.392, 95%CI: 1.243-1.559), local household registration (OR=0.760, 95%CI: 0.689-0.839), hypothyroidism (OR=1.443, 95%CI: 1.160-1.794), intrahepatic cholestasis of pregnancy (ICP) (OR=1.874, 95%CI: 1.570-2.237), and diabetes mellitus (OR=1.367, 95%CI: 1.230-1.519), multipara (OR=0.693, 95%CI: 0.623-0.770), multiple births (OR=2.443, 95%CI: 2.135-2.795), family history of hypertension (OR=3.347,95%CI: 2.666-4.203), and in vitro fertilization-embryo transfer (IVF-ET) assisted reproduction (OR=1.821, 95%CI: 1.594-2.080) were the influencing factors of gestational hypertension. The area under the ROC curve constructed by the predictive model of gestational hypertension was AUC=0.655 (95%CI: 0.645-0.665).

Conclusion

The risk factors of gestational hypertension are older age, hypothyroidism, ICP, diabetes, multiple births, family history of hypertension, and IVF-ET assisted reproduction. The protective factors of gestational hypertension are local household registration and multipara. The predictive model of gestationall hypertension established in this study has good discrimination ability and has certain predictive value.

Gestational hypertension  /  Hospitalization  /  Influencing factors  /  Predictive model
唐雨欣, 李黎, 罗会强, 李吉杰. 2016—2022年住院产妇妊娠期高血压疾病发生情况及影响因素分析. 现代预防医学, 2024 , 51 (1) : 60 -64 . DOI: 10.20043/j.cnki.MPM.202308111
Yu-xin TANG, Li LI, Hui-qiang LUO, Ji-jie LI. Analysis of the incidence and influencing factors of gestational hypertension in hospitalized parturient from 2016 to 2022[J]. Modern Preventive Medicine, 2024 , 51 (1) : 60 -64 . DOI: 10.20043/j.cnki.MPM.202308111
正文
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妊娠期高血压疾病是妊娠期常见并发症，发生率约为5%～12%，包括妊娠期高血压、子痫前期、子痫、妊娠合并慢性高血压等[1]。妊娠期高血压疾病是导致孕产妇和围产儿的患病率及死亡率增加的最常见原因之一，也是世界上孕妇死亡的3个主要原因之一，该病严重威胁着母婴的健康[2-5]。近年来，尽管由于国家对孕产妇健康的重视以及产检制度的完善，我国的子痫和子痫前期的患病率明显下降，但由于2016年全面开放二胎及2021年开放三胎以来，由于高龄产妇的增加，妊娠期高血压疾病的患病率仍持续增加[6]。因此，为了解妊娠期高血压疾病的发生情况，本研究通过回顾性分析2016—2022年妇产科住院分娩产妇的高血压疾病发生率，了解妊娠期高血压疾病的发生特点和多年来的变化情况，进一步采用1:1病例对照研究的方法来探讨妊娠期高血压疾病发生的影响因素并建立妊娠期高血压的预测模型。
1　资料与方法
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1.1　资料来源
本研究回顾性收集2016年1月1日—2022年12月31日于四川省某三甲妇产儿童专科医院的住院分娩产妇的病历资料，收集的信息包括产妇的基本信息、妊娠期的合并症和并发症，既往史和家族史等。患者的合并症和并发症根据疾病和有关健康问题的国际统计分类（ICD-10）进行统计。
在进行妊娠期高血压疾病的影响因素分析时，将妊娠期高血压疾病（除外妊娠合并慢性高血压）产妇作为实验组，共计4 425名产妇进入实验组。在其余产妇中按照出院日期等距抽样的办法，抽取与与高血压疾病产妇比例为1:1的产妇作为对照组，共计4 425名产妇进入对照组。本研究获得四川大学华西第二医院医学伦理委员会（伦理号：261）的批准，且获得了对患者免除知情同意书的申请。
1.2　观察指标
产妇的基本信息包括年龄、血型、身高、体重、婚姻状况、文化程度、户籍地址、孕期是否参加工作，妊娠期的合并症和并发症包括妊娠合并甲状腺功能减退、妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）、糖尿病、前置胎盘、甲状腺功能亢进等，既往史和家族史包括妊娠次数、分娩次数、流产次数、高血压家族史、是否体外受精-胚胎移植（in vitro fertilization and embryo transfer，IVF-ET）辅助生殖等。患者的年龄划分为高龄（分娩年龄≥35岁）和非高龄（分娩年龄<35岁），患者的孕前BMI划分为非超重组（<24 kg/m2）和超重组（≥24 kg/m2）。
1.3　统计学方法
采用excel 2011和SPSS 26.0对数据进行整理和分析，采用χ2检验进行单因素分析，采用logistic回归分析探讨妊娠期高血压疾病的影响因素，建立妊娠期高血压疾病的预测模型，检验水准α=0.05。
2　结果
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2.1　不同年份妊娠期高血压疾病发生情况及各亚型患病率
2016—2022年该院共收治入院101 583名产妇，其中妊娠期高血压疾病的产妇共5 376名，住院产妇妊娠期高血压疾病的患病率为0.053。7年来，不同年份的妊娠期高血压疾病的患病率差异有统计学意义（χ2=45.551，P<0.001），不同年间妊娠期高血压疾病的患病率呈现总体上升的趋势（χ2趋势=4.323，P=0.038），见表1。
妊娠期高血压疾病各亚型的患病率为：妊娠期高血压患病率为0.015，慢性高血压患病率为0.009，子痫前期患病率为0.014，重度子痫前期患病率为0.015，子痫患病率为0.000 3。妊娠期高血压疾病各亚型患病率在2016—2022年间的趋势χ2检验均有统计学差异，妊娠期高血压（χ2趋势=6.013，P=0.014）、慢性高血压（χ2趋势=61.185，P<0.001）、重度子痫前期（χ2趋势=55.139，P<0.001）、子痫（χ2趋势=3.911，P=0.048）均呈现总体下降的趋势，子痫前期（χ2趋势=13.268，P<0.001）呈现总体上升的趋势。
2.2　妊娠期高血压疾病单因素分析
本研究共纳入8 850名产妇（试验组和对照组均为4 425例）进行影响因素分析，试验组组产妇的平均年龄为（32.11±4.613）岁，对照组产妇的平均年龄为（31.36±4.076）岁，高血压组产妇的年龄高于对照组产妇，差异有统计学意义（t=8.115，P<0.001）。
单因素分析结果显示，高血压的分布情况在是否高龄、孕期是否参加工作、是否本地户籍、是否甲减、是否ICP、是否糖尿病、是否为初产妇、是否为多胎、是否流产次数≥2次、是否有高血压家族史、是否IVF-ET辅助生殖之间有统计学差异（P<0.05），高血压的分布在不同文化程度、是否已婚、是否胎盘前置、是否甲亢、不同血型的孕妇之间无统计学意义（P>0.05）。见表2。
2.3　妊娠期高血压疾病多因素分析及预测模型的构建
将单因素分析中有统计学意义的变量纳入多因素分析，模型的变量赋值情况均为：0=否，1=是。采用逐步法进行logistic回归模型的建立，进入α=0.05，去除α=0.1。结果显示χ2=1 054.911（P<0.001），模型具有统计学意义。
Logistic回归模型结果显示，高龄、本地户籍、甲状腺功能减退、ICP、糖尿病、经产妇、多胎、高血压家族史、IVF-ET辅助生殖是妊娠高血压的影响因素（P<0.05），见表3。
2.4　妊娠期高血压疾病影响因素预测模型的构建
根据表3的结果建立妊娠期高血压疾病预测模型（Logit模型）：Logit(P)=0.331×高龄-0.156×孕期参加工作-0.274×本地户籍+0.367×甲减+0.628×ICP+0.312×糖尿病-0.367×经产妇+0.893×多胎+1.208×高血压家族史+0.599×IVF-ET辅助生殖-0.232。
以模型的预测概率作为检验变量，以临床是否发生妊娠期高血压疾病作为金标准，绘制ROC曲线评价模型的区分度，结果显示，ROC曲线下面积为0.689（95%CI：0.678～0.700），见图1。采用采用Hosmer-Lemeshow检验，结果显示χ2=7.621（P=0.471），有统计学意义，表明该模型拟合较好。
3　讨论
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2016—2022年期间，住院产妇妊娠期高血压患病率为0.053，妊娠期高血压患病率较高，本次研究所纳入的医院是西南地区唯一的卫生部直属妇产儿童专科医院，因此收治了较多周边城市的危重症患者。2016—2022年期间住院分娩的妊娠期高血压疾病的发生率为0.053，低于颜雪梅等人[4]报道的2012—2019年住院产妇的妊娠期高血压疾病的发生率，说明近年来妊娠期高血压疾病的患病率有所降低。本次研究结果显示，2016年妊娠期高血压疾病呈上升趋势，2019年开始下降，直至2021年妊娠期高血压又呈现上升趋势。这可能与2016年全面开放二胎以及2021年开放三胎的政策初期高龄产妇比例有所增加导致的。
高龄、甲状腺功能减退、ICP、糖尿病、高血压家族史是妊娠期高血压疾病的危险因素。高龄是妊娠期高血压疾病的危险因素（OR=1.392），高龄人群怀孕后由于子宫等器官的衰退、自身免疫机制等原因容易导致孕妇的外周血管阻力增加，造成妊娠期高血压疾病的发生，本研究的结果与王佳佳等人[6]的研究结果一致。甲状腺功能减退是妊娠期高血压疾病的危险因素（OR=1.443），既往的研究表明[7-8]，甲状腺功能减退不仅会增加心血管疾病发生的风险，也会对血管内皮的功能和脂代谢产生一定的影响，因此甲状腺功能减退会增加产妇发生高血压疾病的风险，该结论与郭菁菁[9]的甲状腺功能减退与妊娠期高血压疾病的相关性及母婴结局的meta分析结论一致。ICP是妊娠期高血压疾病的危险因素（OR=1.874），本研究结果与既往的的研究结果一致，周旭平等人[10]的研究结果显示，ICP是高血压疾病的危险因素（OR=1.440）。李伟等人[11]的研究结果显示，孕妇发生ICP时，雌激素水平的升高可能会引起胎盘绒毛表面的血管痉挛，从而导致妊娠妊娠期高血压疾病的发生。妊娠期糖尿病是妊娠期高血压疾病的危险因素（OR=1.367，95%CI：1.230～1.519），该研究结果与既往的研究结果一致，王佳佳等人[6]的研究结果显示，妊娠糖尿病史妊娠期高血压的危险因素（OR=5.124）。高血压疾病是一种遗传性疾病，具有高血压家族史的孕妇更容易发生妊娠期高血压疾病，冯永亮、简珊等人[12-13]的研究结果均显示，具有高血压家族史的孕妇发生妊娠期高血压疾病的可能性是无高血压家族史孕妇的3.61～7.34倍。
多胎、IVF-ET辅助生殖是妊娠期高血压疾病的危险因素。多胎是妊娠期高血压疾病的危险因素（OR=2.443）；IVF-ET辅助生殖是妊娠期高血压疾病的危险因素（OR=1.821）。该研究结果与既往的研究结果一致，周旭平等人[10]的研究结果显示，多胎（OR=2.22）、IVF-ET辅助生殖（OR=1.25）是妊娠期高血压疾病的危险因素；张翠等人[2]的研究结果显示，多胎产妇的高血压疾病患病率明显高于单胎产妇；姜婷婷等人[14]的研究结果显示，多胎是妊娠期高血压疾病的危险因素（OR=3.273）。2019年妊娠期高血压疾病血液管理专家共识[15]认为，多胎孕妇由于子宫张力过高，IVF-ET辅助生殖孕妇由于内分泌系统变化机制的影响，更容易发生妊娠期高血压。
本地户籍、经产妇是妊娠期高血压疾病的保护因素。本地户籍是妊娠期高血压疾病的保护因素（OR=0.760），这是可能是由于样本医院是该地区的危重孕产妇救治中心，外地的危重孕妇才会选择来样本医院，这也是本研究的局限性，后续研究中可纳入多个医院开展多中心的研究，从而全面反映妊娠期高血压疾病的发生情况及影响因素。经产妇是妊娠期高血压疾病的保护因素（OR=0.693），本研究结果与周旭平等人[10]的宁波市住院分娩产妇中妊娠期高血压一文中的研究结果一致，随着三胎政策的开放，经产妇的比例会有所增加，这可能会在一定程度上降低妊娠期高血压疾病的发生率。
本研究进一步建立了影响因素的预测模型，结果显示ROC曲线下面积为AUC=0.689（95%CI：0.678～0.700），说明该模型能够在一定程度上预测产妇发生妊娠期高血压疾病的风险。此外，Hosmer-Lemeshow检验，结果显示χ2=7.621（P=0.471），有统计学意义，表明该模型拟合较好，可用于产妇的妊娠期高血压疾病的预测。因此该模型具有一定的临床指导意义，对于早预防早发现妊娠期高血压疾病具有一定的实际意义。
基金
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  • 四川省科技厅软科学(2022JDR0197)
文献
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中华医学会心血管病学分会女性心脏健康学组， 中华医学会心血管病学分会高血压学组.妊娠期高血压疾病血压管理专家共识(2019)[J].中华心血管病杂志，2020，48（3）：195-204.
Women's Heart Health Group of the Chinese Medical Association Cardiovascular Disease Branch, Hypertension Group of the Chinese Medical Association Cardiovascular Disease Branch. Expert consensus on blood pressure management of pregnancy induced hypertension(2019)[J]. Chinese Journal of Cardiovascular Disease, 2020, 48(3): 195-204.
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doi: 10.20043/j.cnki.MPM.202308111
  • 接收时间：2023-08-08
  • 首发时间：2026-03-19
  • 出版时间：2024-01-10
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  • 收稿日期：2023-08-08
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四川省科技厅软科学(2022JDR0197)
作者信息
    1.四川大学华西第二医院病案管理部，出生缺陷及相关妇儿疾病教育部重点实验室，四川 成都 610041
    2.四川大学华西医院

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李吉杰，E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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