关键词: 胎儿生长受限, 妊娠期肝内胆汁淤积症, 影响因素, 临床特征, 预测价值

Abstract:

Objective　To construct a Nomogram model to predict fetal growth restriction in patients with intrahepatic cholestasis of pregnancy (ICP) based on the clinical features, and to verify its efficacy. Methods　The clinical data of 344 patients with ICP treated at Jinan Maternal and Child Health Hospital Affiliated to Shandong First Medical University from January 2018 to January 2024 were retrospectively analyzed. They were followed up until delivery. They were divided into an occurrence group and a non-occurrence group according to whether they had fetal growth restriction, and the clinical data were compared between the two groups by independent-sample t test and χ² test. The influencing factors of ICP complicated with fetal growth restriction were analyzed by the multivariate logistic regression analysis. The individualized prediction Nomogram model was constructed using the R software, and receiver operating characteristic curves (ROC) and calibration curves were drawn to verify the prediction efficacy of the model. Results　Among the 344 patients, 51 had fetal growth restriction, with an incidence rate of 14.83%. The proportions of the patients with pregnancy-induced hypertension syndrome and gestational diabetes mellitus and the level of total bile acid in the occurrence group were higher than those in the non-occurrence group(all P<0.05), and the amniotic fluid index and folic acid level were lower (both P<0.05). Pregnancy-induced hypertension syndrome (OR=2.675, 95%CI 1.382-5.179), gestational diabetes mellitus (OR=2.921, 95%CI 1.494-5.711), total bile acid (OR=1.956, 95%CI 1.089-3.515), amniotic fluid index (OR=0.471, 95%CI 0.285-0.780), and folic acid (OR=0.525, 95%CI 0.322-0.856) were the influencing factors of fetal growth restriction in the patients (all P<0.05). Taking the influencing factors as risk predictors, an individualized prediction Nomogram model for fetal growth restriction in the patients was constructed. The ROC showed that the area under the curve, sensitivity, and specificity for predicting fetal growth restriction in the patients with ICP were 0.932 (95%CI 0.869-0.970), 94.12%, and 85.67%, respectively; the calibration curve showed that the prediction probability of the model was close to the actual probability; the Hosmer-Lemeshow goodness-of-fit test showed that the fitting was good (χ²=1.905, P=0.312). Conclusions　Pregnancy-induced hypertension syndrome, gestational diabetes mellitus, total bile acid, amniotic fluid index, and folic acid are the influencing factors of fetal growth restriction in patients with ICP. The individualized prediction Nomogram model based on the above clinical features has good prediction efficacy for ICP complicated with fetal growth restriction and good clinical application value.

Key words: Fetal growth restriction,  , Intrahepatic cholestasis of pregnancy,  , Influencing factors,  , Clinical features,  , Predictive value