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摘要：
【摘要】 目的 构建预测剖宫产产妇产后抑郁（postpartum depression, PPD）发生风险的列线图模型。 方法 纳入2021年5月至2021年10月于徐州医科大学附属医院行剖宫产手术的341例产妇，根据产后3个月的爱丁堡产后抑郁量表（Edinburgh Postnatal Depression Scale, EPDS）评分是否≥10分分为PPD组（109例）和非PPD组（232例）。采用Logistic回归分析筛选PPD的独立危险因素，以列线图法对各危险因素进行综合并建模。采用受试者工作特征（receiver operating characteristic, ROC）曲线、校准曲线、Hosmer‑Lemeshow拟合优度检验、决策曲线分析（decision curve analysis, DCA）等评估模型，最后以Bootstrap法进行内部验证。 结果 PPD的发生率为31.96%。Logistic回归分析显示：早产、初产妇、夫妻平均月收入<5 000元、产前抑郁、产前焦虑、社会支持水平低、婚姻满意度低是剖宫产产妇发生PPD的独立危险因素，其比值比（odds ratio, OR）及95％CI分别为3.514（1.681~7.346）、2.105（1.119~3.958）、2.145（1.176~3.914）、13.491（5.345~34.052）、2.841（1.429~5.647）、5.231（1.371~19.956）、9.446（4.208~21.205），P值均<0.05。以上述因素构建列线图模型，其预测剖宫产产妇PPD发生风险的ROC曲线下面积（area under the curve, AUC）为0.873（95%CI 0.830~0.915），灵敏度和特异性分别为80.7%和82.2%；校准曲线为斜率接近１的直线；Hosmer‑Lemeshow检验χ²值为3.571，P值为0.735；DCA显示当潜在风险阈值取25.1%时可获得较好的净收益。内部验证显示该模型具有良好的一致性。 结论 剖宫产产妇PPD发生率较高且影响因素较为复杂，本研究构建的列线图模型有助于对PPD进行早期筛查。
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Abstract: 【Abstract】 Objective To construct a nomogram model to predict the risk of postpartum depression (PPD) after cesarean section. Methods A total of 341 parturients who underwent cesarean section in the Affiliated Hospital of Xuzhou Medical University from May 2021 to October 2021 were included in this study. If the score of the Edinburgh Postpartum Depression Scale (EPDS) at 3 months postpartum ≥10, the participant was divided into the PPD group (n=109), otherwise into the non‑PPD group (n=232). Logistic regression was used to screen independent risk factors of PPD. A nomogram model was constructed by integrating these independent risk factors and evaluated by receiver operating characteristic (ROC) curve, calibration curve, Hosmer‑Lemeshow goodness‑of‑fit test， and decision curve analysis (DCA). Finally, the prediction model was then internally verified by Bootstrap. Results The incidence of PPD was 31.96%. Logistic regression showed that preterm delivery, primiparae, average monthly income of couples <5 000, prenatal depression, prenatal anxiety, low level of social support, and low level of marital satisfaction were independent risk factors for PPD after cesarean section. Odds ratio (OR) and 95% confidence interval (CI) were 3.514 (1.681, 7.346), 2.105 (1.119, 3.958), 2.145 (1.176, 3.914), 13.491 (5.345, 34.052), 2.841 (1.429, 5.647), 5.231 (1.371, 19.956) and 9.446 (4.208, 21.205), respectively (all P<0.05). The nomogram model was constructed by the above factors. The area under the ROC curve for predicting the risk of PPD was 0.873 (95%CI 0.830−0.915), with the sensitivity and specificity of 80.7% and 82.2%, respectively. The calibration curve was a straight line with a slope of nearly 1, the goodness‑of‑fit test showed χ²=3.571, P=0.735, the DCA showed a good net gain when the potential risk threshold was 25.1%, and internal validation showed a good consistency of the model. Conclusions The incidence of PPD in parturients after cesarean section is high and the influencing factors are complicated. The nomogram model constructed in this study can facilitate early screening.
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