【摘要】 目的:通过临床肝功能数据驱动的聚类分析以识别子痫前期(PE)患者的不同亚类，并探讨不同亚类肝功能特征与妊娠并发症的相关性。方法:收集2012年1月至2022年12月在福建省妇幼保健院产检并分娩的单胎PE孕妇2230例临床资料，以分娩前13个肝功能指标为基线变量，应用聚类法对所有纳入对象进行亚型分类，比较不同亚类患者的临床特征，并采用单因素Logistic回归分析各亚类患者发生妊娠并发症和合并症的风险情况。结果:聚类分析结果显示，纳入研究的PE患者被分为3个亚类，代表了患者肝功能的不同特征。第一类患者(n=1065)存在碱性磷酸酶(ALP)水平升高为主要特征的肝脏酶学指标异常；第二类患者(n=648)存在总胆红素(TBIL)、直接胆红素(DBIL)和间接胆红素(IBIL)水平升高的胆红素代谢指标异常；第三类患者(n=517)同时存在丙氨酸转氨酶(ALT)、天门冬氨酸转氨酶(AST)水平升高的肝脏酶学指标异常，总胆汁酸(TBA)水平升高的胆汁酸检测指标异常，以及总蛋白(TP)、白蛋白(ALB)、球蛋白(GLB)水平降低的肝脏蛋白合成功能指标异常。三类PE患者在年龄、重度PE、贫血、心功能异常及肾功能异常方面差异均有统计学意义(P<0.05)。单因素Logistic回归分析显示，第三类患者妊娠期肝内胆汁淤积症、胎儿生长受限、胎膜早破及早产风险显著高于第一、二类(P<0.05),胎盘早剥风险高于第二类(P<0.05);第一类患者胎盘早剥和胎儿生长受限风险高于第二类(P<0.05)。结论:聚类分析可利用肝功能特征对PE患者进行亚型分类，进而识别妊娠并发症的发生，对认识PE异质性和促进个体化管理具有一定意义。更多还原

【Abstract】 Objective:To identify different subtypes of patients with preeclampsia(PE) through clinical liver function index data-driven the cluster analysis, to explore the correlation between liver function of different subtypes and pregnancy complications.Methods:From January 2012 to December 2022,the general data of 2230 singleton pregnant women with PE who underwent prenatal examination and delivered in Fujian Maternity and Child Health Hospital were collected.Using 13 liver function indexes before delivery as baseline variables, all included subjects were classified into subtypes by cluster method.The clinical characteristics of different subtypes of PE patients were compared.Single-factor Logistic regression was used to analyze the risk of pregnancy complications among subtypes.Results:PE patients were divided into 3 subgroups that represented different characteristics of patients’ liver function.The first subtype(n=1065) exhibited abnormal liver enzymology index characterized by increased alkaline phosphatase(ALP) level.The second subtype(n=648) showed abnormal bilirubin metabolism index with the highest levels of total bilirubin(TBIL),direct(DBIL) and indirect bilirubin(IBIL).The third subtype(n=517) had abnormal liver enzymology indexes with elevated alanine aminotransferase(ALT) and aspartate aminotransferase(AST) levels, abnormal bile acid detection indexes with elevated total bile acid(TBA) levels, and abnormal liver synthesis function indexes with decreased total protein(TP),albumin(ALB),and globulin levels(GLB).Significant differences were observed among the three subtypes in age, severe PE,anemia, cardiac dysfunction, and renal dysfunction(P<0.05).Single-factor Logistic regression demonstrated that the third subtype had significantly higher risks of intrahepatic cholestasis of pregnancy, fetal growth restriction, premature rupture of membranes, and preterm birth compared to the first and second subtypes(P<0.05),as well as a higher risk of placental abruption than the second subtype(P<0.05).The first subtype had higher risks of placental abruption and fetal growth restriction than the second subtype(P<0.05).Conclusions:Cluster analysis could be used to subclassify PE patients by liver function characteristics, so as to identify the occurrence of pregnancy complications.The results had significance for understanding the heterogeneity of PE and promoting individualized management.更多还原