СОВРЕМЕННЫЕ ВОЗМОЖНОСТИ ПРОГНОЗИРОВАНИЯ ПРЕЭКЛАМПСИИ И ЕЁ ОСЛОЖНЕНИЙ. ОБЗОР ЛИТЕРАТУРЫ

Введение: Гипертензивные расстройства во время беременности являются одной из основных причин материнской и перинатальной заболеваемости и смертности во всём мире. После установления диагноза преэклампсии тяжелой степени для определения приоритетности и планирования дальнейшей тактики ведения необходима точная оценка риска, как для матери, так и для плода, в различные моменты времени. Прогностическая модель - это альтернативная основа для клинической практики, для прогнозирования будущих результатов пациентов и для принятия решений по их улучшению.

Цель исследования: анализ литературных данных моделей прогнозирования преэклампсии и ее осложнений.

Методы: был проведен анализ 55 англо- и русскоязычных публикаций из баз данных PubMed, Clinical Key, Web of Science Core Collection, eLibrary, Google Scholar за последние 10 лет, с января 2009 года по июнь 2018 г. Критерии включения: публикации, в которых содержался инструмент прогнозирования (модель), содержащий три или более переменных, и которые обеспечивали вероятность исхода, либо предлагали диагностические или лечебные действия, для описания производительности модели прогнозирования использовались дискриминация и/или калибровка, проводилась внутренняя и внешняя валидация модели. Для поиска были использованы следующие поисковые запросы: «preeclampsia AND prognosis», «preeclampsia AND complications» «EPH AND probability learning», «Hypertension-Edema-Proteinuria Gestosis AND prediction», «прогнозирование преэклампсии», «предикторы гестоза», «осложнения преэклампсии».

Результаты: Найденные опубликованные исследования содержали модели раннего прогнозирования преэклампсии и неблагоприятных материнских и перинатальных исходов. Данный литературный обзор помог найти проблемы с прогнозированием неблагоприятного перинатального исхода при преэклампсии, все существующие модели имеют одно важное ограничение для обобщения – все они предназначены для одноплодной беременности, имеет место относительная дороговизна моделей, а также не было найдено сведений о влиянии модели на клиническую практику: количество койко-дней, количество ненужных диагностических и лечебных мероприятий, осложнения.

Выводы: вследствие наличия в найденных исследованиях систематических ошибок и ограничений, а также отсутствие адекватных внешних проверок валидации, надёжность и достоверность существующих моделей прогнозирования преэклампсии и ее осложнений весьма сомнительны.

Гульнара Т. Нургалиева 1, https://orcid.org/0000-0002-2161-105X

Гульяш А. Танышева 2, http://orcid.org/0000-0002-9074-6302

Гульшат К. Манабаева 1, https://orcid.org/0000-0002-8217-7680

 

1 Кафедра акушерства и гинекологии,

2 Кафедра интернатуры по акушерству и гинекологии,

Государственный медицинский университет города Семей,

г. Семей, Республика Казахстан.

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Библиографическая ссылка

Нургалиева Г.Т., Танышева Г.А., Манабаева Г.К. Современные возможности прогнозирования преэклампсии и её осложнений. Обзор литературы / / Наука и Здравоохранение. 2018. 4 (Т.20). С. 86-106.

Nurgaliyeva G.T., Tanysheva G.A., Manabaeva G.K. The modern possibilities of prediction of pre-eclampsia and its complications. A literature review // Nauka i Zdravookhranenie [Science & Healthcare]. 2018, (Vol.20) 4, pp. 86-106.

Нургалиева Г.Т., Танышева Г.А., Манабаева Г.К. Преэклампсияны болжаудың қазіргі заман мүмкіндіктері және оның асқынулары. Әдебиеттерді шолу / / Ғылым және Денсаулық сақтау. 2018. 4 (Т.20). Б. 86-106.


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