早期心肌损伤对新生儿败血症预后的预测作用  

The predicted effect of early myocardial damage on poor prognosis of neonatal sepsis

作　　者：何丹妮 黎帆 陈源美 李伟[4] 李宁[4] 卢秀秀 孙中媛 张莉鹏 张琪 HE Dan-ni;LI Fan;CHEN Yuan-mei(Institute of Clinical Medical Sciences,China-Japan Friendship Hospital,Beijing 100029,China;不详)

机构地区：[1]中日友好医院临床医学研究所,北京100029 [2]中日友好医院儿科,北京100029 [3]广州市妇女儿童医疗中心新生儿科,广东广州510000 [4]首都儿科研究所附属儿童医院重症医学科,北京100020

出　　处：《中日友好医院学报》2021年第4期207-210,215,共5页Journal of China-Japan Friendship Hospital

基　　金：中日友好医院人才引进课题启动基金(2019-RC-3)。

摘　　要：目的:探索早期心肌损伤对新生儿败血症不良预后的预测作用。方法:收集2017年9月~2019年2月新生儿重症监护室收治的61例新生儿败血症临床资料,评估患儿危重情况,运用Logistic回归分析与死亡结局相关的危险因素,绘制ROC曲线图,建立列线图和死亡结局可视化预测模型。结果:脑钠肽(BNP)、器官衰竭数目及降钙素原(PCT)是新生儿败血症死亡结局的危险因素(OR>1,P<0.05),射血分数、左室短轴缩短率是保护因素(OR<1,P<0.05)。新生儿败血症BNP每升高500pg/ml死亡风险增加0.29倍;射血分数降低1%死亡风险增加0.15倍;左室短轴缩短率降低1%死亡风险增加0.18倍;PCT每升高10ng/ml死亡风险增加0.14倍(P<0.05)。BNP、射血分数、左室短轴缩短率和PCT的工作特征曲线下面积分别为0.6903、0.2847、0.2743和0.5905,4项指标联合预测的ROC曲线下面积达0.8799。对新生儿死亡结局预测度为0.803(P<0.01)。结论:早期心肌损伤指标BNP、射血分数、左室短轴缩短率及PCT,对新生儿败血症结局具有良好的预测作用。Objective:To explore the predicted effect of early myocardial damage on poor prognosis of neonatal sepsis.Methods:Continuously collect clinical data of 61 neonates with sepsis who were admitted to Neonatal Intensive Care Units(NICU)from September 2016 to February 2019.Assess critical conditions of each neonatal patient,use Logistic regression to analyze the risk factors related to the death outcome,draw a ROC curve diagram,and use the nomogram to establish,evaluate and visualize the death outcome prediction model.Results:BNP,number of organ failure and PCT were risk factors for the death outcome of neonatal sepsis(OR>1,P<0.05),ejection fraction and short axis shortening rate were the protective factors of death outcome(OR<1,P<0.05).The risk of death in patients with sepsis increased 0.29 times for every 500 pg/ml increase in BNP;0.15 times for every 1%decrease in ejection fraction;0.18 times for every 1%decrease in the short-axis shortening rate(P<0.05)and 0.14 times for every 10 ng/ml increase in PCT(P<0.05).The BNP,ejection fraction,short axis shortening rate,PCT areas under ROC curve were 0.6903,0.2847,0.2743 and 0.5905,respectively.The area under the ROC curve predicted by the four indicators was 0.8799.Early combination of BNP,ejection fraction,short-axis shortening rate and PCT could draw a nomogram to predict the outcome of neonatal death.The predictive degree was C=0.803(P<0.01).Conclusion:The early combination of BNP,ejection fraction,short axis shortening rate and PCT has a good predictive effect on the outcome of neonatal sepsis.

关 键 词：新生儿 败血症 心肌损伤 预后预测 

分 类 号：R722.131[医药卫生—儿科]