极早和超早产儿支气管肺发育不良风险评分的临床研究  

Risk scoring system for bronchopulmonary dysplasia in very and extremely preterm infants

作　　者：高琦 蒋海燕[1] 何海英[1] 刘利军[1] Gao Qi;Jiang Haiyan;He Haiying;Liu Lijun(Department of Pediatrics,the Third Staff Hospital of Baotou Steel Group,Baotou 014010,China;Department of Pediatrics,the First Affiliated Hospital of Baotou Medical College,Baotou 014010,China)

机构地区：[1]包钢集团第三职工医院儿科,014010 [2]包头医学院第一附属医院儿科,014010

出　　处：《中华围产医学杂志》2021年第12期922-926,共5页Chinese Journal of Perinatal Medicine

基　　金：包头市科技计划项目(2017S2001-2-2)。

摘　　要：目的建立极早和超早产儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)的风险评分模型,探讨BPD的危险因素。方法本研究为回顾性研究。研究对象为包钢集团第三职工医院新生儿科2013年12月至2018年12月收治的胎龄<32周、住院时间≥28 d的极早和超早产儿254例。根据是否发生BPD,分为BPD组(129例)和非BPD组(125例)。收集这些患儿的临床资料,通过t检验、χ^(2)检验、秩和检验及多因素logistic回归分析BPD的危险因素,建立风险评分系统,并利用受试者工作特征(receiver operating characteristic,ROC)曲线及灵敏度、特异度评价其效果。结果胎龄、新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)、呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)、通气支持时间>7 d是发生BPD的危险因素(P值均<0.05)。根据多因素logistic回归分析结果建立BPD风险评分系统,结果ROC曲线下面积为0.868(95%CI:0.823~0.913,P<0.001),最大约登指数为0.644时,灵敏度为0.884(95%CI:0.812~0.931),特异度为0.760(95%CI:0.674~0.830)。结论胎龄、NRDS、VAP、通气支持时间长是BPD的危险因素。建立的风险评分模型对极早和超早产儿BPD的预测有一定价值。Objective To investigate the risk factors and establish a risk scoring system for bronchopulmonary dysplasia(BPD)in very and extremely preterm infants.Methods From December 2013 to December 2018,254 very and extremely preterm infants with less than 32 weeks of gestation hospitalized for 28 d and above in the Third Staff Hospital of Baotou Steel Group were retrospectively enrolled.According to the diagnostic criteria of BPD,they were divided into the BPD group(n=129)or the non-BPD group(n=125).Clinical data and the risk factors for BPD were analyzed with univariate t-test,Chi-square test,rank-sum test,and multivariate logistic regression analysis.Based on the results,the risk scoring system was evaluated by receiver operating characteristic(ROC)curve,sensitivity,and specificity.Results Logistic regression analysis showed that gestational age,neonatal respiratory distress syndrome(NRDS),ventilator-associated pneumonia(VAP),and duration of ventilation>7 d were the risk factors for BPD(all P<0.05).When the area under the ROC curve was 0.868(95%CI:0.823-0.913,P<0.001)and the maximum Youden index was 0.644,the sensitivity of the scoring systems for BPD was 0.884(95%CI:0.812-0.931),and the specificity was 0.760(95%CI:0.674-0.830).Conclusions Gestational age,NRDS,VAP,and prolonged duration of ventilation were the risk factors for BPD.The risk scoring system established has the prediction value on BPD in very and extremely preterm infants.

关 键 词：支气管肺发育不良 婴儿 极早产 婴儿 超早产 危险因素 风险评分 

分 类 号：R722.6[医药卫生—儿科]