基于倾向性评分匹配法探讨儿童原发性肠套叠灌肠复位的预后影响因素  

Risk factors for prognosis of primary intussusception treated by enema reduction in children based on propensity score matching analysis

作　　者：赵金都 高群 卢贤映 张振强 潘祝彬 陈晨 胡一新 Zhao Jindu;Gao Qun;Lu Xianying;Zhang Zhenqiang;Pan Zhubin;Chen Chen;Hu Yixin(First Department of General Surgery,Anhui Provincial Children′s Hospital,Hefei 230051,China)

机构地区：[1]安徽省儿童医院普外一科,合肥230051

出　　处：《国际外科学杂志》2022年第5期314-319,I0007,共7页International Journal of Surgery

基　　金：2021年度安徽省卫生健康委重点科研项目(AHWJ2021a025)。

摘　　要：目的探讨儿童原发性肠套叠灌肠复位的预后影响因素。方法收集安徽省儿童医院2017年1月—2020年12月收治的519例急性肠套叠患儿临床资料,其中男性346例,女性173例;年龄3~69个月,中位年龄15个月。按照预后情况分为预后不良组(n=71)和预后良好组(n=448),使用倾向性评分匹配(PSM)对两组患儿进行匹配,得到组间基线均衡的样本。比较两组灌肠方式、套头位置、白细胞计数、血清乳酸、CO_(2)结合力、CRP、腹腔积液以及超重/肥胖等变量的差异,再将单因素分析有统计学差异的变量与预后情况进行1∶1条件Logistic回归分析,探讨原发性肠套叠灌肠复位预后的独立影响因素。结果519例原发性肠套叠患儿中发生预后不良71例(13.7%)。PSM前两组性别、年龄、病程时间、血便、腹泻、发热症状的比较,差异均有统计学意义(P<0.05),腹痛/哭闹、呕吐症状比较,差异无统计学意义(P>0.05)。使用PSM法,两组共69对匹配成功,匹配后以上协变量在两组间分布都达到均衡(P>0.05)。单因素分析显示两组灌肠方式、套头位置、腹腔积液、血清乳酸水平、超重/肥胖情况差异有统计学意义(P<0.05)。1∶1条件Logistic回归分析显示灌肠方式(OR=3.478,95%CI:1.150~10.517,P=0.027)、套头位置(OR=6.596,95%CI:1.669~26.056,P=0.007)、血清乳酸(OR=1.012,95%CI:1.003~1.021,P=0.010)、超重/肥胖(OR=6.085,95%CI:1.650~22.436,P=0.007)为预后的独立影响因素。结论儿童原发性肠套叠灌肠复位预后不良的独立危险因素为空气灌肠、套头位于左半结肠、血清乳酸水平升高和超重/肥胖。Objective To evaluate the risk factors for prognosis of primary intussusception treated by enema reduction in children.Methods A retrospective analysis of 519 patients with primary intussusception in Anhui Provincial Children′s Hospital from January 2017 to December 2020 was performed.Among the 519 patients,there were 346 males and 173 females.The median age was 15 months,with a range of 3 to 69 months,some basic information was collected.Patients were divided into bad prognosis group(n=71)and good prognosis group(n=448)according to prognosis.Propensity score matching(PSM)was conducted to reduce confounding bias between the groups.Conditional logistic regression were used to analysis the risk factors of primary intussusception treated by enema reduction.Results There were 71 cases of poor prognosis among 519 primary intussusception patients,incidence was 13.7%.Before PSM,there was significant difference in 6 covariates,including gender,age,duration of symptoms,bloody stool,diarrhoea and fever between two group(P<0.05).There was no significant difference in abdominal pain and vomit between two group(P>0.05).With propensity score matching,69 pairs of patients were sucessfully matched.After PSM,distribution of the above covariates reached equilibrium between two groups(P>0.05).There were statistically significant differences in enema reduction,mass location,seroperitoneum,lactic acid and overweight/obese between the two groups(P<0.05).Conditional logistic regression analysis confirmed that enema reduction(OR=3.478,95%CI:1.150-10.517,P=0.027),mass location(OR=6.596,95%CI:1.669-26.056,P=0.007),lactic acid(OR=1.012,95%CI:1.003-1.021,P=0.010),overweight/obese(OR=6.085,95%CI:1.650-22.436,P=0.007)were independent factors for predicting prognosis of primary intussusception treated by enema reduction.Conclusions AER,mass located left hemicolon,elevated lactic acid and overweight/obese were independent risk factors for poor prognosis of primary intussusception treated by enema reduction.

关 键 词：肠套叠 儿童 灌肠 预后 倾向评分匹配法 

分 类 号：R726.5[医药卫生—儿科]