儿童神经源性膀胱上尿路损害预测模型的建立和验证  

Establishment and validation of a predictive model for neurogenic urinary tract injury in children

作　　者：李琦 蔡淼 陈静[1] 蒲青崧 杨兴欢 吴盛德[1] 刘星[1] 林涛[1] 何大维[1] 文建国[2] 魏光辉[1] Li Qi;Cai Miao;Chen Jing;Pu Qingsong;Yang Xinghuan;Wu shengde;Liu Xing;Lin Tao;He Dawei;Wen Jianguo;Wei Guanghui(Department of Urology,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering Ministry of Education,Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation base of Child development and Critical Disorders,Children′s Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Urology,First Affiliated Hospital of Zhengzhou University,Henan Joint International Pediatric Urodynamic Laboratory,Zhengzhou 450052,China)

机构地区：[1]重庆医科大学附属儿童医院泌尿外科儿童泌尿生殖发育与组织工程重点实验室儿童发育疾病研究教育部重点实验室国家儿童健康与疾病临床医学研究中心儿童发育重大疾病国家国际科技合作基地儿科学重庆市重点实验室,重庆400010 [2]郑州大学第一附属医院泌尿外科河南省小儿尿动力国际联合实验室,郑州450052

出　　处：《中华医学杂志》2022年第38期2988-2993,共6页National Medical Journal of China

基　　金：国家自然科学基金(U1904208);国家儿童健康与疾病临床医学研究中心临床医学研究项目(NCRCCHD-2020-GP-04)。

摘　　要：目的建立儿童神经源性膀胱(NB)发生上尿路损害的预测模型并验证其效能。方法以2011年1月至2021年12月重庆医科大学附属儿童医院收治的143例NB住院患儿及郑州大学第一附属医院收治的84例NB住院患儿为研究对象,将前者设为训练集,后者设为验证集,对两者的一般参数进行比较。通过Lasso回归和多因素logistic回归分析筛选出NB患儿发生上尿路损害的危险因素,将危险因素纳入并建立列线图预测模型。分别在训练集和验证集中对模型进行内部和外部验证,采用受试者工作特征曲线下面积(AUC)验证模型的准确性。结果纳入的227例NB患儿中,男121例、女106例,年龄(10.2±3.8)岁。训练集和验证集之间除年龄外其他参数差异均无统计学意义(均P>0.05);Lasso回归和多因素logistic回归分析显示:逼尿肌漏尿点压(DLPP)≥40 cmH_(2)O(OR=4.76,95%CI:2.01~11.26,1 cmH_(2)O=0.098 kPa)、伴有膀胱过度活动(OAB)(OR=3.08,95%CI:1.34~7.04)、膀胱顺应性(BC)<20 ml/cmH_(2)O(OR=3.65,95%CI:1.41~9.47)、既往泌尿系感染史(OR=2.73,95%CI:1.09~6.81)以及腹压或其他排尿方式(OR=2.86,95%CI:1.20~6.82)是NB患儿发生上尿路损害的危险因素(均P<0.05);使用上述参数建立儿童NB发生上尿路损害的列线图模型并进行内部和外部验证,训练集和验证集的AUC值分别为0.84(95%CI:0.77~0.91)和0.86(95%CI:0.79~0.94)。结论本研究构建的儿童NB上尿路损害预测模型有较高的准确度和临床适用性,可帮助临床医生早期发现高危患儿并及时进行干预。Objective To establish a predictive model for upper urinary tract damage in children with neurogenic bladder and verify its efficacy.Methods From January 2011 to December 2021,143 children with NB in the Children′s Hospital of Chongqing Medical University and 84 children with NB in the First Affiliated Hospital of Zhengzhou University were selected as the research objects.The former is set as the training set and the latter is set as the validation set,and the general parameters of the two are compared.The independent risk factors of upper urinary tract damage in children with NB were screened out by Lasso regression,and multivariate logistic regression analysis and a nomogram prediction model was established.The models were validated internally and externally on the training set and validation set,respectively,and the area under the receiver operating curve(ROC)was used to verify the accuracy of the model.Results A total of 227 children with NB were included in this study,including 121 males and 106 females,aged(10.2±3.8)years.There was no significant difference in other parameters except age between the training set and validation set(all P>0.05);Lasso regression and multivariate logistic regression analysis showed that detrusor leakage point pressure(DLPP)≥40 cmH_(2)O(OR=4.76,95%CI:2.01-11.26,1 cmH_(2)O=0.098 kPa),overactive bladder(OAB)(OR=3.08,95%CI:1.34-7.04),bladder compliance(BC)<20 ml/cm H_(2)O(OR=3.65,95%CI:1.41-9.47),history of previous urinary tract infection(OR=2.73,95%CI:1.09-6.81),and abdominal pressure/other voiding patterns(OR=2.86,95%CI:1.20-6.82)were risk factors for upper urinary tract damage in children with NB(all P<0.05).The above parameters were used to establish a nomogram model of upper urinary tract damage in children with NB.The internal and external validation results show that the AUC values for the training and validation sets were 0.84(95%CI:0.77-0.91)and 0.86(95%CI:0.79-0.94),respectively.Conclusion The prediction model of upper urinary tract damage in children with NB constr

关 键 词：儿童 神经源性膀胱 上尿路损害 预测模型 病例对照研究 

分 类 号：R726.9[医药卫生—儿科]