基于儿童血清多种维生素水平构建儿童抽动障碍预测模型及其临床价值分析  

Prediction model of tic disorder in children based on multiple vitamin level and analysis of its clinical value

作　　者：段朱岩 王珺[1,4] 黄贵民 王晓燕 杨圣海[1] 陈述花[5] 王立文 DUAN Zhu-yan;WANG Jun;HUANG Gui-min(Department of Neurology,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;不详)

机构地区：[1]首都儿科研究所附属儿童医院神经内科,北京100020 [2]首都儿科研究所附属儿童医院健康大数据研究中心,北京100020 [3]首都儿科研究所附属儿童医院保健科,北京100020 [4]北京协和医学院研究生院,北京100010 [5]首都医科大学附属北京儿童医院神经内科,北京100045

出　　处：《中国实用儿科杂志》2022年第10期776-781,共6页Chinese Journal of Practical Pediatrics

基　　金：北京市卫生系统高层次卫生技术人才培养计划(2015-3-084);首都临床特色应用研究(Z131107002213159)。

摘　　要：目的 探讨血清中多种维生素浓度与抽动障碍(TD)相关性,从而为临床实践提供更系统全面的循证学依据。方法 回顾2018年7月至2021年6月就诊首都儿科研究所附属儿童医院神经内科的1089例TD患儿临床资料;对照同期医院保健科健康体检的753例儿童相关资料,分析两组儿童血清多种维生素水平。随机按7:3的比例分为训练集和验证集,采用R软件中的caret包,在训练集中比较维生素A(VA)、维生素B(VB)、维生素B(VB)、维生素B(VB)、维生素B(VB)、维生素B(VB)、维生素C(VC)、维生素D(VD)、维生素E(VE)的水平并构建预测模型。并对其进行可靠性验证。结果 训练集儿童Logistic回归风险模型提示:儿童血清VA、VB、VB、VB、VB、VD的水平、男性和年龄是影响TD发生的独立危险因素。结合Logistic模型,绘制列线图。可视化列线图提示:年龄在4~10岁、男性、以及VA、VB、VB、VB、VD不足或缺乏儿童的赋分高。列线图训练集一致性指数C-index为0.761(95%CI:0.708~0.813),证实列线图模型达到中上等区分度,有临床价值。训练集受试者工作特征曲线(ROC)结果显示曲线下面积(AUC)=0.737,校准曲线和决策曲线分析法(DCA)分析显示模型的可靠性较好,验证集中的ROC结果显示AUC=0.726,表明该模型具有一定的临床参考价值。结论 儿童血清VA、VB、VB、VB、VB、VD的水平、男性和年龄是影响TD发生的独立危险因素。由列线图可见4~10岁的男性儿童不足或缺乏VA、VB、VB、VB和VD更易出现抽动障碍,因此,抽动障碍患儿血清VA、VB、VB、VB和VD的水平与抽动障碍之间存在显著的相关性,对于抽动障碍儿童应常规评估维生素营养状况,为TD的治疗奠定基础。Objective To explore the correlation between serum multivitamin concentration and TD,in order to providea more systematic and comprehensive evidence-based evidence for clinical practice. Methods The clinical data of 1,089children with TD diagnosed in Children’s Hospital of Capital Institute of Pediatrics from July 2018 to June 2021 wereretrospectively collected(TD group);753 patients who received health examination during the same period wereselected as the control group.The serum multivitamin levels of the two groups were analyzed. The caret package of Rsoftware was used to randomly divide the two groups of children into training set and verification set in a ratio of 7:3.Thelevels of vitamin A(VA),vitamin B(VB),vitamin B(VB),vitamin B(VB),vitamin B(VB),vitamin B(VB),vitamin C(VC),vitamin D(VD)and vitamin E(VE)were compared in the training set. Construct the prediction modeland verify its reliability. Results The logistic regression risk model for children in the training set suggested that the levels of serum VA,VB,VB,VB,VBand VD inchildren,male and age were independent risk factorsfor the occurrence of TD. Combined with theLogistic regression risk model,a visual Nomogramwas drawn. Visual nomogram suggested that agebetween 4-10 years old,male,and deficiency in VA,VB,VB,VBand VD had the high scores.In the training set of children’s data,the C-index was 0.761(95% CI:0.708-0.813). It is was confirmed that the nomogram model had achieved middle and upper distinction and had clinicalvalue. The results of Receiver Operating Characteristic curve(ROC)in the training set showed that Area Under Curve(AUC)was 0.737. Calibration Curve and Decision Curve Analysis(DCA)showed that the model had good reliability,and the ROC results in the verification set showed AUC was 0.726,indicating that the model had certain clinicalreference value. Conclusion Serum levels of VA,VB,VB,VB,VBand VD in the children,male and age areindependent risk factors for TD. It can be seen from the nomogram that male children aged 4 to 10 years old

关 键 词：抽动障碍 维生素 儿童 预测模型 

分 类 号：R72[医药卫生—儿科]