不同支气管肺发育不良诊断标准临床应用研究  

A study on the clinical application of different diagnostic criteria for bronchopulmonary dysplasia

作　　者：鲁阳珂 康文清[1] 严惠 王馨 王颍源[1] 赵艳梅[1] 张晓媛 Lu Yangke;Kang Wenqing;Yan Hui;Wang Xin;Wang Yingyuan;Zhao Yanmei;Zhang Xiaoyuan(Neonatal Intensive Care Unit,Children's Hospital Affiliated to Zhengzhou University,Henan Children's Hospital,Zhengzhou Key Laboratory of Neonatal Disease Research,Zhengzhou 450018,China;Henan Provincial Clinical Research Center for Pediatric Diseases,Children's Hospital Affiliated to Zhengzhou University,Zhengzhou 450018,China)

机构地区：[1]郑州大学附属儿童医院,河南省儿童医院NICU,郑州市新生儿疾病研究重点实验室,郑州450018 [2]郑州大学附属儿童医院,河南省儿科疾病临床研究中心,郑州450018

出　　处：《中华新生儿科杂志（中英文）》2022年第6期510-514,共5页Chinese Journal of Neonatology

基　　金：河南省医学科技攻关计划省部共建项目(2018010041)。

摘　　要：目的比较不同诊断标准对早产儿支气管肺发育不良(bronchopulmonary dysplasia, BPD)诊断和分级的影响, 以及两种新诊断标准的一致性。方法采用回顾性队列研究, 收集2020年1~12月郑州大学附属儿童医院新生儿诊疗中心收治的胎龄<32周早产儿临床资料, 分别按照早产儿BPD的2001 NICHD标准、2018 NICHD标准和2019 NRN标准进行诊断和分级, 采用χ2检验比较不同标准BPD的诊断率和病死率, 采用Kappa系数检验比较2018 NICHD标准和2019 NRN标准两种新诊断标准的一致性。结果共纳入231例胎龄<32周早产儿, 男130例, 女101例, 死亡9例。按照2018 NICHD标准, BPD组97例(42.0%), Ⅰ级16例, Ⅱ级44例, Ⅲ级31例, ⅢA级6例;非BPD134例(58.0%)。BPD的整体诊断率2001 NICHD标准(112/231, 48.5%)、2018 NICHD标准(97/231, 42.0%)和2019 NRN标准(91/231, 39.4%)之间差异无统计学意义(P>0.05);Ⅲ级BPD(2018 NICHD标准包括Ⅲ级+ⅢA级)诊断率, 2001 NICHD标准(76/231, 32.9%)高于2018 NICHD标准(37/231, 16.0%)和2019 NRN标准(15/231, 6.5%), 2018 NICHD标准高于2019 NRN标准, 差异有统计学意义(P<0.05)。BPD整体病死率3种标准差异无统计学意义(P>0.05);Ⅲ级BPD病死率, 2001 NICHD标准(3/76, 3.9%)低于2018 NICHD标准(9/37, 24.3%)和2019 NRN标准(3/15, 20.0%), 差异有统计学意义(P<0.05)。2018 NICHD标准和2019 NRN标准对BPD整体诊断高度一致(Kappa值=0.946), 阳性一致率93.8%(95%CI 85.5%~97.5%);但对BPD的分级诊断一致性较弱(Kappa值=0.597)。结论早产儿BPD的2001 NICHD标准已不适用, 重度BPD诊断率过高, 因而重度BPD病死率最低;2018 NICHD标准全面、细化, 2019 NRN标准简单、易实施, 两种新标准对BPD的整体诊断高度一致, 但分级诊断一致性较弱。Objective To compare the results of clinical diagnosis and severity grading in preterm infants with bronchopulmonary dysplasia(BPD)using three different diagnostic criteria and the consistency of two new diagnostic criteria.Methods From January to December,2020,infants with gestational age<32 w admitted to neonatal intensive care unit of our hospital were retrospectively enrolled in this cohort study.The patients were diagnosed and graded according to the 2001,2018 and 2019 criteria of BPD.Chi-square test was used to compare the differences of BPD diagnostic rate and mortality rate using three criteria and Kappa coefficient test was used to compare the consistency between the two new criteria of 2018 NICHD and 2019 NRN.Results A total of 231 preterm infants were enrolled,including 130 males(56.3%)and 101 females.9 patients were dead.According to 2018 NICHD criteria,97 cases(42.0%)were diagnosed with BPD,including 16 gradeⅠ,44 gradeⅡ,31 gradeⅢand 6 gradeⅢA.The remaining 134 cases were not BPD(58.0%).No significant differences existed(P>0.05)among the diagnostic rates of 2001 criteria(112/231,48.5%),2018 criteria(97/231,42.0%)and 2019 criteria(91/231,39.4%).For gradeⅢBPD,the diagnostic rate of 2001 criteria was significantly higher than the 2018 criteria(including gradeⅢand gradeⅢA,16.0%)and 2019 criteria(6.5%)and the diagnostic rate of 2018 criteria was also significantly higher than 2019 criteria(P<0.05).No significant differences existed in the overall mortality rate of BPD among three criteria(P>0.05),however,the case mortality rate of gradeⅢBPD of 2001 criteria(3.9%)was significantly lower than 2018 criteria(24.3%)and 2019 criteria(20.0%)(P<0.05).The 2018 and 2019 criteria were highly consistent in the overall diagnostic rate of BPD(Kappa value=0.946),the positive consistency rate was 93.8%(95%CI 85.5%~97.5%)and the negative consistency rate was 100.0%(95%CI 96.5%~100.0%).But the consistency of severity grading for BPD was weak(Kappa value=0.597)between the two criteria.Conclusions The 2001 NIC

关 键 词：支气管肺发育不良 诊断标准 婴儿 早产 诊断率 一致性 

分 类 号：R722.6[医药卫生—儿科]