小儿肠套叠水压灌肠复位后复发的影响因素及列线图预测模型构建  

Influencing factors of recurrence after reduction of intussusception by hydraulic enema in children and construction of a line graph prediction model

作　　者：郭建康 柏艳红 梁优 GUO Jiankang;BAI Yanhong;LIANG You(Department of Ultrasound,3201 Hospital,Hanzhong,Shaanxi 723000,China)

机构地区：[1]三二〇一医院超声医学科,陕西汉中723000

出　　处：《中国优生与遗传杂志》2022年第11期2008-2015,共8页Chinese Journal of Birth Health & Heredity

基　　金：一般项目-社会发展区域(2021SF-044)。

摘　　要：目的 探讨小儿肠套叠水压灌肠复位后复发的影响因素及列线图预测模型构建。方法 选取三二〇一医院2019年1月至2022年2月接收的肠套叠患儿224例,设为训练集。依据复位成功后48h内是否再次发生肠套叠将训练集数据分为复发组(31例)和非复发组(193例)。按照相同标准选取2021年3月至2022年1月的96例肠套叠患儿,设为验证集。收集患儿临床资料、比较超声影像学资料。基于筛选的因素构建列线图预测模型,并对该模型进行验证。结果 发病时间≥24 h、血便、禁食时间、继发因素、“同心圆”最大径、“套筒征”平均长度、肠壁血流信号、腹腔积液均是小儿肠套叠水压灌肠复位后复发的预测因素(P<0.05)。结合超声影像指标和临床资料构建的列线图模型的校准度和区分度均较好,决策曲线显示阈值概率在1%~90%时,有较高的净获益值。结论 本研究利用超声影像学结合临床资料构建的列线图模型校准度和区分度均较好,可为临床研究提供理论参考。具备“同心圆”最大径≥34.66 mm、“套筒征”平均长度≥4.97 cm、肠壁有血流信号、肠套叠周围有腹腔积液的超声影像学特征以及临床发病时间≥24 h、有血便、继发因素、禁食时间<4 h的肠套叠患儿在水压灌肠复位后复发率较高。Objective To investigate the influencing factors of recurrence after reduction by water pressure enema in children with intussusception and the construction of the Nomogram model. Methods 224 children with intussusception admitted in 3201 Hospital from January 2019 to February 2022 were selected as the training set. According to the recurrence of intussusception within 48 hours after successful reduction, the training data were divided into recurrent group(n=31) and non-recurrent group(n=193). According to the same standard, 96 children with intussusception from March 2021 to January 2022 were selected as the verification set. The clinical data of the children were collected and the ultrasonic imaging data were compared. Based on the screening factors, a Nomogram model was constructed and verified. Results The time of onset ≥24hours, bloody stool, fasting time, secondary factors, the maximum diameter of “concentric circle”, the average length of “sleeve sign”, intestinal wall blood flow signal and celiac effusion were predictive factors of recurrence after reduction by water pressure enema in children with intussusception(P<0.05). The calibration and discrimination of the Nomogram model constructed by combining ultrasound image index and clinical data were good, and the decision curve showed that when the threshold probability was between 1% and 90%, the net benefit value was higher. Conclusion The calibration and differentiation of the Nomogram model constructed by ultrasound imaging combined with clinical data are good, which can provide theoretical reference for clinical research. The children with the largest diameter of “concentric circle” ≥34.66 mm, the average length of “sleeve sign”≥4.97 cm, blood flow signal in intestinal wall, abdominal effusion around intussusception,clinical onset time ≥24 hours, bloody stool, secondary factors and fasting time <4 hours are at higher risk of recurrence after hydrostatic enema reduction.

关 键 词：肠套叠 水压灌肠复位 超声影像学 复发 预测价值 

分 类 号：R725.7[医药卫生—儿科]