儿童再发性泌尿道感染的危险因素及预测模型的构建和验证  

Establishment of risk prediction model of recurrent urinary tract infection in children and nursing countermeasures

作　　者：吴瑞娟 杨艳芳[1] 贾璐彩 丁碧玉 李莹[1] 曹亚青 WU Ruijuan;YANG Yanfang;JIA Lucai;DING Biyu;LI Ying;CAO Yaqing(Department of Urology,Children's Hospital Affiliated to Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院泌尿外科,河南郑州450000

出　　处：《安徽医学》2023年第4期415-419,共5页Anhui Medical Journal

基　　金：高校重点科研项目资助计划A类(编号:19A320017)。

摘　　要：目的探讨儿童再发性泌尿道感染的危险因素,并建立其感染风险预测模型,为临床提供便捷有效的预测方法及预防措施。方法选取2020年8月至2021年7月在河南省儿童医院泌尿外科确诊为泌尿道感染患儿237例,依据随访结果,未再发生泌尿道感染患儿205例为非再发组,复发或再发泌尿道感染患儿32例为再发组。收集两组患儿临床资料,通过单因素和多因素logis⁃tic回归分析患儿再发性泌尿道感染的影响因素,并构建其再发性泌尿道感染风险预测模型,通过受试者工作特征(ROC)曲线和校准曲线进行模型评价,采用Hosmer-Lemeshow拟合优度检验。结果237例泌尿道感染患儿经随访发现,再发性泌尿道感染的发生率为13.50%;再发组的贫血、过敏体质、便秘、膀胱输尿管反流和其他类型泌尿系统畸形患儿数占比高于非再发组(P均<0.05),再发组的IgA和IgG水平降低及病原菌为大肠埃希菌患儿数占比明显高于非再发组(P<0.05)。多因素logistic回归分析结果显示,女性、膀胱输尿管反流、其他类型泌尿系统畸形、过敏体质、便秘、IgA水平降低、IgG水平降低、贫血、病原菌(大肠埃希菌)是儿童再发性泌尿道感染的危险因素(P均<0.05)。预测模型对应的曲线下面积为0.868,95%CI为0.812~0.983,以0.753为最佳截断值,此时模型的特异度为71.46%,灵敏度为87.29%,一致性指数为0.816,预测和实际再发生泌尿道感染风险一致性的校准曲线拟合度较好。结论儿童再发性泌尿道感染的危险因素众多,以这些危险因素构建的感染风险预测模型具有良好的预测效能,为儿童泌尿道感染再复发、临床预防、诊治提供了一定的参考。Objective To explore the risk factors of recurrent urinary tract infection in children and establish a risk prediction model of re⁃current urinary tract infection in children.Methods A total of 237 children with urinary tract infection diagnosed in the Department of Urology of our hospital from August 2020 to July 2021 were selected.According to the follow-up results,205 children without urinary tract infection were selected as the non recurrent group,and 32 children with recurrent or recurrent urinary tract infection were in the recurrent group.The clinical data of two groups of children were collected,the independent influencing factors of recurrent urinary tract infection in children were analyzed by univariate and multivariate logistic regression,and the prediction model was constructed.The ROC curve and calibration curve were used for model evaluation,and Hosmer lemeshow goodness of fit test was used.Results Altogether 237 children with urinary tract infec⁃tion were followed up.The incidence of recurrent urinary tract infection was 13.50%.The proportion of anemia,allergic constitution,constipa⁃tion,vesicoureteral reflux and other types of urinary system malformations in the recurrent group was higher than that in the non recurrent group(all P<0.05).The decrease of IgA and IgG levels and the proportion of children with Escherichia coli as the pathogen in the recurrent group were significantly higher than those in the non-recurrent group(P<0.05).Multivariate logistic regression analysis showed that gender(fe⁃male),vesicoureteral reflux,other types of urinary system abnormalities,allergic constitution,constipation,lower IgA level,lower IgG level,anemia,and pathogenic bacteria(Escherichia coli)were independent risk factors for recurrent urinary tract infection in children(all P<0.05).The AUC value corresponding to the prediction model was 0.868,95%CI was 0.812~0.983,and 0.753 was the best cut-off value.At this time,the specificity of the model was 71.46%,the sensitivity was 87.29%,and the consistency ind

关 键 词：再发性泌尿道感染 风险预测模型 大肠埃希菌 泌尿系统畸形 

分 类 号：R726.9[医药卫生—儿科]