新生儿巨细胞病毒感染致听力受损的危险因素分析及列线图预测模型构建  

Analysis of risk factors for hearing loss caused by neonatal cytomegalovirus infection and construction of a nomogram prediction model

作　　者：郭燕 徐利[1] 郑钦亮 倪佰亭 陶艳玲[1] Guo Yan;Xu Li;Zheng Qinliang;Ni Baiting;Tao Yanling(Department of Pediatrics,Affiliated Hospital of Jining Medical College,Jining 272029,China)

机构地区：[1]济宁医学院附属医院儿科,济宁272029

出　　处：《中华实验和临床病毒学杂志》2023年第4期398-403,共6页Chinese Journal of Experimental and Clinical Virology

基　　金：国家自然科学基金(81700702)。

摘　　要：目的分析新生儿巨细胞病毒(cytomegalovirus,CMV)感染致听力受损的危险因素,进行列线图预测模型构建,并评估其区分度和一致性。方法收集2018年6月至2021年3月本院救治的先天性和围生期CMV感染新生儿250例,依据听力是否受损分为听力受损组50例,听力未受损组200例。Logistic回归分析影响新生儿CMV感染致听力受损的危险因素。采用R软件构建预测新生儿CMV感染致听力受损风险的列线图模型,并使用ROC曲线及校准曲线验证列线图模型的区分度和一致性。结果建模组250例CMV感染新生儿中,听力受损发生率为20.00%。听力受损组妊娠14周前原发性母体感染比例、患儿入院时尿液CMV病毒载量>5×10^(4)拷贝/ml比例、CMV感染有症状比例、头颅MRI异常比例明显高于听力未受损组(χ^(2)=12.545、11.812、11.801、9.025,P=0.000、0.001、0.001、0.003)。患儿入院时尿液CMV病毒载量>5×10^(4)拷贝/ml、CMV感染有症状、头颅MRI异常是影响新生儿CMV感染致听力受损的危险因素(OR=2.388、6.765、4.993,P=0.022、0.000、0.001),由此构建的列线图预测模型采用Bootstrap内部验证,Hosmer-Lemeshow拟合优度检验χ^(2)=6.055,P=0.301,ROC曲线下面积为0.817,95%CI:0.754~0.880,外部验证结果显示,校准曲线的预测概率与实际概率接近,有良好的一致性,AUC为0.791(95%CI:0.716~0.866)。结论本研究构建的预测新生儿CMV感染致听力受损风险的列线图模型,可用于新生儿CMV感染后听力受损的预测。Objective To analyze the risk factors of hearing loss caused by neonatal cytomegalovirus(CMV)infection,to construct a nomogram prediction model,and to evaluate its discrimination and consistency.Methods Data of a total of 250 neonates with congenital and perinatal CMV infection who were treated in our hospital from June 2018 to March 2021 were collected,and grouped into hearing-impaired group of 50 cases and hearing-unimpaired group of 200 cases according to whether the hearing was impaired or not.Logistic regression analysis was performed to analyze the risk factors affecting hearing loss caused by CMV infection in neonates.R software was applied to construct a nomogram model for predicting the risk of hearing loss caused by CMV infection in neonates,and the ROC curve and calibration curve were analyzed to verify the discrimination and consistency of the nomogram model.Results Among 250 CMV-infected neonates in the modeling group,the incidence of hearing impairment was 20.00%.The proportion of primary maternal infection before 14 weeks of gestation,the proportion of urine CMV viral load>5×10^(4)copies/ml,the proportion of symptomatic CMV infection and the proportion of abnormal head MRI in the hearing-impaired group were significantly higher than those in the hearing-unimpaired group(χ^(2)=12.545,11.812,11.801,and 9.025,P=0.000,0.001,0.001,and 0.003).That urine CMV viral load>5×10^(4)copies/ml,symptomatic CMV infection and abnormal head MRI were the risk factors affecting hearing loss caused by CMV infection in neonates(OR=2.388,6.765,and 4.993,P=0.022,0.000,and 0.001),the prediction model of the line graph was constructed using Bootstrap internal verification,Hosmer-Lemeshow goodness of fit test=6.055,P=0.301,area under ROC curve was 0.817,95%CI=0.754~0.880,and external verification result showed that the predicted probability of the calibration curve was close to the actual probability and has a good agreement,with an AUC of 0.791(95%CI=0.716~0.866).Conclusions The nomogram model constructed in this study t

关 键 词：巨细胞病毒 新生儿 听力损伤 列线图 

分 类 号：R722.13[医药卫生—儿科]