应用GAMLSS方法构建1~16岁儿童青少年扰动系数参考值的横断面调查  

Reference value of disturbance coefficient of children and adolescents aged 1 to 16 years by GAMLSS: A cross-sectional survey

作　　者：幸奠伟 周硕彦 王宸浩 蒋文良 金萍[3] 石艳[4] 赵安玲 王道聪 方芳[1] 符跃强[1] 许峰[1] XING Dianwei;ZHOU Shuoyan;WANG Chenhao;JIANG Wenliang;JIN Ping;SHI Yan;ZHAO Anling;WANG Daocong;FANG Fang;FU Yueqiang;XU Feng(Pediatric Intensive Care Unit,Children's Hospital of Chongqing Medical University,Chongqing 400014,China;The People's Hospital of Dazu,Chongqing,Chongqing 402360,China;Shenzhen Maternity&Child Healthcare Hospital,Shenzhen 518133,China;The First People's Hospital of Liangshan Yi Autonomous Prefecture,Sichuan 615000,China;The Second People's Hospital of Jiangjin,Chongqing,Chongqing 402289,China;Wuxi County People's Hospital,Chongqing 405800,China)

机构地区：[1]重庆医科大学附属儿童医院重症医学科,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014 [2]重庆市大足区人民医院,重庆402360 [3]深圳市宝安区妇幼保健院,深圳518133 [4]凉山彝族自治州第一人民医院,四川615000 [5]重庆市江津区第二人民医院,重庆402289 [6]巫溪县人民医院,重庆405800

出　　处：《中国循证儿科杂志》2023年第4期267-271,共5页Chinese Journal of Evidence Based Pediatrics

基　　金：重庆市技术创新与应用发展专项重点项目:cstc2020jscx-sbqw0006;国家儿童健康与疾病临床医学研究中心临床医学研究一般项目:NCRCCHD-2020-GP-08;重庆市自然科学基金面上项目:cstc2020jcyj-msxmX1087。

摘　　要：背景扰动系数(DC)是无创脑水肿动态监测仪的主要技术参数,国内外尚无儿童青少年正常参考值。目的 建立1~16岁儿童青少年DC的参考值区间。设计多中心前瞻性横断面调查。方法 2020年3月至2023年3月于重庆市、四川省和深圳市6家医院、2所幼儿园和小学招募1~16岁无颅脑损伤的儿童青少年为研究对象,采用无创脑水肿动态监护仪连续监测15 min,取监测均值为受试者的最终DC值。基于位置、尺度、形状广义的可加模型(GAMLSS)绘制不同年龄DC的P1、P5、P10、P25、P50、P75、P90、P95、P99百分位数及百分位数曲线。采用独立样本t检验分析不同性别DC均值的差异,通过方差分析比较各年龄组DC均值及差异,通过绘制散点图及Loess局部加权非参数回归曲线探索DC随年龄、体重、头围增加的变化特点。主要结局指标DC。结果 研究期间1 247名无颅脑损伤儿童青少年纳入本文分析,男787名(63.1%),女460名。拟合不同年龄儿童青少年DC百分位数曲线,DC水平随年龄增长而增长,在5岁后增长放缓并逐渐停止增长。在总体人群中,男、女性DC水平差异无统计学意义(P=0.051);各年龄组不同性别儿童青少年DC差异均无统计学意义。相关性分析显示,当年龄<5岁、体重<18.0 kg和头围<51.0 cm时,DC与年龄、体重和头围均存在显著正相关(r分别为0.663、0.454和0.474);反之,当年龄≥5岁、体重≥18.0 kg和头围≥51.0 cm时,DC变化不明显,逐渐稳定于107。结论 本研究构建了1~16岁儿童青少年DC的百分位数曲线图,当年龄<5岁时,DC随年龄增长而增长;当年龄≥5岁时,DC逐渐稳定于107。Background The disturbance coefficient(DC)is the main technical parameter of non-invasive brain edema dynamic monitoring instruments,and there is no normal reference value for children and adolescents at home abroad.Objective To establish the reference intervals of DC for children and adolescents aged 1-16 years.Design Multi-center prospective cross-sectional survey.Methods From March 2020 to March 2023,children and adolescents aged 1-16 years without craniocerebral injury were recruited from 6 hospitals 2 kindergarten and primary schools in Chongqing,Sichuan and Shenzhen.The non-invasive brain edema dynamic monitor was used for continuous monitoring for 15 minutes,and the monitoring average was taken as the final DC value of the subjects.Generalized Additive Models for Location,Scale,and Shape(GAMLSS)were used to draw P 1,P 5,P 10,P 25,P 50,P 75,P 90,P 95,P 99 percentile values and percentile curves for disturbance coefficients of different ages.Independent sample t-test was used to analyze the difference of DC between boys and girls,and analysis of variance was used to calculate the DC mean value in different age groups and the difference of DC in different age groups.The changes of DC with age,weight and head circumference were explored by drawing scatter plots and Loess local weighted nonparametric regression curves.Main outcome measures Disturbance coefficient.Results A total of 1247 children and adolescents with no cranial injuries were included in the study,including 787 males(63.1%)and 460 females.The observed fitted percentile curves of disturbance coefficients for children and adolescents of different ages showed that the level of disturbance coefficients gradually increased with age,and the growth of disturbance coefficient curves slowed down and eventually stopped after 5 years of age.In the overall population,there was no significant difference in DC levels between males and females(P>0.05),and there was no significant difference in DC among children and adolescents of different ages and genders.Corr

关 键 词：儿童青少年 扰动系数 参考值 百分位数曲线 GAMLSS 

分 类 号：R179[医药卫生—妇幼卫生保健]