极/超早产儿中重度脑室周围-脑室内出血预测模型的研究  

A prediction model for moderate to severe periventricular-intraventricular hemorrhage in very/extremely preterm infants

作　　者：刘希 乔丹 贝斐[1] Xi Liu;Dan Qiao;Fei Bei(Department of Neonatology,Shanghai Children's Medical Center,Shanghai Jiao tong University School of Medicine,Shanghai 200127,China)

机构地区：[1]国家儿童医学中心,上海交通大学医学院附属上海儿童医学中心新生儿科,上海200127

出　　处：《中华新生儿科杂志（中英文）》2023年第12期715-720,共6页Chinese Journal of Neonatology

基　　金：上海市浦东新区卫生和计划生育委员会科研项目(PW2022D-09)。

摘　　要：目的开发极/超早产儿中重度脑室周围-脑室内出血(periventricular-intraventricular hemorrhage, PIVH)早期预测模型并进行内部验证。方法选择2017年1月1日至2021年12月31日上海交通大学附属上海儿童医学中心新生儿重症监护病房收治的出生胎龄<32周、生后24 h内入院的极/超早产儿进行回顾性研究。根据生后2周内头颅超声结果将纳入患儿分为无或轻度PIVH组和中重度PIVH组。收集母亲孕产史和患儿出生史、患儿生后24 h内血常规和血气分析等临床资料。采用单因素分析、逐步回归法和多因素logistic回归分析筛选可能的预测因素, 建立早期疾病预测模型。应用受试者工作特征(receiver operating characteristic, ROC)曲线评价模型的区分度, 采用Hosmer-Lemesshow检验评价模型的校准度, 通过Bootstrap方法进行内部验证。结果共纳入512例极/超早产儿, 无或轻度PIVH组460例(89.8%), 中重度PIVH组52例(10.2%)。剖宫产(OR=0.323, 95%CI 0.155~0.669, P<0.001)、出生胎龄(OR=0.789, 95%CI 0.633~0.979, P<0.001)、生后24 h内应用血管活性药物(OR=2.487, 95%CI 1.152~5.184, P=0.008)、生后24 h内红细胞血红蛋白浓度(OR=0.956, 95%CI 0.930~0.981, P<0.001)和生后24 h内乳酸浓度(OR=1.246, 95%CI 1.075~1.440, P=0.004)是中重度PIVH的独立影响因素, 可预示中重度PIVH的发生(敏感度73.1%, 特异度81.2%, AUC=0.818)。Hosmer-Lemesshow检验显示该模型与临床实际中重度PIVH的发生概率一致性较好(χ2=2.394, P=0.302)。经Bootstrap内部验证, 该模型具有较好的区分度(AUC=0.801)。结论通过母亲孕产史和早产儿生后24 h内临床资料可建立中重度PIVH的早期预测模型, 有助于临床决策和评估预后。Objective To develop and validate an early prediction model for moderate and severe periventricular-intraventricular hemorrhage(M/S PIVH)in very/extremely preterm infants(V/EPIs).Methods From January 1,2017 to December 31,2021,preterm infants with gestational age(GA)<32 w admitted to the Neonatal Intensive Care Unit of our hospital within 24 h after birth were enrolled.The infants were assigned into no-or-mild(N/M)PIVH group and M/S PIVH group according to postnatal cranial ultrasound within 2 w after birth.Clinical data including pregnancy and perinatal history,complete blood counts(CBC)and blood gas analysis(BGA)within 24 h after birth were retrospectively collected.The univariate analysis,stepwise regression analysis and multivariate logistic regression analysis were used to determine possible predictive risk factors and to establish an early prediction model.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of the model.The Hosmer-Lemesshow test was introduced to make calibrations of the model.Bootstrap method was used for internal validation.Results Among 512 preterm infants,460(89.8%)were in N/M PIVH group and 52(10.2%)in M/S PIVH group.Cesarean section(OR=0.323,95%CI 0.155-0.669,P<0.001),GA(OR=0.789,95%CI 0.633-0.979,P<0.001),use of vasoactive drugs(OR=2.487,95%CI 1.152-5.184,P=0.008),mean corpuscular hemoglobin concentration(MCHC)(OR=0.956,95%CI 0.930-0.981,P<0.001)and maximum lactate level(OR=1.246,95%CI 1.075-1.440,P=0.004)were independent risk factors of M/S PIVH in the early stage(sensitivity=73.1%,specificity=81.2%,AUC=0.818).The Hosmer-Lemesshow test showed that the model correlated well with the actual incidence of M/S PIVH(χ2=2.394,P=0.302).The Bootstrap internal validation showed that the model had a realistic estimate of its performances(AUC=0.801).Conclusions An early prediction model for M/S PIVH can be established based on pregnancy/perinatal history and clinical data within 24 h after birth.The model is helpful for prognosis evaluation and clinical decision-m

关 键 词：脑室周围-脑室内出血 早产儿 预测模型 

分 类 号：R722.6[医药卫生—儿科]