院内儿童感染性腹泻发生影响因素及其发生风险的列线图模型  

Influencing Factors of Infectious Diarrhea in Hospitalized Children and Nomogram Risk Prediction Model

作　　者：马孟琦 杨弋 MA Mengqi;YANG Yi(Department of Pediatric Eye Health,Qinhuangdao Maternal and Child Health Center,Qinhuangdao,Hebei 066000,China;Center for Disease Control and Prevention,Lianshan District,Huludao,Liaoning 125000,China)

机构地区：[1]秦皇岛市妇幼保健院儿童眼保健科,河北秦皇岛066000 [2]连山区疾病预防控制中心,辽宁葫芦岛125000

出　　处：《临床误诊误治》2024年第4期63-69,共7页Clinical Misdiagnosis & Mistherapy

基　　金：秦皇岛市2023年度市级科学技术研究与发展计划自筹经费项目(202301A081)。

摘　　要：目的探讨院内儿童感染性腹泻发生影响因素及其发生风险的列线图模型。方法回顾性收集2020年4月—2023年4月996例住院患儿临床资料,按住院期间是否发生感染性腹泻分为发生组72例与未发生组924例。调查儿童感染性腹泻发生率,并通过单因素、Lasso回归、多因素Logistic回归方程分析院内儿童感染性腹泻发生的影响因素。采用R语言绘制预测院内儿童感染性腹泻发生风险的列线图模型,采用受试者工作特征曲线评价列线图模型的预测效能。结果996例患儿住院期间72例发生感染性腹泻,发生率为7.23%,以病毒感染为主(48例)。多因素Logistic回归分析显示:年龄<3岁、体质量指数≤18.4 kg/m^(2)、餐前便后未洗手、病房未每日通风消毒、肠道菌群失调、分泌型免疫球蛋白A(sIgA)≤7.27μg/mL、CD4+/CD8+≤1.55是院内儿童感染性腹泻发生的独立危险因素,住院时间<3 d、白细胞介素-17(IL-17)≤11.74 pg/mL是院内儿童感染性腹泻发生的保护因素(P<0.01)。列线图模型的一致性指数为0.858,该列线图模型预测院内儿童感染性腹泻发生风险的曲线下面积为0.858(95%CI:0.814,0.903),敏感度为68.74%,特异度为86.24%。结论院内儿童感染性腹泻以病毒感染为主,年龄、体质量指数、餐前便后洗手、住院时间、病房每日通风消毒、肠道菌群失调及sIgA、IL-17、CD4+/CD8+水平是院内儿童感染性腹泻发生的影响因素,临床可根据此制订针对性应对措施,加强医院感染管理,降低院内儿童感染性腹泻的发生风险。Objective To explore the influencing factors of infectious diarrhea in hospitalized children and nomogram risk prediction model.Methods The clinical data of 996 hospitalized children from April 2020 to April 2023 were retrospectively collected.According to occurrence of infectious diarrhea during hospitalization,the patients were divided into a occurrence group(n=72)and a non-occurrence group(n=924).The incidence of infective diarrhea in children was investigated,and the influencing factors of infective diarrhea in children were analyzed by univariate,Lasso regression and multivariate Logistic regression equations.R language was used to draw a nomogram model to predict the risk of infective diarrhea in hospitalized children,and receiver operating characteristic(ROC)curve was used to evaluate the predictive performance of the nomogram model.Results Of the 996 children,72 had infectious diarrhea during hospitalization,and the incidence rate was 7.23%,mainly virus infection(n=48).Multivariate Logistic regression analysis showed that age<3 years,body mass index(BMI)≤18.4 kg/m^(2),no washing hands before and after using the toilet,no daily ventilation and disinfection in wards,intestinal flora disturbance,secreted immunoglobulin A(sIgA)≤7.27μg/mL,and CD4+/CD8+≤1.55 were the independent risk factors for infectious diarrhea in hospitalized children.The duration of hospitalization<3 d and interleukin-17(IL-17)≤11.74 pg/mL were the protective factors for infective diarrhea in hospitalized children(P<0.01).The consistency index of the histogram was 0.858,and the area under the curve of this nomogram model in predicting the risk of infective diarrhea in hospitalized children was 0.858(95%CI:0.814,0.903),the sensitivity was 68.74%,and the specificity was 86.24%.Conclusion Viral infection is the main cause of infective diarrhea in children during hospitalization.Age,BMI,hand-washing before and after meals,length of hospital stay,daily ventilation and disinfection in wards,intestinal flora disturbance,sIgA,IL-17 and C

关 键 词：感染性腹泻 儿童 医院感染 影响因素 分泌型免疫球蛋白A 白细胞介素-17 应对措施 预测效能 

分 类 号：R725.7[医药卫生—儿科]