基于新生儿、孕妇临床特征构建新生儿呼吸窘迫综合征的预测模型  

Construction of Prediction Model of Neonatal Respiratory Distress Syndrome Based on the Clinical Characteristics of Newborns and Pregnant Women

作　　者：曲海新[1] 张雅静[1] 郭卫平[2] 袁二伟[1] 王玲玲 李坤[3] QU Haixin;ZHANG Yajing;GUO Weiping;YUAN Erwei;WANG Lingling;LI Kun(Department of Neonatology,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China;Departments of Pediatrics,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China;Outpatient Department of Pediatrics,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院新生儿科,河北张家口075000 [2]河北北方学院附属第一医院儿科,河北张家口075000 [3]河北北方学院附属第一医院儿科门诊,河北张家口075000

出　　处：《临床误诊误治》2024年第8期63-68,共6页Clinical Misdiagnosis & Mistherapy

基　　金：2021年度河北省医学科学研究课题计划项目(20211818)。

摘　　要：目的基于新生儿、孕妇临床特征构建新生儿呼吸窘迫综合征(NRDS)的预测模型。方法选取2020年1月—2023年1月收治的102例NRDS患儿纳入NRDS组,另择同期健康新生儿150例纳入无NRDS组,回顾性收集临床资料。分析2组新生儿情况、孕妇情况,采用多因素Logistic回归分析NRDS发生的危险因素,建立预测模型,并绘制受试者工作特征(ROC)曲线分析预测模型对NRDS的预测价值。结果与无NRDS组比较,NRDS组胎龄<34周、出生体质量<2 kg、分娩方式为剖宫产、胎儿窘迫、胎膜早破、酸中毒比例高(P<0.05,P<0.01)。与无NRDS组比较,NRDS组孕妇年龄≥35岁、初产、妊娠期高血压疾病、妊娠期糖尿病、合并生殖道感染、产前检查低于9次比例高,血清25-羟基维生素D(25-OH-D)水平低(P<0.05,P<0.01)。胎龄<34周、出生体质量<2 kg、分娩方式为剖宫产、胎儿窘迫,以及孕妇年龄≥35岁、妊娠期糖尿病、产前检查低于9次为NRDS发生的独立危险因素(P<0.05,P<0.01);孕妇血清25-OH-D水平升高为其保护因素(P<0.01)。根据上述结果构建预测模型,并绘制ROC曲线,结果显示,当Logit(P)>18.570时,预测NRDS发生的曲线下面积为0.893,诊断敏感度为81.37%、特异度为82.00%。结论胎龄<34周、出生体质量<2 kg、分娩方式为剖宫产、胎儿窘迫,以及孕妇年龄≥35岁、妊娠期糖尿病、产前检查低于9次为NRDS的独立危险因素,孕妇血清25-OH-D水平升高为其保护因素,据此构建预测模型对NRDS预测价值较高,可为筛选高危患儿、制订临床干预策略提供依据。Objective To construct a prediction model of neonatal respiratory distress syndrome(NRDS)based on the clinical characteristics of newborns and pregnant women.Methods In total,102 children with NRDS admitted from January 2020 to January 2023 were included in the NRDS group,and another 150 healthy newborns were included in the non-NRDS group during the same period.Clinical data were retrospectively collected,and the conditions of newborns and pregnant women in the two groups were analyzed.The risk factors of NRDS were analyzed by multivariate Logistic regression,the prediction model was established,and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of the prediction model for NRDS.Results Compared with the non-NRDS group,the proportion of the gestational age<34 weeks,birth weight<2 kg,delivery mode of cesarean section,fetal distress,premature rupture of membranes,acidosis was higher in the NRDS group(P<0.05,P<0.01).Compared with the non-NRDS group,the pregnant women in the NRDS group had higher proportion of≥35 years of age,first delivery,gestational hypertension,gestational diabetes,combined reproductive tract infection,prenatal examination less than 9 times,but lower levels of serum 25-hydroxyvitamin D(25-OH-D)(P<0.05,P<0.01).Gestational age<34 weeks,birth weight<2 kg,delivery mode of cesarean section,fetal distress,maternal age≥35 years,gestational diabetes,prenatal examination less than 9 times were independent risk factors for NRDS(P<0.05,P<0.01),while the increase of serum level of 25-OH-D in pregnant women was a protective factor(P<0.01).According to the above results,a prediction model was constructed and the ROC curve was drawn.The results showed that when Logit(P)was>18.570,the area under the curve for predicting the occurrence of NRDS was 0.893,the diagnostic sensitivity was 81.37%,and the specificity was 82.00%.Conclusion Gestational age<34 weeks,birth weight<2 kg,delivery mode of cesarean section,fetal distress,maternal age≥35 years,gestational diabetes,and

关 键 词：呼吸窘迫综合征 新生儿 剖宫产 胎儿窘迫 糖尿病 妊娠 25-羟基维生素D 危险因素 预测 受试者工作特征曲线 

分 类 号：R722.12[医药卫生—儿科]