儿童室间隔缺损介入封堵术后发生残余分流的预测模型及对长期预后影响  

Prediction model of residual shunt occurring after interventional closure of ventricular septal defect in child patients and the effect of residual shunt on the long-term prognosis

作　　者：王欢[1] 易岂建[2] 邓萌[3] 苏建军[1] WANG Huan;YI Qijian;DENG Meng;SU Jianjun(Ward AreaⅣ,Department of Pediatrics,Zunyi Municipal First People′s Hospital,Zunyi,Guizhou Province 563000,China)

机构地区：[1]遵义市第一人民医院儿科四病区,贵州遵义563000 [2]重庆医科大学附属儿童医院心内科 [3]遵义市第一人民医院PICU,贵州遵义563000

出　　处：《介入放射学杂志》2024年第12期1293-1297,共5页Journal of Interventional Radiology

基　　金：贵州省科技厅科技计划资助项目(黔科合基础-ZK[2021]一般396)。

摘　　要：目的构建并验证儿童室间隔缺损介入封堵术后发生残余分流的预测模型,分析残余分流患儿预后情况。方法选取2017年1月至2023年3月遵义市第一人民医院及重庆医科大学附属儿童医院收治的室间隔缺损患儿178例,按照8∶2随机分为训练集144例和验证集34例,均行介入封堵术,术后随访12个月内残余分流发生情况。分析儿童室间隔缺损介入封堵术后发生残余分流的影响因素。建立儿童室间隔缺损介入封堵术后残余分流发生的预测模型,并进行模型的验证及效能评估。统计残余分流发生患儿预后情况。结果训练集144例患儿中,21例(14.58%)介入封堵术后发生残余分流;验证集34例患儿中,5例(14.71%)发生残余分流。logistic回归分析显示,室间隔缺损基底部大小(OR=5.339,95%CI:2.197~12.975)、缺损处压差(OR=4.384,95%CI:1.804~10.655)、封堵器直径(OR=4.707,95%CI:1.937~11.439)是儿童室间隔缺损介入封堵术后残余分流发生的影响因素(P<0.05)。以上述影响因素作为预测变量建立列线图预测模型,模型验证结果显示C-index指数为0.808(95%CI:0.761~0.839),预测儿童室间隔缺损介入封堵术后残余分流发生的校正曲线趋近于理想曲线(P>0.05)。训练集ROC曲线结果显示,列线图模型预测儿童室间隔缺损介入封堵术后残余分流发生的灵敏度80.95%,特异度为84.55%,AUC为0.855(95%CI:0.774~0.937)。验证集ROC曲线结果显示,列线图模型预测儿童室间隔缺损介入封堵术后残余分流发生的灵敏度80.00%,特异度为86.21%,AUC为0.871(95%CI:0.791~0.943)。训练集21例发生残余分流患儿,有14例(66.67%)出现残余分流自愈,残余分流自愈组残余分流>4 mm的占比低于残余分流未自愈组(P<0.05)。结论室间隔缺损基底部大小、缺损处压差、封堵器直径是儿童室间隔缺损介入封堵术后残余分流发生的影响因素,基于此构建的预测模型预测儿童室间隔缺损介入封堵术后残Objective To construct and validate a prediction model of residual shunt occurring after interventional closure of ventricular septal defect(VSD)in child patients,and to analyze the prognosis of the child patients with residual shunt.Methods A total of 178 child patients with VSD,who were admitted to the hospital to receive treatment from January 2017 to March 2023,were selected for this study.Adopting a 8∶2 ratio,the child patients were randomly divided into the training set(n=144)and the validation set(n=34).Interventional closure of VSD was carried out in all the child patients.During the postoperative follow-up of 12 months,the occurrence of the residual shunt was recorded.The factors influencing the occurrence of residual shunt after interventional closure of VSD in child patients were analyzed.A prediction model for residual shunt after interventional closure of VSD in child patients was established and validated,and its efficacy was evaluated.The prognosis of the child patients having residual shunt was analyzed.Results Residual shunt occurred in 21 child patients(14.58%,21/144)in the training set and in 5 child patients(14.71%,5/34)in the validation set.Logistic regression analysis showed that the size of the base of VSD(OR=5.339,95%CI:2.197-12.975),pressure difference at the site of defect(OR=4.384,95%CI:1.804-10.655),and diameter of occluder(OR=4.707,95%CI:1.937-11.439)were the influencing factors for residual shunt occurring after interventional closure of VSD in child patients(P<0.05).Taking the above influencing factors as the predictive variables,a nomogram prediction model was established.The verification results of the nomogram model showed that the C-index was 0.808(95%CI:0.761-0.839),and the correction curve for predicting residual shunt after interventional closure of VSD in child patients was close to the ideal curve(P>0.05).ROC curve analysis of the training set indicated that the sensitivity,specificity and AUC of the nomogram model for predicting residual shunt after interventional closur

关 键 词：室间隔缺损 介入封堵术 残余分流 列线图 预测 预后 

分 类 号：R726[医药卫生—儿科]