脑出血患儿并发脑积水的危险因素及预测模型  

Risk factors for hydrocephalus in children with cerebral hemorrhage and its prediction model

作　　者：许慧峰 晋艳勇 苟若澜 胡明哲 Xu Huifeng;Jin Yanyong;Gou Ruolan;Hu Mingzhe(Department of Neurosurgery,Xiamen Children's Hospital/Children's Hospital of Fudan University at Xiamen,Xiamen 361006,China)

机构地区：[1]厦门市儿童医院/复旦大学附属儿科医院厦门医院神经外科,福建厦门361006

出　　处：《临床荟萃》2025年第4期325-328,共4页Clinical Focus

摘　　要：目的调查脑出血患儿并发脑积水的危险因素,构建预测模型。方法选取2016年4月-2023年12月本院收治的脑出血患儿共计120例的临床资料进行回顾性分析,统计并发脑积水情况,进行单因素与多因素logistic回归分析以明确其发生的危险因素。结果120例脑出血患儿中发生脑积水22例,占18.33%(22/120);脑积水组年龄<8岁、脑脊液蛋白质>3 g/L、脑室出血、住院并发症的患儿占比较非脑积水组更高(P<0.05);多因素logistic回归分析结果显示,年龄<8岁(OR=4.593)、脑脊液蛋白质>3 g/L(OR=6.525)、脑室出血(OR=14.500)是影响脑积水发生的独立危险因素(P<0.05);预测模型预测脑出血患儿并发脑积水的曲线下面积为0.841,95%CI为0.749~0.934,敏感度为0.928,特异度为0.783;验证的ROC曲线下面积为0.822,95%CI为0.706~0.937;进行Hosmer-Lemeshow拟合优度检验(χ^(2)=1.635,P=0.201),说明本模型具有良好的可信度。结论脑出血患儿可能会发生脑积水,年龄、脑脊液蛋白质水平、出血部位均为脑积水发生的危险因素,通过建立预测模型能够有效评估脑积水发生率。Objective To explore the risk factors of hydrocephalus in children with cerebral hemorrhage and to create a prediction model.Methods A retrospective analysis was conducted on the clinical data of 120 children with cerebral hemorrhage admitted from April 2016 to December 2023.The incidence of concurrent hydrocephalus was statistically analyzed.Univariate and multivariate logistic regression analyses were used to clarify the risk factors for its occurrence.Results Among 120 children with cerebral hemorrhage,22/120(18.33%)developed hydrocephalus.The proportion of patients<8 years old,cerebrospinal fluid protein>3 g/L,intraventricular hemorrhage,and hospitalization complications in the hydrocephalus group was significantly higher than that of the non-hydrocephalus group(P<0.05).Multivariate logistic regression analysis showed that<8 years old(OR=4.593),cerebrospinal fluid protein>3 g/L(OR=6.525),and intraventricular hemorrhage(OR=14.500)were independent risk factors affecting the occurrence of hydrocephalus(P<0.05).The area under the curve(AUC)of the prediction model in identifying hydrocephalus in children with cerebral hemorrhage was 0.841,with a 95%confidence interval(CI)of 0.760-0.937,a sensitivity of 0.928,and a specificity of 0.783.In the validation set,the AUC was 0.822,with a 95%CI of 0.706-0.937.Conduct Hosmer Lemeshow test showed an acceptable goodness of fit(χ^(2)=1.635,P=0.201),indicating a good credibility.Conclusion Children with cerebral hemorrhage may develop hydrocephalus,and age,cerebrospinal fluid protein level,bleeding site are all risk factors for hydrocephalus.Establishing a prediction model can effectively evaluate the incidence of hydrocephalus.

关 键 词：脑出血 脑积水 危险因素 预测模型 

分 类 号：R743.34[医药卫生—神经病学与精神病学]