新生儿细菌性脑膜炎危险因素评估及临床预测模型的建立  

Assessment of risk factors for neonatal bacterial meningitis and establishment of a clinical prediction model

作　　者：陈冠初 程坤 厚舒阳 霍媛 唐建明[1] 赵芳萍[1] 李伟阳 高红霞[1] Chen Guanchu;Cheng Kun;Hou Shuyang;Huo Yuan;Tang Jianming;Zhao Fangping;Li Weiyang;Gao Hongxia(Department of Neonatology,Gansu Provincial Women and Child Healthcare Hospital(Gansu Central Hospital),Lanzhou 730050,China)

机构地区：[1]甘肃省妇幼保健院(甘肃省中心医院)新生儿科,兰州730050

出　　处：《中华围产医学杂志》2025年第4期313-319,共7页Chinese Journal of Perinatal Medicine

基　　金：甘肃省自然科学基金(21JR7RA658);兰州市科技计划项目(2023-ZD-12)。

摘　　要：目的探讨新生儿细菌性脑膜炎(bacterial meningitis,BM)的危险因素,并构建新生儿BM列线图预测模型。方法采用回顾性队列研究,选择2019年12月至2024年2月甘肃省妇幼保健院新生儿科行腰椎穿刺脑脊液检查的1228例新生儿。计算机随机按7∶3比例分为训练队列和验证队列,采用秩和检验或χ^(2)检验比较两队列间差异;同时根据是否为BM分为BM组和非BM组。在训练队列中采用多因素logistic回归模型(向前逐步回归法)筛选BM的影响因素,使用受试者工作特征曲线下面积和Hosmer-Lemeshow拟合优度检验分别评估模型的区分度和校准度,校准曲线评估模型的准确性并绘制模型列线图。采用Bootstrap重复取样法进行内部验证。最后使用决策曲线分析评估模型的临床实用性。结果1228例新生儿中,BM 151例(12.3%)。训练队列共859例,其中106例(12.3%)BM、753例(87.7%)非BM;验证队列共369例,其中45例(12.2%)BM、324例(87.8%)非BM。训练队列的多因素logistic回归分析结果显示,败血症(OR=4.446,95%CI:2.583~7.653)、惊厥(OR=3.749,95%CI:1.930~7.280)、体温最高值高(OR=2.027,95%CI:1.636~2.513)、C-反应蛋白高(OR=1.007,95%CI:1.003~1.012)为发生BM的独立危险因素,出生胎龄大(OR=0.946,95%CI:0.898~0.995)和血红蛋白高(OR=0.990,95%CI:0.981~0.998)为BM保护因素(P值均<0.05)。基于此构建新生儿BM列线图预测模型并验证其准确性,训练队列和验证队列中列线图模型的受试者工作特征曲线的曲线下面积分别为0.796(95%CI:0.750~0.843)和0.781(95%CI:0.700~0.862),Hosmer-Lemeshow拟合优度检验均P>0.05,临床决策曲线显示在大部分阈值范围具有较好的净获益。结论败血症、惊厥、体温最高值高、C-反应蛋白高增加新生儿BM发生风险,以此联合出生胎龄、血红蛋白构建的列线图模型可为预测新生儿BM发生风险提供一定参考。Objective To investigate the risk factors and construct a nomogram prediction model for neonatal bacterial meningitis(BM).Methods A retrospective cohort study was conducted on 1228 neonates who underwent lumbar puncture for cerebrospinal fluid examination in the Department of Neonatology at Gansu Provincial Women and Child Healthcare Hospital from December 2019 to February 2024.The subjects were randomly divided into a training cohort and a validation cohort at a ratio of 7∶3 using a computer program.Rank sum test or Chi-square tests were used to compare differences between the two cohorts.The subjects were divided into BM and non-BM groups based on the presence or absence of BM.Multivariate logistic regression analysis(forward stepwise regression method)was used in the training cohort to identify risk factors for BM.The area under the receiver operating characteristic curve(AUC)and the Hosmer-Lemeshow goodness-of-fit test were used to assess the discrimination and calibration of the model,respectively.Calibration curves were used to evaluate the accuracy of the model and to construct the nomogram.Internal validation was performed using the Bootstrap resampling method.Decision curve analysis was used to assess the clinical utility of the model.Results Among the 1228 neonates,151(12.3%)had BM.The training cohort included 859 neonates,of whom 106(12.3%)had BM and 753(87.7%)did not.The validation cohort included 369 neonates,of whom 45(12.2%)had BM and 324(87.8%)did not.The results of the multivariate logistic regression analysis in the training cohort showed that sepsis(OR=4.446,95%CI:2.583-7.653),convulsions(OR=3.749,95%CI:1.930-7.280),high maximum body temperature(OR=2.027,95%CI:1.636-2.513),and elevated C-reactive protein(OR=1.007,95%CI:1.003-1.012)were independent risk factors for BM,while greater gestational age at birth(OR=0.946,95%CI:0.898-0.995)and higher hemoglobin levels(OR=0.990,95%CI:0.981-0.998)were protective factors for BM(all P<0.05).Based on these findings,a nomogram prediction model for neonatal

关 键 词：细菌性脑膜炎 腰椎穿刺 新生儿 危险因素 列线图 

分 类 号：R722.1[医药卫生—儿科]