胎龄<34周早产儿坏死性小肠结肠炎需手术治疗的预测模型
Predictive model of necrotizing enterocolitis requiring surgical treatment in preterm infants with gestational age<34 weeks
殷小利 1王杨1
作者信息
- 1. 安徽医科大学第一附属医院儿科,安徽合肥 230022
- 折叠
摘要
目的 构建胎龄<34 周早产儿坏死性小肠结肠炎(NEC)需手术治疗的预测模型.方法 选取2016 年1月至 2023 年12 月出生于安徽医科大学第一附属医院胎龄<34 周且住院期间患NEC的早产儿196 例,根据不同治疗方式分为两组,接受外科手术治疗的患儿为手术组(n=47),保守治疗的患儿为非手术组(n=149).采用单因素及多因素logistic回归分析需手术治疗的影响因素,并建立预测模型,采用受试者操作特征(ROC)曲线评估列线图模型的价值.结果 两组的胎龄、出生体重、发病时体重、发病 24 h内淋巴细胞计数(LC)、中性粒细胞计数/淋巴细胞计数比值(NLR)、C反应蛋白(CRP)及降钙素原(PCT)水平比较,差异有统计学意义(P<0.05).多因素logistic回归分析结果显示,出生体重(OR=0.997,95%CI:0.994～0.999)、发病 24 h内NLR(OR=1.356,95%CI:1.141～1.611)、CRP(OR=1.016,95%CI:1.002～1.031)、PCT(OR=1.034,95%CI:1.007～1.062)是胎龄<34 周早产儿NEC需手术治疗的影响因素(P<0.05).利用R软件绘制列线图预测胎龄<34 周早产儿NEC手术治疗风险的ROC曲线,曲线下面积为 0.835(95%CI:0.769～0.902),模型具有良好的预测价值.结论 胎龄<34周早产儿出生体重越低,NEC发病 24 h内NLR、CRP及PCT水平越高,需外科手术治疗的风险越大,列线图作为简单可靠的预测模型,可为临床诊治提供参考依据.
Abstract
Objective To establish a predictive model of necrotizing enterocolitis requiring surgical treatment in preterm infants with gestational age<34 weeks.Methods A total of 196 premature infants with gestational age<34 weeks and NEC during hospitalization were selected from the First Affiliated Hospital of Anhui Medical University from January 2016 to December 2023.They were divided into two groups according to different treatment methods.The children receiving surgical treatment were classified as operation group(n=47),and the children receiving conservative treatment were classified as non-operation group(n=149).Univariate and multivariate logistic regression were used to analyze the influencing factors requiring surgical treatment,and predictive model was established.Receiver operating characteristic(ROC)curve was used to evaluate the value of the nomogram model.Results There were significant differences in gestational age,birth weight,weight at onset,lymphocyte count(LC),neutrophil to lymphocyte ratio(NLR),C-reactive protein(CRP)and procalcitonin(PCT)levels within 24 h of onset between the two groups(P<0.05).Multivariate logistic regression analysis showed that birth weight(OR=0.997,95%CI:0.994-0.999),NLR(OR=1.356,95%CI:1.141-1.611),CRP(OR=1.016,95%CI:1.002-1.031)and PCT(OR=1.034,95%CI:1.007-1.062)were the influencing factors for surgical treatment of NEC in preterm infants with gestational age<34 weeks(P<0.05).R software was used to draw a column graph to predict the ROC curve of the risk of surgical treatment for NEC in premature infants with gestational age<34 weeks.The area under the curve was 0.835(95%CI:0.769-0.902),indicating that the model had good predictive value.Conclusion The lower the birth weight of preterm infants with gestational age<34 weeks and the higher the level of NLR,CRP and PCT within 24 h of the onset of NEC,the greater the risk of surgical treatment.As a simple and reliable prediction model,the nomogram can provide reference for clinical diagnosis and treatment.
关键词
坏死性小肠结肠炎/早产儿/手术/预测模型Key words
Necrotizing enterocolitis/Preterm infant/Surgery/Predictive model引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据