胎龄≤32周的低出生体质量儿支气管肺发育不良的预测模型
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四川省德阳市科技计划项目(2022SCZ134;2021SZZ068);


Prediction nomogram for bronchopulmonary dysplasia in low birth weight infants borne earlier than 32 weeks
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    摘要:

    目的:构建胎龄≤32周的低出生低体质量儿发生支气管肺发育不良(BPD)的早期预测列线图模型。方法:选取胎龄≤32周且体质量<2 500 g的早产儿进行回顾性分析。探究发生BPD的危险因素,并利用受试者工作特征(ROC)曲线下面积(AUC)、敏感度及特异度评价其效果。利用Bootstrap重复抽样的方法对模型进行内部验证。采用Hosmer-Lemeshow拟合优度检验进行校准度评价,采用临床决策曲线(DCA)评价该模型的临床效能。结果:共纳入260例早产儿,其中BPD组79例;非BPD组181例。多因素Logistic回归分析显示:孕母分娩前未规律使用激素(OR=3.317,95%CI:1.377~7.990)、胎龄(OR=0.528,95%CI:0.401~0.695)、新生儿呼吸窘迫综合征(OR=3.175,95%CI:1.529~6.593)、机械通气(OR=2.537,95%CI:1.215~5.300)是胎龄≤32周的低出生体质量儿发生BPD的独立危险因素(P<0.05)。建立生后早期BPD风险的列线图模型,AUC为0.836(95%CI:0.784~0.887),界值为0.293时,敏感度为0.810(95%CI:0.724~0.897),特异度为0.779(95%CI:0.719~0.839),提示模型鉴别能力良好;利用DCA评估预测模型的临床有效性,显示当建模队列的阈值概率为10%~70%时,进行临床预测具有较高的净收益。结论:孕母分娩前未规律使用激素、胎龄、新生儿呼吸窘迫综合征、接受机械通气的胎龄≤32周的低出生体质量儿发生BPD的风险增加;可视化的列线图风险预测模型的建立对临床医生早期识别BPD提供了直观工具。

    Abstract:

    Objective:To explore and validate a nomogram for early prediction of bronchopulmonary dysplasia(BPD)in low birth weight infants borne earlier than 32 weeks.Methods:Preterm infants with a birth weight of less than 2 500 g and ges-tational age≤32 weeks were selected for retrospective analysis.The risk factors of BPD were analyzed,and its effectiveness was evaluated using the area under the receiver operating characteristic(ROC)curve,sensitivity,and specificity.Internal valida-tion of the model was conducted using Bootstrap resampling.Hosmer-Lemeshow test and decision curve analysis(DCA)were used for evaluating calibration and clinical applicability.Results:A total of 260 preterm infants were included in the study,with 79 cases in the BPD group and 181 cases in the non-BPD group.The results of the multivariate Logistic regression analysis showed that the lack of regular prenatal steroid use before maternal delivery(OR=3.317,95%CI:1.377~7.990),gestational age(OR=0.528,95%CI:0.401~0.695),neonatal respiratory distress syndrome(NRDS,OR=3.175,95%CI:1.529~6.593),and mechanical ventilation(OR=2.537,95%CI:1.215~5.300)were independent risk factors for BPD in preterm in-fants with low birth weight(P<0.05).Based on the results of the multivariate Logistic regression analysis,a nomogram model was established,with the area under the ROC curve being 0.836(95%CI:0.784~0.887).At a cutoff value of 0.293,the sen-sitivity was 0.810(95%CI:0.724~0.897),and the specificity was 0.779(95%CI:0.719~0.839),indicating that the model has good discriminative ability.The clinical effectiveness of the predictive model was assessed using the DCA,which showed that when the threshold probability for the modeling cohort was between 10%and 70%,there was a higher net benefit for the clinical prediction of infants.Conclusion:Maternal irregular use of hormones before delivery,gestational age,NRDS,and me-chanical ventilation in low birth weight infants borne earlier than 32 weeks increase the risk of BPD.The establishment of a no-mogram model provides clinicians with a visual tool for early identification of BPD.

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高阳;潘亮;刘前芳;李倩;崔新萍;曾燕;.胎龄≤32周的低出生体质量儿支气管肺发育不良的预测模型[J].川北医学院学报,2025,40(10):1328-1332.

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  • 在线发布日期: 2025-11-03
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