摘要
目的 分析宫内窘迫新生儿发生缺氧缺血性脑病(HIE)的危险因素,并构建个体化列线图预测模型。方法 收集2017年1月—2021年12月淮安市第二人民医院新生儿科收治的具有宫内窘迫暴露因素且发生HIE的新生儿96例(病例组),另选择同期本院收治的具有宫内窘迫暴露因素但未发生HIE的新生儿96例(对照组),采用logistic回归分析筛选影响宫内窘迫新生儿发生HIE的危险因素;采用R软件构建列线图模型,同时进行模型验证。结果 1 min Apgar评分<7分(P<0.001)、不规律产前检查(P=0.003)、妊高症(P<0.001)、脐带异常(P=0.043)、产程异常(P=0.001)、pH<7.0(P=0.009)、碱剩余<-12.0 mmol/L(P=0.003)是宫内窘迫新生儿发生HIE的独立危险因素。ROC曲线下面积为0.875(95%CI:0.826~0.925)。校准曲线斜率接近1,且H-L拟合优度检验χ^(2)=7.221,P=0.513。结论 1 min Apgar评分<7分、不规律产前检查、妊高症、脐带异常、产程异常、pH<7.0、碱剩余<-12.0 mmol/L均是宫内窘迫新生儿发生HIE的独立危险因素,根据以上指标构建的列线图预测模型具有较好的预测效能,能准确预测宫内窘迫新生儿发生HIE风险。
Objective To analyze the risk factors for hypoxic-ischemic encephalopathy(HIE) in neonates with intrauterine distress,and to develop a personalized nomograph prediction model.Methods Ninety-six neonates with exposure factors of intrauterine distress and HIE(case group) treated in the Neonatology Department of Huaian Second People’s Hospital from January 2017 to December 2021 were collected,96 neonates with exposure factors of intrauterine distress who did not develop HIE(control group) treated in our hospital during the same period were selected.Logistic regression analysis was performed to screen the risk factors affecting the risk of HIE in neonates with intrauterine distress;R software was used to construct a nomogram model to predict the risk of HIE in neonates with intrauterine distress,and the model was meanwhile validated.Results 1 min Apgar score <7 points(P<0.001),irregular prenatal examination(P=0.003),pregnancy-induced hypertension(P<0.001),abnormal umbilical cord(P=0.043),abnormal labor process(P=0.001),pH<7.0(P=0.009),alkaline residue <-12.0 mmol/L(P=0.003) were independent risk factors for HIE in neonates with intrauterine distress.The area under the ROC curve was 0.875(95% CI: 0.826-0.925).The slope of the calibration curve was close to 1,and the H-L goodness-of-fit test χ^(2)=7.221,P=0.513.Conclusion 1 min Apgar score<7,irregular prenatal examination,pregnancy induced hypertension,umbilical cord abnormality,abnormal labor process,pH<7.0,and alkaline residue <-12.0 mmol/L are all independent risk factors for HIE in neonates with intrauterine distress.The nomograph prediction model constructed using the above indicators has good predictive power and can accurately predict the risk of HIE in neonates with intrauterine distress.
作者
王聪颖
张帆
WANG Congying;ZHANG Fan(Department of Neonatology,Huaian Second People's Hospital,Huaian,Jiangsu 223022,China)
出处
《中华全科医学》
2023年第3期369-373,共5页
Chinese Journal of General Practice
基金
江苏省妇幼健康科研项目(F202029)。
关键词
宫内窘迫
新生儿
缺氧缺血性脑病
列线图预测模型
Intrauterine distress
Neonates
Hypoxic-ischemic encephalopathy
Nomogram prediction model
