早产儿和出生低体重儿慢性肾脏疾病的风险预测研究

Study on the risk prediction of chronic kidney disease in premature infants and low birth weight infants

目的分析早产儿和出生低体重儿罹患慢性肾脏疾病(CKD)的风险因素。方法2005年1月-2019年1月收集三亚市3个重点医院的出生低体重儿以及早产儿病例,对所有可追溯的儿童进行为期18个月随访,观察CKD的检出率,分析出生后临床资料、入组后实验室检查资料以及随访资料结果,采用Logistics回归分析观察早产及出生低体重儿发生CKD的风险因素,采用ROC曲线分析观察各风险因素对评估CKD的效能。结果最终纳入1269例受试者,其中确诊CKD 39例,检出率为3.07%。二元Logistic回归分析显示,孕周≥29.37周、内生肌酐清除率(Ccr)≤36.53 ml(min·1.73 m^(2))、血清白蛋白≥39.43 g/L和运动行为指数≥10.17是早产儿以及出生低体重儿罹患CKD的保护因素(β=-0.290、-0.117、-0.038、-0.559,P<0.05);血肌酐(Scr)≥47.58μmol/L、舒张压≥85.69 mmHG、尿白蛋白≥12.16 mg/L、空腹血糖≥5.61 mmol/L是早产儿以及出生低体重儿罹患CKD的危险因素(β=0.047、0.069、0.315、1.510,P<0.05)。ROC分析显示,Ccr、血清白蛋白、舒张压、血肌酐、尿白蛋白、空腹血糖以及运动行为指数在预测早产儿以及出生低体重儿罹患CKD中均具有一定价值(P<0.05),且Ccr和Scr预测效能更佳(AUC分别为0.794和0.738)。结论Scr、舒张压、尿白蛋白、空腹血糖过高是早产儿以及出生低体重儿发生CKD的危险因素,而高运动指数、高血清白蛋白、高孕周有利于降低早产儿和出生低体重儿CKD的发生,且Ccr和Scr具备评判早产儿以及出生低体重儿CKD发生的效能,但应重视和鉴别假阳性病例。

Objective To explore the risk factors of chronic kidney disease(CDK)in premature infants and low birth weight infants.Methods Cases of low birth weight and premature infants from three key hospitals in Sanya,Hainan Province were collected in this study from January 2005 to January 2019.All traceable children were followed up for 18 months to observe the screening rate of CKD.The clinical data after birth,the laboratory examination data after enrollment and the results of follow-up data were analyzed.Logistic regression analysis was used to observe the risk factors of CKD in preterm and low birth weight infants.ROC curve analysis was used to observe the effectiveness of each risk factor in evaluating CKD.Results A total of 1269 subjects were included in the study,of whom 39(3.07%)cases were diagnosed with CKD.Binary Logistic regression analysis showed that gestational age≥29.37 weeks,endogenous creatinine clearance(Ccr)≤36.53 ml/(min·1.73 m^(2)),serum albumin≥39.43 g/L,and exercise behavior index≥10.17 were the protective factors for preterm infants and low birth weight infants from CKD(β=-0.290,-0.117,-0.038,-0.559,P<0.05),serum creatinine(Scr)≥47.58μmol/L,diastolic blood pressure≥85.69 mmHg,urine albumin≥12.16 mg/L,fasting blood glucose≥5.61 mmol/L were risk factors for CKD in preterm infants and low birth weight infants(β=0.047,0.069,0.315,1.510,P<0.05).ROC analysis showed that Ccr,serum albumin,diastolic blood pressure,blood creatinine,urine albumin,fasting blood glucose,and exercise behavior index had certain value in predicting CKD in preterm infants and low birth weight infants(P<0.05),and Ccr and Scr had better predictive performance(AUC=0.794,0.738).Conclusions Scr diastolic blood pressure,urine albumin,and fasting blood glucose are risk factors for CKD in preterm infants and low birth weight infants.High exercise index,high serum albumin,and high gestational age are beneficial to reduce CKD in premature and low birth weight infants.Ccr and Scr can predict the occurrence of CKD in preterm infants and low birth weight infants,but attention should be paid to the identification of false positive cases.