儿童动脉导管未闭介入封堵后血小板减少的危险因素和预测模型

Risk factors and prediction model of thrombocytopenia in children with patent ductus arteriosus after transca-theter closure

目的探讨儿童动脉导管未闭(PDA)介入封堵后血小板减少的危险因素,并建立PDA介入封堵后血小板减少预测模型。方法选取2016年11月至2020年1月于南京医科大学附属儿童医院就诊的39例PDA介入封堵后发生血小板减少的病例,并以同时期就诊的138例PDA介入封堵后未发生血小板减少病例作为对照,采用Logistic回归模型探索PDA介入封堵后发生血小板减少可能的危险因素,建立随机森林模型预测PDA介入封堵后血小板减少的发生。结果患儿PDA介入封堵后,发生血小板减少的时间为术后1~7 d,血小板恢复时间为术后2~22 d。单因素Logistic回归模型表明,患儿动脉导管肺动脉端内径大小(OR=9.54,95%CI:2.08~48.84,P=0.004)和术前血小板计数(OR=0.99,95%CI:0.98~0.99,P=0.001)与PDA介入封堵后发生血小板减少相关。随机森林模型显示,动脉导管肺动脉端内径对PDA介入封堵后发生血小板减少的相对重要性最大。结论患儿动脉导管内径大是导致PDA封堵术后血小板减少的重要危险因素,术前血小板计数增高是PDA封堵术后血小板减少的相对保护因素,动脉导管肺动脉端内径对预测PDA介入封堵后发生血小板减少的相对重要性最大。

Objective To explore the risk factors of thrombocytopenia in children with patent ductus arteriosus(PDA)after transcatheter closure,and to establish a prediction model of thrombocytopenia after transcatheter closure of PDA.Methods A total of 39 PDA children with thrombocytopenia after transcatheter closure treated in Children′s Hospital of Nanjing Medical University from November 2016 to January 2020 were selected.During the same period,138 PDA children without thrombocytopenia after transcatheter closure were included in the control group.Logistic regression model was used to explore the possible risk factors of thrombocytopenia after transcatheter closure in PDA children,and a random forest model was established to predict the occurrence of thrombocytopenia after transcatheter closure of PDA.Results After transcatheter closure of PDA,children developed thrombocytopenia within 1 to 7 days,and the platelet count recovered within 2 to 22 days.Logistic regression model suggested that the diameter of pulmonary artery end of arterial catheter(OR=9.54,95%CI:2.08-48.84,P=0.004)and preoperative platelet count(OR=0.99,95%CI:0.98-0.99,P=0.001)were correlated with the occurrence of thrombocytopenia after transcatheter closure of PDA.The random forest model indicated that PDA inner diameter was the most important factor for predicting the occurrence of thrombocytopenia after transcatheter closure of PDA.Conclusions A large diameter of arterial duct is an important risk factor and increased preoperative platelet count is a protective factor for thrombocytopenia after transcatheter closure of PDA.Diameter is of the greatest significance in predicting the occurrence of thrombocytopenia after transcatheter closure of PDA.