早产儿呼吸窘迫综合征并发支气管肺发育不良风险预测模型的构建及验证

Construction and validation of a risk prediction model for bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome

目的:构建并验证早产儿呼吸窘迫综合征(RDS)并发支气管肺发育不良(BPD)风险预测模型。方法:选取2014年1月至2022年5月贵州省某三甲医院的1 122例RDS早产儿为研究对象,包括建模组993例和验证组129例。建模组分为BPD组147例和非BPD组846例,采用多因素Logistic回归分析筛选危险因素,构建列线图预测模型,并验证模型的预测效能。结果:出生体重(BW)、机械通气时间、血清25-羟维生素D[25-(OH)D]<20 ng·ml^(-1)、输注红细胞悬液和肺出血是早产儿RDS并发BPD的独立危险因素(P<0.05)。建模组受试者工作特征曲线下面积(AUC)为0.950,95%CI为0.932~0.968,验证组AUC为0.940,95%CI为0.899~0.981,表明该模型具有较好的区分度。Brier评分为0.053分,Hosmer-Lemeshow拟合优度检验显示χ^(2)=6.214,P=0.623,结合校准曲线说明该模型一致性较好。结论:本研究所构建的列线图预测模型可为早产儿RDS并发BPD的早期临床预测提供简便、直观的评估工具。

Objective:To construct and validate a risk prediction model for bronchopulmonary dysplasia(BPD)in preterm infants with respiratory distress syndrome(RDS).Methods:A total of 1122 cases with RDS in a tertiary hospital in Guizhou Province from January 2014 to May 2022 were selected as our research subjects,including 993 in modeling group and 129 in validation group.The modeling group was divided into BPD group(n=147)and non-BPD group(n=846).Multivariate Logistic regression analysis was used to screen out the risk factors and a nomogram prediction model was constructed.The prediction effectiveness of this model was verified.Results:Birth weight(BW),duration of mechanical ventilation,serum 25-hydroxyvitamin D[25-(OH)D]<20 ng·ml^(-1),red blood cell suspension transfusion and pulmonary hemorrhage were independent risk factors for BPD in preterm infants with RDS(P<0.05).The area under the receiver operating characteristic curve(AUC)of the modeling group was 0.950,95%CI 0.932-0.968,and the AUC of the validation group was 0.940,95%CI 0.899-0.981,indicating that the model had a good discrimination degree.The Brier score was 0.053,and the Hosmer-Lemeshowgoodness-of-fit test showed χ^(2)=6.214,P=0.623,which indicated that the model had good consistency with the calibration curve.Conclusion:The nomogram model is a simple and intuitive evaluation tool for early clinical prediction of BPD in preterm infants with RDS.