超早产儿生后不同日龄发生中/重度支气管肺发育不良的预测模型构建

Constructing prediction models for the moderate/severe bronchopulmonary dysplasia in extremely preterm infants at different days after birth

目的构建超早产儿生后不同日龄发生中/重度支气管肺发育不良(BPD)的预测模型。方法回顾性选取2017年9月至2019年12月期间在广州医科大学附属第三医院出生、胎龄<28周且诊断为BPD的超早产儿为研究对象,分为轻度BPD和中/重度BPD 2组,将单因素分析中P<0.05变量纳入多因素Logistic回归进行风险评估分析,建立早期预测模型,进行验证并评估预测效能。结果共纳入研究对象90例,其中轻度BPD组和中/重度BPD组分别为58例(64.4%)和32例(35.6%)。多因素Logistic回归分析结果显示,超早产儿生后7日龄影响中/重度BPD发生的因素有出生体质量、孕母孕前BMI≥25 kg/m^(2)、出生后1分钟Apgar评分≤7分和肺炎。14日龄危险因素有子痫前期、孕母孕前BMI≥25 kg/m^(2)、肺炎和具有血流动力学意义动脉导管未闭(hsPDA)。28日龄危险因素有子痫前期、孕母孕前BMI≥25 kg/m^(2)、有创机械通气时间和hsPDA。生后7、14和28日龄预测模型的ROC曲线下AUC值分别为0.864(95%CI 0.776~0.952)、0.860(95%CI 0.774~0.946)和0.863(95%CI 0.783~0.944)。基于高危因素构建列线图模型,校准后曲线接近参考线,预测值与实际值接近,模型具有较好的校准度。结论超早产儿生后第7、14、28日龄时发生中/重度BPD的危险因素略有差别,主要集中在出生体质量、孕母孕前BMI≥25 kg/m^(2)、生后1分钟Apgar评分≤7分、肺炎、子痫前期、hsPDA和有创机械通气天数等指标,根据不同因素所构建的不同时间点的预测模型均具有较好的预测价值,可以为临床提供指导。

Objective To construct prediction models for moderate/severe bronchopulmonary dysplasia(BPD)in extremely preterm infants at different days after birth.Methods The preterm infants with BPD at a gestational age of<28 weeks at the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to December 2019 were retrospectively selected.They were divided into the mild-BPD group and moderate/severe-BPD group.The significant variables screened by using single-factor analysis were subject to risk assessment analysis by multivariate Logistic regression analysis.Early prediction models were established,and the predictive performance was validated and evaluated.Results Ninety extremely preterm infants were included in this study,including 58 cases(64.4%)in the mild-BPD group and 32 cases(35.6%)in the moderate/severe-BPD group.Multiple Logistic regression analysis showed birth weight,maternal pre-pregnancy body mass index(BMI)≥25 kg/m^(2),1-minute Apgar score≤7 after birth and pneumonia were the influencing factors for moderate/severe BPD at 7 days after birth.Preeclampsia,maternal pre-pregnancy BMI≥25 kg/m^(2),pneumonia and hsPDA were the risk factors for moderate/severe BPD at 14 days postnatal age.Preeclampsia,maternal pre-pregnancy BMI≥25 kg/m^(2),days of invasive mechanical ventilation and hsPDA were the risk factors for moderate/severe BPD at 28 days after birth.The area under the receiver operating characteristic(ROC)curve of the prediction models for 7,14 and 28 days after birth were 0.864(95%CI 0.776-0.952),0.860(95%CI 0.774-0.946)and 0.863(95%CI 0.783-0.944),respectively.A nomogram was constructed based on high risk factors,the calibrated curve was close to the reference line,and the predicted value was close to the actual value,indicating good calibration of the model.Conclusions The risk factors for moderate/severe BPD in preterm infants vary slightly on 7,14 and 28 days after birth,mainly the birth weight,maternal pre-pregnancy BMI≥25 kg/m^(2),1-minute Apgar score≤7,pneumonia,preeclampsia,hsPDA and days of invasive mechanical ventilation.The predictive models based on different factors at different time points have good predictive value,which can provide guidance for clinical practice.