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| 早产儿支气管肺发育不良的临床诊治分析及严重程度预测模型构建 |
| Analysis of clinical diagnosis and treatment of bronchopulmonary dysplasia in preterm infants and construction of severity prediction modelSong Zhijun, Luo Hao, Chu Xiaoyun, Zhang Xiaoyue, Weng Bowen, Cai Cheng |
| 投稿时间：2024-11-21 修订日期：2024-11-21 |
| DOI： |
| 中文关键词: 支气管肺发育不良 危险因素 早产儿 临床诊治分析 严重程度预测模型 |
| 英文关键词: Bronchopulmonary dysplasia Risk factors Premature infants Clinical diagnosis and treatment analysis Severity prediction model |
| 基金项目: |
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| 摘要点击次数: 12 |
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| 中文摘要: |
| 目的：探讨早产儿支气管肺发育不良（Bronchopulmonary dysplasia，BPD）的临床诊治及并发症情况，建立BPD病情严重程度预测模型。
方法 选取2018年1月-2022年12月在上海市儿童医院新生儿重症监护病房(NICU)住院的胎龄≤32周极早产儿854例，依据纳排标准，最终纳入极早产儿713例。根据2018年美国国立儿童健康与人类发展研究所（NICHD）发布的BPD诊断标准，分组为BPD组（n=164）和非BPD组（n=549），比较两组患儿及孕母的临床资料，通过单因素及逐步回归多因素分析筛选出BPD发生的高危因素及临床诊治情况，来构建BPD严重程度预测模型。
结果 胎龄、无创通气时间、总用氧时间、总住院时间、hsPDA、PDA最大直径、FGR、血管活性药物及肺表面活性物质使用比例是早产儿发生BPD的独立危险因素（均p＜0.05，OR＞1）。构建列线图模型，得到ROC曲线下面积（AUC）是0.93，列线图校准曲线斜率趋近于1；并进行拟合优度检验，c2=8.2865,，P=0.406。
结论 胎龄、无创通气时间、总用氧时间、总住院时间、hsPDA、PDA最大直径、FGR、血管活性药物及肺表面活性物质使用比例是早产儿发生BPD的独立危险因素。根据不同因素所构建的BPD发生风险及严重程度的预测模型均具有较好的预测价值，可以为临床提供指导。 |
| 英文摘要: |
| Objectives: To study the clinical diagnosis, treatment and complications of Bronchopulmonary dysplasia (BPD) in preterm infants, and to establish a prediction model for the severity of BPD. Methods: A total of 854 very preterm infants with gestational age ≤32 weeks admitted to the neonatal intensive care unit (NICU) of Shanghai Children"s Hospital from January 2018 to December 2022 were enrolled. According to the inclusion and exclusion criteria, 713 very preterm infants were finally included. According to the diagnostic criteria of BPD issued by the National Institute of Child Health and Human Development (NICHD) in 2018, the infants were divided into BPD group (n=164) and non-BPD group (n=549). The clinical data of the infants and mothers were compared between the two groups. Univariate and multivariate stepwise regression analyses were used to screen out risk factors for BPD and clinical diagnosis and treatment. To construct a prediction model for the severity of BPD. Results：Gestational age, duration of noninvasive ventilation, duration of oxygen therapy, length of hospital stay, hsPDA, maximum diameter of PDA, FGR, rates of use of vasoactive agents and pulmonary surfactant were independent risk factors for BPD in preterm infants (all p < 0.05, OR > 1). The area under the ROC curve (AUC) was 0.93, and the slope of the nomogram calibration curve was close to 1. And the goodness of fit test, c2=8.2865, P=0.406. Conclusions：Gestational age, duration of noninvasive ventilation, duration of oxygen therapy, length of hospital stay, hsPDA, maximum diameter of PDA, FGR, rates of use of vasoactive agents and pulmonary surfactant are independent risk factors for BPD in preterm infants. The prediction models for the risk and severity of BPD based on different factors have good predictive value and can provide guidance for clinical practice. |
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