宫内窘迫新生儿发生缺氧缺血性脑病风险的列线图预测模型建立

王聪颖; 张帆

doi:10.16766/j.cnki.issn.1674-4152.002885

宫内窘迫新生儿发生缺氧缺血性脑病风险的列线图预测模型建立

doi: 10.16766/j.cnki.issn.1674-4152.002885

王聪颖^,,
张帆

淮安市第二人民医院新生儿科, 江苏淮安 223022

基金项目:

江苏省妇幼健康科研项目 F202029

详细信息

通讯作者:
王聪颖，E-mail: wjcyyj87@163.com

中图分类号: R722.1 R446
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- 被引次数: 0
出版历程
- 收稿日期: 2022-11-28
- 网络出版日期: 2023-04-19

Establishment of a nomogram prediction model for the risk of hypoxic-ischemic encephalopathy in neonates with intrauterine distress

WANG Congying^,,
ZHANG Fan

Department of Neonatology, Huaian Second People ' s Hospital, Huaian, Jiangsu 223022, China

摘要

摘要: 目的分析宫内窘迫新生儿发生缺氧缺血性脑病(HIE)的危险因素，并构建个体化列线图预测模型。方法收集2017年1月—2021年12月淮安市第二人民医院新生儿科收治的具有宫内窘迫暴露因素且发生HIE的新生儿96例(病例组)，另选择同期本院收治的具有宫内窘迫暴露因素但未发生HIE的新生儿96例(对照组)，采用logistic回归分析筛选影响宫内窘迫新生儿发生HIE的危险因素；采用R软件构建列线图模型，同时进行模型验证。结果 1 min Apgar评分＜7分(P < 0.001)、不规律产前检查(P=0.003)、妊高症(P < 0.001)、脐带异常(P=0.043)、产程异常(P=0.001)、pH < 7.0(P=0.009)、碱剩余 < -12.0 mmol/L(P=0.003)是宫内窘迫新生儿发生HIE的独立危险因素。ROC曲线下面积为0.875(95% CI：0.826~0.925)。校准曲线斜率接近1，且H-L拟合优度检验χ²=7.221，P=0.513。结论 1 min Apgar评分＜7分、不规律产前检查、妊高症、脐带异常、产程异常、pH < 7.0、碱剩余 < -12.0 mmol/L均是宫内窘迫新生儿发生HIE的独立危险因素，根据以上指标构建的列线图预测模型具有较好的预测效能，能准确预测宫内窘迫新生儿发生HIE风险。
- 宫内窘迫 /
- 新生儿 /
- 缺氧缺血性脑病 /
- 列线图预测模型
Abstract: Objective To analyze the risk factors for hypoxic-ischemic encephalopathy (HIE) in neonates with intrauterine distress, and to develop a personalized nomograph prediction model. Methods Ninety-six neonates with exposure factors of intrauterine distress and HIE (case group) treated in the Neonatology Department of Huaian Second People ' s Hospital from January 2017 to December 2021 were collected, 96 neonates with exposure factors of intrauterine distress who did not develop HIE (control group) treated in our hospital during the same period were selected. Logistic regression analysis was performed to screen the risk factors affecting the risk of HIE in neonates with intrauterine distress; R software was used to construct a nomogram model to predict the risk of HIE in neonates with intrauterine distress, and the model was meanwhile validated. Results 1 min Apgar score < 7 points (P < 0.001), irregular prenatal examination (P=0.003), pregnancy-induced hypertension (P < 0.001), abnormal umbilical cord (P=0.043), abnormal labor process (P=0.001), pH < 7.0 (P=0.009), alkaline residue < -12.0 mmol/L (P=0.003) were independent risk factors for HIE in neonates with intrauterine distress. The area under the ROC curve was 0.875 (95% CI: 0.826-0.925). The slope of the calibration curve was close to 1, and the H-L goodness-of-fit test χ²=7.221, P=0.513. Conclusion 1 min Apgar score < 7, irregular prenatal examination, pregnancy induced hypertension, umbilical cord abnormality, abnormal labor process, pH < 7.0, and alkaline residue < -12.0 mmol/L are all independent risk factors for HIE in neonates with intrauterine distress. The nomograph prediction model constructed using the above indicators has good predictive power and can accurately predict the risk of HIE in neonates with intrauterine distress.
- Intrauterine distress /
- Neonates /
- Hypoxic-ischemic encephalopathy /
- Nomogram prediction model

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图 1 宫内窘迫新生儿发生HIE风险的列线图模型

Figure 1. Nomogram model for the risk of HIE in neonates with intrauterine distress

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图 2 列线图预测宫内窘迫新生儿发生HIE风险的ROC曲线

Figure 2. ROC curve of the nomogram for predicting the risk of HIE in neonates with intrauterine distress

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图 3 列线图预测宫内窘迫新生儿发生HIE风险的校准曲线

Figure 3. Calibration curve of the nomogram for predicting the risk of HIE in neonates with intrauterine distress

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表 1 宫内窘迫新生儿发生HIE风险的单因素分析

Table 1. Univariate analysis of the risk of HIE in neonates with intrauterine distress

项目		病例组(96例)	对照组(96例)	统计量	P值
新生儿性别[例(%)]	男	75(78.13)	53(55.21)	11.344^a	0.001
	女	21(21.88)	43(44.79)
胎龄(x±s，周)		40.93±1.82	40.48±2.07	1.600^b	0.111
新生儿类别[例(%)]	足月新生儿	70(72.92)	92(95.83)	19.121^a	< 0.001
	过期产儿	26(27.08)	4(4.17)
新生儿出生时体质量(x±s，g)		2 864.78±402.94	3 146.47±542.36	4.085^b	< 0.001
小于胎龄儿[例(%)]		12(12.50)	9(9.38)	0.481^a	0.488
大于胎龄儿[例(%)]		2(2.08)	3(3.13)	0.205^a	0.650
Apgar评分(1 min)＜7分[例(%)]	是	51(53.13)	20(20.83)	21.477^a	< 0.001
	否	45(46.88)	76(79.17)
Apgar评分(5 min)＜7分[例(%)]	是	24(25.00)	8(8.33)	9.600^a	0.002
	否	72(75.00)	88(91.67)
新生儿呼吸性酸中毒[例(%)]	是	45(46.88)	17(17.71)	18.676^a	< 0.001
	否	51(53.13)	79(82.29)
孕妇年龄(x±s，岁)		29.63±5.24	28.82±4.93	1.103^b	0.271
母亲职业[例(%)]	知识分子	14(14.58)	20(20.83)	6.160^a	0.104
	工人	12(12.50)	21(21.88)
	农民	20(20.83)	20(20.83)
	无业	50(52.08)	35(36.46)
父亲职业[例(%)]	知识分子	18(18.75)	25(26.04)	16.157^a	0.001
	工人	23(23.96)	37(38.54)
	农民	18(18.75)	21(21.88)
	无业	37(38.54)	13(13.54)
高龄产妇[例(%)]	是	31(32.29)	17(17.71)	5.444^a	0.020
	否	65(67.71)	79(82.29)
首次妊娠[例(%)]	是	53(55.21)	72(75.00)	8.276^a	0.004
	否	43(44.79)	24(25.00)
不规律产前检查[例(%)]	是	29(30.21)	9(9.38)	13.124^a	< 0.001
	否	67(69.79)	87(90.63)
妊娠期贫血[例(%)]	是	27(28.13)	10(10.42)	9.675^a	0.002
	否	69(71.88)	86(89.58)
妊高症[例(%)]	是	36(37.50)	11(11.46)	17.608^a	< 0.001
	否	60(62.50)	85(88.54)
GDM[例(%)]	是	29(30.21)	14(14.58)	6.743^a	0.009
	否	67(69.79)	82(85.42)
羊水污染[例(%)]	是	31(32.29)	3(3.13)	28.021^a	< 0.001
	否	65(67.71)	93(96.88)
羊水过少[例(%)]	是	12(12.50)	6(6.25)	2.207^a	0.137
	否	84(87.50)	90(93.75)
脐带异常[例(%)]	是	33(34.38)	8(8.33)	19.383^a	< 0.001
	否	63(65.63)	88(91.67)
胎盘早剥[例(%)]	是	12(12.50)	2(2.08)	7.705^a	0.006
	否	84(87.50)	94(97.92)
前置胎盘[例(%)]	是	14(14.58)	11(11.46)	0.414^a	0.520
	否	82(85.42)	85(88.54)
产程异常[例(%)]	是	35(36.46)	10(10.42)	18.141^a	< 0.001
	否	61(63.54)	86(89.58)
分娩方式[例(%)]	自然分娩	59(61.46)	55(57.29)	0.345^a	0.557
	剖宫产	37(38.54)	41(42.71)
pH[例(%)]	< 7.0	75(78.13)	50(52.08)	14.328^a	< 0.001
	≥7.0	21(21.88)	46(47.92)
碱剩余[例(%)]	<-12.0 mmol/L	83(86.46)	56(58.33)	18.999^a	< 0.001
	≥-12.0 mmol/L	13(13.54)	40(41.67)
二氧化碳分压(x±s，mmHg)		80.35±10.06	70.46±9.75	6.917^b	< 0.001
氧分压(x±s，mmHg)		14.48±2.02	16.02±2.29	4.941^b	< 0.001
碳酸氢根(x±s，mmol/L)		18.62±2.39	20.75±2.46	6.085^b	< 0.001
注：^a为χ²值，^b为t值；1 mmHg=0.133 kPa。

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表 2 变量赋值情况

Table 2. Variable assignment

变量	类别	赋值方法
因变量	宫内窘迫新生儿是否发生HIE	否=0，是=1
自变量	新生儿性别	女=0，男=1
	新生儿	足月新生儿=0，过期产儿=1
	新生儿出生时体质量	以实际值赋值
	Apgar评分(1 min)＜7分	否=0，是=1
	Apgar评分(5 min)＜7分	否=0，是=1
	新生儿呼吸性酸中毒	否=0，是=1
	父亲职业	知识分子=(0, 0, 0)，工人=(1, 0, 0)，农民=(0, 1, 0)，无业=(0, 0, 1)，以知识分子为参照
	高龄产妇	否=0，是=1
	首次妊娠	是=0，否=1
	不规律产前检查	否=0，是=1
	妊娠期贫血	否=0，是=1
	妊高症	否=0，是=1
	GDM	否=0，是=1
	羊水污染	否=0，是=1
	脐带异常	否=0，是=1
	胎盘早剥	否=0，是=1
	产程异常	否=0，是=1
	pH	≥7.0=0， < 7.0=1
	碱剩余	≥-12.0 mmol/L=0， < -12.0 mmol/L=1
	二氧化碳分压	以实际值赋值
	氧分压	以实际值赋值
	碳酸氢根	以实际值赋值

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表 3 宫内窘迫新生儿发生HIE风险的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of the risk of HIE in neonates with intrauterine distress

因素	B	SE	Waldχ²	P值	OR值	95% CI
Apgar评分	1.747	0.431	16.468	0.000	5.738	2.468~13.341
未规律产前检查	1.644	0.555	8.777	0.003	5.178	1.745~15.368
妊高症	1.961	0.484	16.386	0.000	7.104	2.749~18.356
脐带异常	1.137	0.563	4.082	0.043	3.118	1.035~9.399
产程异常	1.819	0.553	10.819	0.001	6.167	2.086~18.233
pH	1.066	0.408	6.834	0.009	2.904	1.306~6.458
碱剩余	1.344	0.452	8.860	0.003	3.836	1.583~9.297

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