早产儿支气管肺发育不良的高危因素临床分析及预测模型构建

Risk factors for bronchopulmonary dysplasia in preterm infants and establishment of a prediction model

摘要:

目的 探讨早产儿支气管肺发育不良（bronchopulmonary dysplasia, BPD）的高危因素，建立风险预测模型。方法 回顾性收集2022年1—12月在上海市儿童医院新生儿重症监护病房住院的早产儿资料，根据2018年美国国立儿童健康与人类发展研究所发布的BPD诊断标准，将其分为非BPD组（n=84）和BPD组（n=36），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，构建风险预测模型。结果 早产儿出生胎龄<28周、无创呼吸支持时间、合并感染性肺炎及孕母合并绒毛膜羊膜炎均为BPD发生的独立危险因素（P<0.05）。基于这些危险因素构建预测BPD发生的列线图模型，得到受试者操作特征曲线下面积是0.93，列线图校准曲线斜率趋近于1；拟合优度检验显示该模型拟合较好（χ2=8.287，P=0.406）。结论 早产儿出生胎龄<28周、无创呼吸支持时间、合并感染性肺炎及孕母合并绒毛膜羊膜炎是BPD发生的独立危险因素。

Abstract:

Objective To investigate the risk factors for bronchopulmonary dysplasia (BPD) in preterm infants, and to establish a risk prediction model.Methods A total of 120 preterm infants who were admitted to the neonatal intensive care unit of Shanghai Children's Hospital from January to December 2022 were included. According to the diagnostic criteria for BPD released by the National Institute of Child Health and Human Development in 2018, they were divided into a non-BPD group (84 infants) and a BPD group (36 infants). The clinical data of the infants and their mothers were compared between the two groups. The univariate analysis and the stepwise multivariate regression analysis were used to identify the risk factors for BPD and establish a risk prediction model.Results The results showed that a gestational age of <28 weeks, duration of noninvasive respiratory support, comorbidity with infectious pneumonia, and chorioamnionitis in the mother were independent risk factors for BPD in preterm infants (P<0.05). A nomogram model for predicting the development of BPD was established based on the risk factors, with an area under the receiver operating characteristic curve of 0.93, and the calibration curve of this nomogram had a slope of about 1. The goodness-of-fit test indicated the model fitted well (χ²=8.287, P=0.406).Conclusions A gestational age of <28 weeks, duration of noninvasive respiratory support, comorbidity with infectious pneumonia, and chorioamnionitis in the mother are independent risk factors for BPD in preterm infants.