探讨新生儿重症高胆红素血症临床风险评估模型的建立
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摘要
目的探讨新生儿重症高胆红素血症临床风险评估模型的建立途径。方法完整收集756例新生儿的临床资料予以回顾性分析研究,资料收集时间为2016年6月~2017年6月。利用临床危险因素结合出院前胆红素水平的方式对新生儿发生重症高胆红素血症的风险进行评估,并利用ROC曲线对模型的预测效果进行检验。结果 756例新生儿中有59例新生儿出现重症高胆红素血症,疾病发生率为7.80%。危险因素包括主要危险因素(胎龄35~36周、出院前胆红素百分位数>P95、头颅血肿范围>3 cm×3 cm、出生3 d体重下降l0%×总体重以上)和次要危险因素(胎龄37周、皮下淤血、混合喂养、胎龄40周及以上、出院前胆红素百分位数为P76~P95)。利用ROC曲线对风险评估模型的临床预测效果进行评估,相应的评估结果显示,该模型对应的ROC曲线下面积为0.735,提示模型具有良好的风险预测效果。结论利用临床危险因素结合出院前胆红素水平的方式对新生儿发生重症高胆红素血症的风险情况进行评价模型建立和风险预测切实可行,模型预测准确性良好。
Objective To explore the ways to establish a clinical risk assessment model of neonatal severe hyperbilirubinemia. Methods The clinical data of 756 newborns were collected completely for retrospective analysis. The data collection period was from June 2016 to June 2017. The clinical risk factors combined with pre-discharge bilirubin levels were used for the evaluation of the risks of neonatal severe hyperbilirubinemia, and ROC curve was used to test the predictive effect of the model. Results Among 756 newborn infants, 59 cases had severe hyperbilirubinemia, with the incidence rate of 7.80%. The risk factors included major risk factors(gestational age of 35-36 weeks, pre-discharge bilirubin percentage >P95, head hematoma range >3 cm×3 cm, birth weight loss over 10%×the total weight) and minor risk factors(gestational age of 37 weeks,subcutaneous congestion, mixed feeding, gestational age of 40 weeks and above,pre-discharge bilirubin percentage of P76-P95). The ROC curve was used to evaluate the clinical predictive effect of the risk assessment model. The corresponding assessment results showed that the area under the ROC curve corresponding to the model was 0.735, suggesting that the model had a good risk predictive effect. Conclusion It is practicable to establish the evaluation model and predict the risk of severe hyperbilirubinemia in newborns by clinical risk factors combined with pre-discharge bilirubin levels, and the accuracy of model prediction is favorable.
Objective To explore the ways to establish a clinical risk assessment model of neonatal severe hyperbilirubinemia. Methods The clinical data of 756 newborns were collected completely for retrospective analysis. The data collection period was from June 2016 to June 2017. The clinical risk factors combined with pre-discharge bilirubin levels were used for the evaluation of the risks of neonatal severe hyperbilirubinemia, and ROC curve was used to test the predictive effect of the model. Results Among 756 newborn infants, 59 cases had severe hyperbilirubinemia, with the incidence rate of 7.80%. The risk factors included major risk factors(gestational age of 35-36 weeks, pre-discharge bilirubin percentage >P95, head hematoma range >3 cm×3 cm, birth weight loss over 10%×the total weight) and minor risk factors(gestational age of 37 weeks,subcutaneous congestion, mixed feeding, gestational age of 40 weeks and above,pre-discharge bilirubin percentage of P76-P95). The ROC curve was used to evaluate the clinical predictive effect of the risk assessment model. The corresponding assessment results showed that the area under the ROC curve corresponding to the model was 0.735, suggesting that the model had a good risk predictive effect. Conclusion It is practicable to establish the evaluation model and predict the risk of severe hyperbilirubinemia in newborns by clinical risk factors combined with pre-discharge bilirubin levels, and the accuracy of model prediction is favorable.
引文
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[11]梁玉美,冯燕妮,潘红飞,等.百色地区新生儿早期重症高未结合胆红素血症病例的危险因素[J].实用医学杂志,2013,29(22):3710-3712.
[12]王瑛,王金秀,江华,等.新生儿高胆红素血症的风险预测[J].临床儿科杂志,2012,30(3):238-241.
[13]孙小凡.新生儿小时胆红素百分位曲线图预测高胆红素血症的研究进展[J].国际儿科学杂志,2015,42(1):18-20,24.
[14]张海霞,赵昕,杨智,等.新生儿高胆红素血症与有机阴离子转运体1B1 T521C/A388G多态性的相关性研究[J].中华儿科杂志,2010,48(9):650-655.
[15]毛旭洁,林振浪,赵益伟,等.光疗后新生儿经皮胆红素测定值与血清胆红素值数学模型研究[J].临床儿科杂志,2015,33(7):632-636.
[2]茵栀黄口服液临床研究协作组.茵栀黄口服液治疗足月新生儿高间接胆红素血症的多中心随机对照研究[J].中华儿科杂志,2011,49(9):663-668.
[3]王艳,董玉霞,邸红芹,等.脐血胆红素水平及排便干预对新生儿病理性黄疸的影响[J].解放军医药杂志,2015,27(10):64-65,68.
[4]董小玥,陈玉林,韩树萍,等.建立新生儿重症高胆红素血症临床风险评估模型[J].中华围产医学杂志,2011,14(8):453-458.
[5]韩树萍,董小玥,余章斌,等.建立新生儿高胆红素血症的临床风险评估模型及其应用研究[C].//第二届围产医学新进展高峰论坛论文集,2010:119-120.
[6]陈兰,石碧珍,韩树萍,等.新生儿高胆红素血症风险的预测[J].中华围产医学杂志,2016,19(11):813-818.
[7]李渝华,郭梅.早产儿胆红素神经毒性的风险和防治的研究进展[J].中华危重症医学杂志(电子版),2014,7(3):214-217.
[8]黄洋洋.游离胆红素对新生儿机体影响的研究进展[J].医学综述,2016,22(16):3151-3153,3157.
[9]石碧珍,陈兰,韩树萍,等.健康新生儿经皮小时胆红素百分位列线图预测高胆红素血症的价值[J].中国当代儿科杂志,2016,18(3):201-205.
[10]李红新,徐美玉,屠文娟,等.血清S1OOB蛋白和脑脊液胆红素水平在新生儿高未结合胆红素血症中检测的意义[J].实用儿科临床杂志,2012,27(14):1086-1087.
[11]梁玉美,冯燕妮,潘红飞,等.百色地区新生儿早期重症高未结合胆红素血症病例的危险因素[J].实用医学杂志,2013,29(22):3710-3712.
[12]王瑛,王金秀,江华,等.新生儿高胆红素血症的风险预测[J].临床儿科杂志,2012,30(3):238-241.
[13]孙小凡.新生儿小时胆红素百分位曲线图预测高胆红素血症的研究进展[J].国际儿科学杂志,2015,42(1):18-20,24.
[14]张海霞,赵昕,杨智,等.新生儿高胆红素血症与有机阴离子转运体1B1 T521C/A388G多态性的相关性研究[J].中华儿科杂志,2010,48(9):650-655.
[15]毛旭洁,林振浪,赵益伟,等.光疗后新生儿经皮胆红素测定值与血清胆红素值数学模型研究[J].临床儿科杂志,2015,33(7):632-636.