文章摘要
胎龄34周以内早产儿NEC发病危险因素及预测模型构建
Risk factors and predictive model construction of NEC in preterm infants within 34 weeks of gestational age
投稿时间:2025-03-17  
DOI:10.3969/j.issn.1000-0399.2026.04.013
中文关键词: 早产儿  坏死性小肠结肠炎  危险因素  预测模型
英文关键词: Premature infants  Necrotizing enterocolitis  Risk factors  Model
基金项目:
作者单位E-mail
韩倩雅 723000 陕西汉中 通用技术三二〇一医院新生儿科  
应海燕 723000 陕西汉中 通用技术三二〇一医院新生儿科  
刘凯 723000 陕西汉中 通用技术三二〇一医院新生儿科 liukai13891695330@163.com 
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中文摘要:
      目的 探讨胎龄34周以内早产儿坏死性小肠结肠炎(NEC)发病危险因素并进一步构建临床预测模型,旨在为准确识别高危发病新生儿并制定针对性早期防治干预方案提供参考。方法 回顾性分析2020年1月至2024年1月于通用技术三二〇一医院分娩胎龄34周以内的317例早产儿资料,根据是否确诊NEC,分为NEC组(n=20)和非NEC组(n=297)。对比两组一般临床资料(胎龄、性别等),使用单因素以及多因素分析的方法分析胎龄34周以内早产儿NEC发病的独立危险因素;利用多因素分析的结果构建胎龄34周以内早产儿NEC发病情况的预测列线图模型,并对模型的预测效能进行分析。结果 317例早产儿中,确诊为NEC共20例,占比6.31%;NEC发病时间为分娩后4~20 d,平均发病时间为分娩后(12.78±3.40)d,其中接受手术治疗71例,保守治疗246例;随访12个月后,脑瘫3例,运动落后1例,发育障碍1例。单因素分析结果显示,NEC组与非NEC组伴窒息、伴呼吸窘迫综合征、伴败血症、输血、母乳喂养、预防性使用益生菌及伴有血流动力学意义的动脉导管未闭情况比较,差异有统计学意义(P<0.05)。多因素logistic分析结果证实,伴窒息、伴呼吸窘迫综合征、伴败血症、输血、未母乳喂养及未预防性使用益生菌均是胎龄34周以内早产儿NEC发病的独立危险因素(P<0.05)。利用呼吸窘迫综合征、败血症、窒息、输血、母乳喂养、预防性益生菌使用构建列线图模型,使用呼吸窘迫综合征、败血症、窒息、输血、母乳喂养、预防性益生菌、列线图对早产儿NEC发生的情况进行受试者工作特征曲线的预测,曲线下面积分别为0.661、0.716、0.756、0.748、0.777、0.740和0.932。结论 胎龄34周以内早产儿NEC发病可能与伴窒息、伴呼吸窘迫综合征、伴败血症、输血、母乳喂养及预防性使用益生菌等因素密切相关;利用以上因素构建的列线图预测模型对于早产儿NEC预测显示出良好的效能,值得在工作中深入分析。
英文摘要:
      Objective To explore the risk factors of NEC in preterm infants within 34 weeks of gestational age and further construct the clinical predictive model to provide reference for accurately identifying high-risk newborns and formulating more targeted early prevention and treatment intervention programs. Methods A total of 317 premature infants within 34 weeks of gestational age during delivery in our hospital from January 2020 to January 2024 were retrospectively included and grouped according to whether NEC was present or not. Univariate and multivariate analysis was used to assess the risk factors for NEC in premature infants under 34 weeks of gestational age. A risk prediction model was constructed for NEC in premature infants under 34 weeks of gestational age and its predictive efficacy was analysed. Results TA total of 20 cases were diagnosed with NEC in all 317 premature infants, accounting for 6.31%. The onset time of NEC was 4 to 20 days after delivery, with an average onset time of (12.78±3.40) days postpartum, among which 71 cases received surgical treatment and 246 cases received conservative treatment. After 12 months of follow-up, there were 3 cases of cerebral palsy, 1 case of movement lag, and 1 case of developmental disorders. Univariate analysis showed statistically significant differences between the NEC group and the non-NEC group in terms of associated asphyxia, respiratory distress syndrome, sepsis, blood transfusion, breastfeeding, prophylactic use of probiotics, and hemodynamically significant patent ductus arteriosus (P<0.05). The results of logistic multivariate analysis confirmed that asphyxia, respiratory distress syndrome, sepsis, blood transfusion, breastfeeding, and prophylactic use of probiotics were all independent risk factors for NEC in premature infants under 34 weeks of gestation (P<0.05). A column chart model was constructed using respiratory distress syndrome, sepsis, asphyxia, blood transfusion, breastfeeding, and prophylactic probiotic use to predict the occurrence of NEC in premature infants using ROC curves. The areas under the curves were 0.661, 0.716, 0.756, 0.748, 0.777, 0.740, and 0.932, respectively. Conclusion The incidence of NEC in preterm infants within 34 weeks of gestational age may be closely related to asphyxia, respiratory distress syndrome, sepsis, blood transfusion, breastfeeding and probiotics. The column chart prediction model constructed using the above factors has shown good performance in predicting NEC in premature infants, and is worth further analysis in the work.
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