Perinatal data,Ultrasound of lung,Bronchopulmonary dysplasia in preterm infants,Mean platelet volume,Prediction model,"/> <span style="font-size:14px;line-height:2;">胎龄≤ 32 周早产儿支气管肺发育不良</span><span style="font-size:14px;line-height:2;">危险因素分析及预测模型构建</span>
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发育医学电子杂志  2025, Vol. 13 Issue (5): 358-365    DOI: 10.3969/j.issn.2095-5340.2025.05.006
  围产医学   论著 |新生儿 |
胎龄≤ 32 周早产儿支气管肺发育不良危险因素分析及预测模型构建
宝 凌 云  李 明 盼  李 佳 欣
 昆 明 市 儿 童 医 院  新 生 儿 科, 云 南  昆 明 650021)
Risk factor analysis and prediction model construction for bronchopulmonary dysplasia in preterm infants with gestational age ≤ 32 weeks
Bao Lingyun, Li Mingpan, Li Jiaxin
Department of Neonatal, Kunming Children’s Hospital, YunnanKunming 650021, China)
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摘要 【摘要】 目的 基于围产期资料、机械通气情况和肺超声评分构建胎龄≤ 32 周早产儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)的预测模型,并对模型进行验证和评价。 方法 采用回顾性队列研究方法,选取2022年1月至2023年8月昆明市儿童医院收治的184例胎龄≤32周早产儿为研究对象,根据 BPD 发生情况分为 BPD 组(n=75)和非 BPD 组(n=109)。比较 2 组基线与围产期资料以及出生后第 3、7、14 天肺超声评分,应用 Spearman 相关性和偏相关性分析肺脏超声评分与 BPD 的关系,多因素Logistic 回归分析评价早产儿 BPD 的危险因素,基于早产儿 BPD 的危险因素绘制预测模型,分别采用Bootstrap 法、一致性分析、临床决策曲线分析评价构建的早产儿 BPD 预测模型的校准度以及预测 BPD与实际情况的一致性、临床效用。统计学方法采用独立样本 t 检验、Mann-Whitney U 检验、χ2 检验或Fisher 确切概率法、受试者工作特征(receiver operating characteristic,ROC)曲线分析。 结果  BPD 组胎龄小于非 BPD 组,小于胎龄儿构成比、出生后第 3 天平均血小板体积(mean platelet volume,MPV)高于非 BPD 组,有创和无创机械通气时间长于非 BPD 组;BPD 组出生后第 3、7、14 天肺超声评分均明显于非 BPD 组(P 值均 <0.05)。Spearman 相关性分析结果显示,出生后第 3 天(r=0.782)、第 7 天(r=0.814)、第 14 天(r=0.875)肺超声评分均与 BPD 呈正相关(P 值均 <0.001);偏相关性分析结果显示,出生后第 3、7、14 天肺超声评分仍与 BPD 呈正相关(P 值均 <0.001),且偏相关性系数仍随出生时间延长递增(分别为0.740、0.803、0.846)。多因素 Logistic 回归分析结果显示,胎龄、小于胎龄儿、有创机械通气时间、无创机械通气时间、出生后第 3 天 MPV、出生后第 14 天肺超声评分是胎龄≤ 32 周早产儿 BPD 的独立危险因素(P 值均 <0.05)。基于多因素 Logistic 回归分析筛选出的危险因素,运用 R 语言绘制胎龄≤ 32 周早产儿BPD 的预测模型显示,其 C-index 为 0.820。ROC 曲线分析结果显示,该模型的曲线下面积(area under 
the curve,AUC)为0.820(95% CI:0.761~0.879),Bootstrap法绘制内部校准图发现校准曲线贴近标准曲线,校准度为 0.816,提示所构建的胎龄≤ 32 周早产儿 BPD 的预测模型区分度良好;外部验证显示,采用所构建的胎龄≤ 32 周早产儿 BPD 的预测模型预测 BPD 与实际情况的一致性为 94.87%,Kappa 值为 0.870(95%CI :0.648~1.091),一致性良好;临床决策分析曲线显示,在阈概率值为 0.06~0.40 时,采用所构建的胎龄≤ 32 周早产儿 BPD 的预测模型预测 BPD 的发生具有临床正向净获益。 结论 基于围产期资料、机械通气情况和肺超声评分构建的胎龄≤ 32 周早产儿 BPD 的预测模型具有良好的区分度、校准度和临床效用,预测 BPD 与实际情况的一致性较高,可作为预测胎龄≤ 32 周早产儿 BPD 发生风险的一个方案,为临床更精准地防治 BPD 提供参考。
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关键词:  围产期资料  肺脏超声  早产儿支气管肺发育不良  平均血小板体积  预测模型    
Abstract: 【Abstract】 Objective To construct and validate a predictive model for bronchopulmonary dysplasia (BPD) in premature infants with gestational age ≤32 weeks based on perinatal data, mechanical ventilation status, and ultrasound scores of lung. Method Using a retrospective cohort study approach, a total of 184 preterm infants with gestational age ≤32 weeks admitted to Kunming Children's Hospital from January 2022 o August 2023 were included. According to the incidence of BPD, they were divided into BPD group (n=75) and non-BPD group (n=109). Baseline and perinatal data, lung ultrasound scores on the 3rd, 7th and 14th day after birth were compared between the two groups. Spearman correlation and partial correlation analysis were used to analyze the relationship between lung ultrasound scores and BPD. Multivariate Logistic regression analysis was performed to evaluate the risk factors of BPD in preterm infants. Based on the risk factors of 
BPD in preterm infants, the prediction model was established. Bootstrap method, consistency analysis and decision curve analysis were used to evaluate the calibration degree, the consistency of BPD prediction model and the actual situation, and the clinical effectiveness of the model. Statistical methods were performed by independent sample t-test, Mann-Whitney U test, χ2 test or Fisher exact probability method, receiver operating characteristic (ROC)curve analysis. Result The gestational age of the BPD group was lower than that of the non-BPD group, and the proportion of small for gestational age infants and mean platelet volume (MPV) on the 3rd day were higher than those of the non-BPD group, and the duration of invasive and non-invasive mechanical ventilation was longer than those in the non-BPD group (all P<0.05). The ultrasound scores of 
lung in the BPD group on the 3rd day , 7th day and 14th day after birth were significantly higher than those in the non-BPD group (all P<0.05). The results of Spearman correlation analysis showed that ultrasound scores of lung on the 3rd day (r=0.782), 7th day (r=0.814) and 14th day (r=0.875) after birth were positively correlated with BPD (all P<0.001). The results of partial correlation analysis showed that the ultrasound scores of lung on the 3rd, 7th and 14th day after birth were still positively correlated with BPD (all P<0.001), and the partial correlation coefficient was still increasing with the extension of birth time (0.740, 0.803, and 0.846, respectively). The results of multivariate Logistic regression analysis showed that gestational age, small for gestational age infants, duration of invasive mechanical ventilation, duration of non-invasive mechanical ventilation, MPV on the 3rd day, and ultrasound scores of lung on the 14th day after birth were independent risk factors for BPD in premature infants with gestational age ≤32 weeks (all P<0.05). Based 
on the risk factors screened by multivariate Logistic regression, the predictive model for BPD in premature infants with gestational age ≤32 weeks was developed using R language, with a C-index of 0.820. The ROC analysis showed that the area under the curve (AUC) of the constructed prediction model was 0.820 (95% CI: 0.761-0.879). The internal calibration plot drawn by Bootstrap method showed that the calibration curve was close to the standard curve, with a calibration degree of 0.816, indicating that the constructed prediction model for BPD in premature infants with gestational age ≤32 weeks had good discrimination. External validation showed that the consistency of the prediction model for BPD in premature infants 
with gestational age ≤32 weeks with the actual situation was 94.87%, with a Kappa value of 0.870 95% CI: 0.648-1.091), indicating good consistency. The clinical decision analysis curve showed that there was a positive net clinical benefit in predicting the occurrence of BPD in premature infants with a threshold probability of 0.06-0.40 using the constructed prediction model for BPD in premature infants with gestational age ≤32 weeks. Conclusion The prediction model of BPD in 
preterm infants with gestational age ≤32 weeks based on perinatal data mechanical ventilation status, and lung ultrasound scores has good discrimination, calibration and clinical effectiveness. The BPD prediction is highly consistent with the actual outcomes. The model may serve as a useful tool for predicting BPD risk in clinical practice.
Key words:  Perinatal data')" href="#">Perinatal data    Ultrasound of lung    Bronchopulmonary dysplasia in preterm infants    platelet volume')" href="#">Mean platelet volume    Prediction model
收稿日期:  2024-10-10                     发布日期:  2025-10-01     
基金资助: 云南省昆明市卫生健康委员会科研课题(2022-06-03-007)
通讯作者:  宝凌云    E-mail:  G23w7t8u5@21cn.com
引用本文:    
宝 凌 云  李 明 盼  李 佳 欣. 胎龄≤ 32 周早产儿支气管肺发育不良危险因素分析及预测模型构建[J]. 发育医学电子杂志, 2025, 13(5): 358-365.
Bao Lingyun, Li Mingpan, Li Jiaxin. Risk factor analysis and prediction model construction for bronchopulmonary dysplasia in preterm infants with gestational age ≤ 32 weeks. Journal of Developmental Medicine(Electronic Version), 2025, 13(5): 358-365.
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http://www.fyyxzz.com/CN/10.3969/j.issn.2095-5340.2025.05.006  或          http://www.fyyxzz.com/CN/Y2025/V13/I5/358
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