中国当代儿科杂志2025，Vol.27Issue(3)：279-285,7.DOI:10.7499/j.issn.1008-8830.2407143
早产儿有血流动力学改变的动脉导管未闭发生的
Predictive factors for hemodynamically significant patent ductus arteriosus in preterm infants and the construction of a nomogram prediction model
摘要
Abstract
Objective To explore the predictive factors for hemodynamically significant patent ductus arteriosus(hsPDA)in preterm infants and to construct a nomogram prediction model for hsPDA occurrence in this population.Methods A retrospective analysis was conducted on the clinical data of preterm infants with gestational age<32 weeks diagnosed with patent ductus arteriosus(PDA)who were delivered at Nanjing Women and Children's Healthcare Hospital from January 2020 to December 2022.The subjects were divided into an hsPDA group(52 cases)and a non-hsPDA group(176 cases)based on the presence of hsPDA.Univariate analysis and multivariate logistic regression analysis were performed to screen predictive variables regarding the general information of the infants at birth,maternal pregnancy and delivery conditions,and relevant indicators during hospitalization.A nomogram prediction model for hsPDA occurrence was constructed using R software in preterm infants.Internal validation was performed using the Bootstrap method.Finally,the predictive model was evaluated for calibration,discrimination ability,and clinical utility.Results Multivariate regression analysis showed that the ratio of the left atrium to aorta diameter(LA/AO),mode of delivery(vaginal),and duration of mechanical ventilation were independent predictive factors for hsPDA in preterm infants(P<0.05).Based on the results of univariate analysis and multivariate logistic regression analysis,variables used to construct the nomogram prediction model for hsPDA risk included:LA/AO ratio,mode of delivery(vaginal),duration of mechanical ventilation,5-minute Apgar score,and the presence of neonatal respiratory distress syndrome requiring surfactant therapy.The area under the receiver operating characteristic curve for this model was 0.876(95%CI:0.824-0.927),and the calibrated curve was close to the ideal reference line,indicating good calibration.The Hosmer-Lemeshow test demonstrated that the model fit well,and the clinical decision curve was above the extreme curves.Conclusions The nomogram prediction model,constructed using five variables(LA/AO ratio,vaginal delivery,duration of mechanical ventilation,5-minute Apgar score,and the presence of neonatal respiratory distress syndrome requiring surfactant therapy),has reference significance for predicting the occurrence of hsPDA in preterm infants and provides valuable guidance for the early clinical identification of hsPDA.关键词
有血流动力学改变的动脉导管未闭/预测因素/列线图模型/早产儿Key words
Hemodynamically significant patent ductus arteriosus/Predictive factor/Nomogram model/Preterm infant引用本文复制引用
穆珺,李书书,苏爱玲,韩树萍,朱金改..早产儿有血流动力学改变的动脉导管未闭发生的[J].中国当代儿科杂志,2025,27(3):279-285,7.基金项目
南京市医学科技发展基金(ZKX19045). （ZKX19045）
