摘要
目的分析小儿免疫性血小板减少症(ITP)复发的危险因素,并构建其风险预测模型。方法选取2020年5月—2023年5月攀枝花市第二人民医院收治的189例ITP患儿作为研究对象,统计其治疗后1年内复发情况。收集ITP患儿的性别、年龄、血型、发病季节等临床资料,采用多因素logistic逐步回归分析ITP患儿复发的危险因素,并构建风险预测模型。采用Hosmer-Lemeshow检验评估模型的校准度,采用受试者工作特征(ROC)曲线评估模型的预测效能。结果随访1年,有35例ITP患儿复发,发生率为18.52%;154例(81.48%)患儿未复发。复发组和非复发组患儿在血型、治疗前病程、前驱感染史、发病季节、抗核抗体、治疗前外周血淋巴细胞计数(PBL)、治疗前血小板计数(PLT)、治疗前血小板平均分布宽度(PDW)、治疗前平均血小板体积(MPV)、治疗后PLT升至有效值时间方面比较,差异均有统计学意义(P<0.05)。logistic逐步回归分析结果显示,治疗前病程长(OR=4.627,95%CI:1.225~17.477)、有前驱感染史(OR=3.180,95%CI:1.306~7.743)、治疗前PLT高(OR=2.683,95%CI:1.436~5.014)、治疗前PBL低(OR=3.589,95%CI:1.632~7.893)、治疗后PLT升至有效值时间长(OR=3.815,95%CI:1.858~7.833)、血型为O型(相较于A型)(OR=4.233,95%CI:1.374~13.040)和发病于秋季(相较于春季)(OR=2.732,95%CI:1.339~5.576)均是儿童ITP复发的危险因素(P<0.05)。据此构建风险预测模型,该模型预测ITP患儿复发的曲线下面积(AUC)为0.872,95%CI:0.816~0.916,敏感度为86.11%,特异度为88.27%,提示该风险预测模型具有较好的预测价值。Hosmer-Lemeshow检验:χ^(2)=0.834,P=0.116,提示风险预测模型与观测值的拟合度一致性较高。结论治疗前病程长、有前驱感染史、治疗前PLT高、治疗前PBL低、治疗后PLT升至有效值时间长、O型血和发病季节为秋季等均是儿童ITP复发的危险因素,以此构建的风险预测模型的预测效能较好。
Objective To analyze risk factors for recurrence of pediatric immune thrombocytopenia(ITP)and to construct a risk prediction model.Methods A total of 189 pediatric ITP patients admitted to the Second People′s Hospital of Panzhihua from May 2020 to May 2023 were enrolled and followed for one year after treatment for recurrence.Clinical data,including sex,age,blood type,and onset season,were collected.Multivariate logistic stepwise regression analysis was used to identify risk factors for recurrence and to construct a risk prediction model.Model calibration was evaluated with the Hosmer-Lemeshow test,and predictive performance was assessed by receiver operating characteristic(ROC)curve analysis.Results During one-year follow-up,35 patients experienced recurrence(18.52%)and 154 patients(81.48%)did not.Significant differences between the recurrent and non-recurrent groups were observed in blood type,disease course before treatment,presence of prodromal infection,onset season,antinuclear antibody status,pre-treatment peripheral blood lymphocyte count(PBL),pre-treatment platelet count(PLT),pre-treatment platelet distribution width(PDW),pre-treatment mean platelet volume(MPV),and time from treatment to PLT rising to an effective value(P<0.05).Multivariate logistic stepwise regression analysis identified the following independent risk factors for recurrence:longer disease course before treatment(OR=4.627,95%CI:1.225-17.477),a history of prodromal infection(OR=3.180,95%CI:1.306-7.743),higher pre-treatment PLT(OR=2.683,95%CI:1.436-5.014),lower pre-treatment PBL(OR=3.589,95%CI:1.632-7.893),longer time for PLT to rise to an effective value after treatment(OR=3.815,95%CI:1.858-7.833),blood type O as compared with type A(OR=4.233,95%CI:1.374-13.040),and onset in autumn as compared with spring(OR=2.732,95%CI:1.339-5.576;P<0.05).The resulting risk prediction model yielded an area under the ROC curve(AUC)of 0.872(95%CI:0.816-0.916),with a sensitivity of 86.11%and specificity of 88.27%,indicating good predictive performance.Hosmer-Lemeshow test indicated good agreement between predicted and observed outcomes(χ^(2)=0.834,P=0.116).Conclusion Longer pre-treatment disease course,a history of prodromal infection,higher pre-treatment PLT,lower pre-treatment PBL,longer time for PLT to rise to an effective value after treatment,blood type O,and autumn onset are risk factors for recurrence of pediatric ITP.The constructed risk prediction model demonstrates good predictive performance.
作者
赖思燕
何荣香
李薇
梁道琼
钱敏
谭微
安世春
Lai Siyan;He Rongxiang;Li Wei;Liang Daoqiong;Qian Min;Tan Wei;An Shichun(Department of Pediatrics,The Second People′s Hospital of Panzhihua,Panzhihua Sichuan 617000,China;Department of Pediatrics,Panzhihua Central Hospital,Panzhihua Sichuan 617000,China;Department of Pediatrics,Affiliated Hospital of Panzhihua University,Panzhihua Sichuan 617000,China)
出处
《保健医学研究与实践》
2025年第6期107-112,共6页
Health Medicine Research and Practice
基金
四川省医学科研课题计划项目(S23070)。
