摘要
目的探讨重度新生儿高胆红素血症(NHB)并发急性胆红素脑病(ABE)的影响因素并构建预测模型及MRI影像特征的诊断价值。方法采用倾向性评分匹配法回顾性搜集131例重度NHB患儿,依据是否并发ABE分为ABE组(34例)及非ABE组(97例),比较两组患儿的临床资料及MRI影像特征,以多因素Logistic回归分析重度NHB并发ABE的影响因素并构建预测模型,采用Omnibus检验、Wald检验、Hosmer-Lemeshow检验及受试者工作特征(ROC)曲线分析预测模型的效果,以及采用ROC曲线分析MRI影像特征的诊断价值。结果单因素分析结果显示,两组间母亲年龄、产次、妊娠合并症、胎膜早破、喂养方式及ABO溶血症的差异均有统计学意义(P均<0.05),MRI影像特征在T_(1)WI苍白球与壳核信号强度比值(G/P)、T_(1)WI苍白球与脑脊液信号强度比值(G/CSF)及表观扩散系数(ADC)G/P间差异均有统计学意义(P均<0.05);多因素Logistic回归显示,母亲年龄≥35岁、产次≥2次、有妊娠合并症、有胎膜早破、纯母乳喂养及有ABO溶血症是重度NHB并发ABE的独立危险因素(P均<0.05),预测模型的Omnibus检验(P=0.000)、Wald检验(P=0.000)、Hosmer⁃Lemeshow检验(P=0.915)及曲线下面积(AUC)值为0.851、敏感度为0.794及特异度为0.804,提示预测模型效果良好;联合G/P T_(1)WI≥1.20、G/CSF T_(1)WI≥2.60及G/P ADC≥1.02三项MRI影像特征的AUC为0.935、敏感度为0.882及特异度为0.887,提示联合诊断价值较高。结论基于多因素分析结果构建的影响因素预测模型及联合MRI影像特征对重度NHB并发ABE具有良好的预测效果及诊断价值。
Objective To explore the influencing factors of severe neonatal hyperbilirubinemia(NHB)complicating acute bilirubin encephalopathy(ABE)and construct a prediction model and evaluate the diagnostic value of MRI image features.Methods A total of 131 neonates with severe hyperbilirubinemia were retrospectively selected using propensity score matching and divided into the ABE group(34 cases)and the non-ABE group(97 cases)based on whether they had ABE.Clinical data and MRI image features were compared between the two groups.Multifactorial Logistic regression was used to analyze the influencing factors of severe NHB complicating ABE and to construct a prediction model.The effect of the prediction model was evaluated using the Omnibus test,Wald test,Hosmer⁃Lemeshow test,and ROC curve analysis.The diagnostic value of MRI image features was also assessed using ROC curve analysis.Results Univariate analysis showed that differences in maternal age,parity,pregnancy complications,premature rupture of membranes,feeding method,and ABO hemolysis were statistically significant between the two groups(all P<0.05).MRI image features,including the signal intensity ratio of the T_(1)WI globus pallidus to putamen(G/P),the signal intensity ratio of the T_(1)WI globus pallidus to cerebrospinal fluid(G/CSF),and the apparent diffusion coefficient(ADC)G/P,were also significantly different(all P<0.05).Multifactorial Logistic regression revealed that maternal age≥35 years,parity≥2,pregnancy complications,premature rupture of membranes,exclusive breastfeeding,and ABO hemolysis were independent risk factors for severe NHB complicating ABE(all P<0.05).The Omnibus test(P=0.000),Wald test(P=0.000),Hosmer⁃Lemeshow test(P=0.915),and ROC curve analysis showed an AUC of 0.851,sensitivity of 0.794,and specificity of 0.804,indicating that the prediction model was effective.The combined MRI image features(G/P T_(1)WI≥1.20,G/CSF T_(1)WI≥2.60,G/P ADC≥1.02)had an ROC curve AUC of 0.935,sensitivity of 0.882,and specificity of 0.887,suggesting high diagnostic value.Conclusion The prediction model based on multifactorial analysis and the combined MRI image features have good predictive and diagnostic value for severe NHB complicating ABE.
作者
徐衡
姜新年
李静
孙涛
XU Heng;JIANG Xinnian;LI Jing(Department of Radiology,Anhui Women and Children's Medical Center,Hefei,Anhui Province 230000,P.R.China)
出处
《临床放射学杂志》
北大核心
2025年第9期1744-1749,共6页
Journal of Clinical Radiology
关键词
新生儿高胆红素血症
急性胆红素脑病
影响因素
影像特征
Neonatal hyperbilirubinemia
Acute bilirubin encephalopathy
Influencing factors
Image features
