摘要
目的构建ABO胎儿新生儿溶血病并发重度高胆红素血症的预测模型并验证其效能,为临床及时干预治疗提供依据。方法回顾性分析2022年1月—2024年12月诊断和治疗的ABO胎儿新生儿溶血病患儿的临床数据,其中204例作为建模集,102例为验证集;再根据有无发生重度高胆红素血症将患儿分为重度高胆红素组和非重度高胆红素组,经单因素分析和二元logistic回归筛选出其并发重度高胆红素血症的风险因素;建立列线图模型,绘制受试者工作曲线和校准曲线评估模型效能;采用临床决策曲线评估该模型的临床实用价值。结果单因素分析和二元logistic回归分析表明,患儿的就诊日龄、直接抗人球蛋白试验阳性、放散液凝集强度和总胆红素/白蛋白值是ABO胎儿新生儿溶血病患儿发生重度高胆红素血症的独立危险因素,其OR值分别为1.303、3.073、3.189和1.863,P<0.05。基于以上变量构建列线图模型,其C指数为0.790,95%置信区间为0.713~0.867,建模集和验证集的曲线下面积分别为0.790和0.754,95%置信区间分别为0.713~0.867和0.638~0.871。校准曲线显示该模型一致性较好,临床决策曲线显示ABO胎儿新生儿溶血病患儿根据该模型预测并发重度高胆红素血症的净收益较高。结论基于就诊日龄、直接抗人球蛋白试验结果、放散液凝集强度和总胆红素/白蛋白值构建的ABO胎儿新生儿溶血病并发重度高胆红素血症列线图模型具有良好的预测效能。
Objective To construct and validate a prediction model for severe hyperbilirubinemia complicating ABO hemolytic disease of the fetus and newborn(ABO-HDNF),providing a basis for timely clinical intervention.Methods We retrospectively analyzed clinical data from 306 ABO-HDNF infants diagnosed and treated between January 2022 and December 2024.Of these,204 cases were regarded as the modeling set and 102 the validation set.Patients were stratified into severe and non-severe hyperbilirubinemia groups.Risk factors for severe hyperbilirubinemia were identified through univariate analysis and binary logistic regression.A nomogram model was constructed,with receiver operating characteristic(ROC)and calibration curves evaluating its performance.Clinical utility of the model was further evaluated using a clinical decision curve.Results Univariate and binary logistic regression analyses identified postnatal time at admission(OR=1.303),positive Direct Antiglobulin Test(OR=3.073),eluate agglutination strength(OR=3.189),and total bilirubin/albumin ratio(OR=1.863)as independent risk factors for severe hyperbilirubinemia(P<0.05).The nomogram demonstrated a C-index of 0.790(95%CI:0.713~0.867).Area under the curve(AUC)values were 0.790(95%CI:0.713~0.867)and 0.754(95%CI:0.638~0.871)for modeling and validation sets,respectively.Calibration curves indicated good consistency,and decision curve analysis showed high net clinical benefit.Conclusion The nomogram incorporating postnatal time,Direct Antiglobulin Test results,eluate agglutination strength,and total bilirubin/albumin ratio exhibits favorable predictive performance for severe hyperbilirubinemia complicating ABO-HDNF.
作者
沈倩云
吴德群
张明
程文国
陈剑
SHEN Qianyun;WU Dequn;ZHANG Ming;CHENG Wenguo;CHEN Jian(Department of Clinical Laboratory,Yangzhou Maternal and Child Health Care Hospital Affiliated to Yangzhou University,Yangzhou 225002)
出处
《临床输血与检验》
2025年第6期802-809,共8页
Journal of Clinical Transfusion and Laboratory Medicine
基金
扬州市重点研发计划(社会发展)项目(No.YZ2024134)资助。
关键词
ABO胎儿新生儿溶血病
重度高胆红素血症
预测模型
列线图
ABO hemolytic disease of the fetus and newborn
Severe hyperbilirubinemia
Predictive model Nomogram
