超早产儿/超低出生体重儿支气管肺发育不良危险因素分析

doi:10.3969/j.issn.1004-583X.2025.01.009

摘要/Abstract

摘要：

目的探究超早产儿/超低出生体重儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)的危险因素,并构建logistic回归预测模型。方法选取2017年1月1日至2023年12月31日周口市妇幼保健院及周口市中医院新生儿重症监护室住院治疗的超早产儿/超低出生体重儿病历资料,严格按照纳入和排除标准,共纳入102例,根据是否发生BPD分为BPD组和非BPD组,比较两组一般资料,采用logistic回归分析导致超早产儿/超低出生体重儿发生BPD的病理原因。结果本研究共纳入102例超早产儿/超低出生体重儿,其中59例出现BPD,发生率为57.8%;胎儿情况:BPD组出生体重小于非BPD组、胎龄小于非BPD组,1 min Apgar评分≤7分、新生儿肺炎、新生儿败血症占比均高于非BPD组,机械通气时间长于非BPD组(P<0.05);孕母情况:BPD组羊膜早破>18 h、绒毛膜羊膜炎占比高于非BPD组,差异有统计学意义(P<0.05);胎龄、出生体重为超早产儿/超低出生体重儿发生BPD独立保护因素,机械通气时间、绒毛膜羊膜炎是超早产儿/超低出生体重儿发生BPD的独立危险因素(P<0.05)。基于多因素结果,构建logistic回归风险预测模型,Logit(P)在0~1,检验结果显示,该模型预测超早产儿/超低出生体重儿并发BPD的曲线下面积(AUC)为0.891(95%CI:0.846~0.939),Hosmer-Lemeshow χ²=6.543,P=0.072。结论 BPD的发生率在超早产儿/超低出生体重儿中明显升高,长时间机械通气、孕母绒毛膜羊膜炎是超早产儿/超低出生体重儿发生BPD的独立危险因素。基于上述因素构建logistic回归预测模型具有较高预测价值,可作为临床预测发生BPD的有效模型,并对后续临床决策具有一定指导意义。

关键词: 支气管肺发育不良, 超早产儿/超低出生体重儿, logistic回归分析, 危险因素

Abstract:

Objective To explore the risk factors of bronchopulmonary dysplasia (BPD) in extremely preterm/low birth weight infants and to construct a logistic regression prediction model. Methods Medical records 140 ultra-premature infants/ultra-low birth weight infants hospitalized in Zhoukou Maternal and Child Health Hospital and the neonatal intensive care unit of Zhoukou Hospital of TCM from January 1, 2017 to December 31, 2023 were recruited. A total of 102 cases were finally included according to the inclusion and exclusion criteria. They were divided into BPD group and non-BPD group based on whether BPD occurred. The general data of the two groups were compared, and the pathological causes of ultra-premature infants/ultra-low birth weight infants were analyzed using logistic regression. Results A total of 102 ultra-premature/ultra-low birth weight infants were included in this study, and 59 of them developed BPD, with an incidence of 57.8%. Fetal conditions were as follows. Infants in the BPD group had significantly lower birth weight and gestational age, but higher proportions of 1-min Apgar≤7 points, neonatal pneumonia and neonatal sepsis, and longer mechanical ventilation time than those of the non-BPD group (P<0.05). Maternal conditions were as follows. The proportions of premature amniotic rupture>18 hours, and chorioamnionitis in the BPD group were significantly higher than those of the non-BPD group (P<0.05). Multivariate logistic regression analysis showed that gestational age and birth weight were independent protective factors for BPD in ultra-premature infants/ultra-low birth weight infants, and mechanical ventilation time and chorioamnionitis were independent risk factors for BPD in ultra-premature infants/ultra-low birth weight infants (P<0.05). Based on the results of multiple factors, a logistic regression risk prediction model was constructed. Logit (P) ranged from 0 to 1. The test results showed that the area under the curve (AUC) of the model in predicting extremely preterm/low birth weight infants with concurrent BPD was 0.891 (95%CI: 0.846-0.939), with the chi-square value (χ²) in the Hosmer-Lemeshow test of 6.543(P=0.072). Conclusion Birth weight, gestational age, duration of mechanical ventilation, and chorioamnionitis are all risk factors for the development of BPD in extremely preterm infants/very low birth weight infants. A logistic regression model based on these factors has high predictive value and can be used as an effective clinical model in predicting the occurrence of BPD. It also has certain guiding significance for subsequent clinical decisions.

Key words: bronchopulmonary dysplasia, ultra-preterm/ultra-low birth weight infants, logistic regression analysis, risk factor

中图分类号:

R563.9

赵一品, 崔清洋. 超早产儿/超低出生体重儿支气管肺发育不良危险因素分析[J]. 临床荟萃, 2025, 40(1): 60-64.

Zhao Yipin, Cui Qingyang. Analysis of risk factors for bronchopulmonary dysplasia in extremely premature/very low birth weight infants[J]. Clinical Focus, 2025, 40(1): 60-64.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2025.01.009

https://huicui.hebmu.edu.cn/CN/Y2025/V40/I1/60

图/表 3

表1 两组一般资料比较

Tab.1 General information between groups

组别	例数	胎龄 (w)		出生体重 (kg)		剖宫产 [例(%)]	1 min Apgar评分 [例(%)]				性别[例(%)]			使用PS [例(%)]		机械通气时间(d)		新生儿肺炎 [例(%)]		新生儿败血症 [例(%)]		妊娠期高血压疾病 [例(%)]
组别	例数	胎龄 (w)		出生体重 (kg)		剖宫产 [例(%)]	≤7分		>7分		男		女	使用PS [例(%)]		机械通气时间(d)		新生儿肺炎 [例(%)]		新生儿败血症 [例(%)]		妊娠期高血压疾病 [例(%)]
BPD组	59	26.15±0.31		1.19±0.18		23(39.0)	35(59.3)		24(40.7)		38(64.4)		21(35.6)	59(100.0)		15.79±3.37		20(33.9)		39(66.1)		6(10.2)
非BPD组	43	27.34±0.38		1.32±0.14		17(39.5)	8(18.6)		35(81.4)		28(65.1)		15(34.9)	42(97.7)		8.36±2.41		3(7.00)		9(20.9)		4(9.3)
χ²/ $t$ 值		17.396		3.944		0.003	16.911				0.006			0.026		12.334		10.322		20.371		0.037
$P$ 值		0.000		0.000		0.955	0.000				0.941			0.873		0.000		0.001		0.000		0.848
组别	羊膜早破>18 h [例(%)]		妊娠糖尿病 [例(%)]		产房复苏史 [例(%)]			产前使用糖皮质激素 [例(%)]		绒毛膜羊膜炎 [例(%)]		产次 (次)			孕次 (次)		吸烟 [例(%)]		饮酒 [例(%)]		前置性胎盘 [例(%)]
BPD组	27(45.8)		15(25.4)		12(20.3)			49(83.1)		33(55.9)		1.83±0.49			1.73±0.38		5(8.5)		4(6.8)		12(20.3)
非BPD组	6(14.0)		7(16.3)		3(7.0)			38(88.4)		10(23.3)		1.79±0.43			1.81±0.41		4(9.3)		3(7.0)		9(20.9)
χ²/ $t$ 值	11.499		1.230		3.541			0.562		10.891		0.428			1.016		0.043		0.128		0.005
$P$ 值	0.001		0.268		0.060			0.454		0.001		0.669			0.312		0.835		0.721		0.942

表1 两组一般资料比较

Tab.1 General information between groups

组别	例数	胎龄 (w)		出生体重 (kg)		剖宫产 [例(%)]	1 min Apgar评分 [例(%)]				性别[例(%)]			使用PS [例(%)]		机械通气时间(d)		新生儿肺炎 [例(%)]		新生儿败血症 [例(%)]		妊娠期高血压疾病 [例(%)]
组别	例数	胎龄 (w)		出生体重 (kg)		剖宫产 [例(%)]	≤7分		>7分		男		女	使用PS [例(%)]		机械通气时间(d)		新生儿肺炎 [例(%)]		新生儿败血症 [例(%)]		妊娠期高血压疾病 [例(%)]
BPD组	59	26.15±0.31		1.19±0.18		23(39.0)	35(59.3)		24(40.7)		38(64.4)		21(35.6)	59(100.0)		15.79±3.37		20(33.9)		39(66.1)		6(10.2)
非BPD组	43	27.34±0.38		1.32±0.14		17(39.5)	8(18.6)		35(81.4)		28(65.1)		15(34.9)	42(97.7)		8.36±2.41		3(7.00)		9(20.9)		4(9.3)
χ²/ $t$ 值		17.396		3.944		0.003	16.911				0.006			0.026		12.334		10.322		20.371		0.037
$P$ 值		0.000		0.000		0.955	0.000				0.941			0.873		0.000		0.001		0.000		0.848
组别	羊膜早破>18 h [例(%)]		妊娠糖尿病 [例(%)]		产房复苏史 [例(%)]			产前使用糖皮质激素 [例(%)]		绒毛膜羊膜炎 [例(%)]		产次 (次)			孕次 (次)		吸烟 [例(%)]		饮酒 [例(%)]		前置性胎盘 [例(%)]
BPD组	27(45.8)		15(25.4)		12(20.3)			49(83.1)		33(55.9)		1.83±0.49			1.73±0.38		5(8.5)		4(6.8)		12(20.3)
非BPD组	6(14.0)		7(16.3)		3(7.0)			38(88.4)		10(23.3)		1.79±0.43			1.81±0.41		4(9.3)		3(7.0)		9(20.9)
χ²/ $t$ 值	11.499		1.230		3.541			0.562		10.891		0.428			1.016		0.043		0.128		0.005
$P$ 值	0.001		0.268		0.060			0.454		0.001		0.669			0.312		0.835		0.721		0.942

表2 支气管肺发育不良的多因素 logistic回归分析

Tab.2 logistic regression analysis of bronchopulmonary dysplasia

影响因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
影响因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
胎龄	-0.177	0.097	3.336	<0.001	0.839	0.748	0.938
机械通气时间	0.779	0.413	3.562	<0.001	2.180	1.463	3.249
出生体重	-0.212	0.114	3.458	<0.001	0.809	0.716	0.914
绒毛膜羊膜炎	1.366	0.675	4.095	<0.001	3.920	2.146	6.359
常数	-8.041	-	-	<0.001	-	-

表2 支气管肺发育不良的多因素 logistic回归分析

Tab.2 logistic regression analysis of bronchopulmonary dysplasia

影响因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
影响因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
胎龄	-0.177	0.097	3.336	<0.001	0.839	0.748	0.938
机械通气时间	0.779	0.413	3.562	<0.001	2.180	1.463	3.249
出生体重	-0.212	0.114	3.458	<0.001	0.809	0.716	0.914
绒毛膜羊膜炎	1.366	0.675	4.095	<0.001	3.920	2.146	6.359
常数	-8.041	-	-	<0.001	-	-

图1 Logistic回归模型的ROC曲线图

Fig.1 ROC curve of logistic regression model

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