基于列线图建立女性不孕预测模型

目的 探讨女性不孕症的危险因素,构建不孕女性个体化风险预测模型。方法 选取2018年5月至2021年10月重庆医科大学附属妇女儿童医院及陆军军医大学西南医院收治的自愿参与本研究的辅助生殖助孕人群为观察组,选取同期在重庆医科大学附属妇女儿童医院产科建档的已自然妊娠<12周的孕妇为对照组,最终纳入观察组4 276例,对照组3 240例。采用问卷填写方式收集数据,采用Logistic回归分析数据并建立列线图预测模型,通过Bootstrap法对模型内部进行验证,采用一致性指数(C-index)及校准曲线评价列线图模型性能。结果 年龄、孕前体质量指数、初潮年龄、毒物接触史、烟草摄入、节食、代餐饮食、毒品摄入、近2年痛经、初次性生活年龄、文化程度、家庭人均月收入、近2年月经量均是女性不孕症的影响因素(P<0.05)。建立的预测不孕风险列线图模型具有较好的预测效能[C-index为0.812 (95%CI:0.802～0.822),校正后C-index为0.810(95%CI:0.800～0.819)]。结论 列线图预测女性不孕症效果良好,提供了预测女性不孕风险可视化工具,具有一定的临床...     

上尿路结石术后并发双J管相关性尿路感染列线图风险预测模型的构建

目的:探讨上尿路结石病人术后并发双J管相关性尿路感染的危险因素,并构建其列线图风险预测模型。方法:回顾性收集2020年7月—2022年6月某三级甲等综合医院收治的216例上尿路结石并留置双J管病人,根据双J管相关性尿路感染的发病情况将其分为感染组与非感染组,采用单因素分析、Logistic回归分析上尿路结石病人术后并发双J管相关性尿路感染的危险因素,构建列线图风险预测模型并评价该模型的实际效用。结果:上尿路结石病人术后并发双J管相关性尿路感染29例(13.43%)。Logistic回归分析结果显示,合并糖尿病、中性粒细胞与淋巴细胞比值(NLR)和肾积水程度是上尿路结石病人术后并发双J管相关性尿路感染的独立危险因素。列线图风险预测模型内部验证结果显示,Hosmer-Lemeshow检验χ²=6.981,P=0.639,ROC曲线下面积为0.853[95%CI(0.774,0.934)]。结论:构建的列线图风险预测模型具有良好的预警作用,为医护人员早期识别上尿路结石术后并发双J管相关性尿路感染的高危人群,及时采取有效的预防措施降低感染率提供依据。     

帕金森病患者并发异动症的列线图预测模型构建

目的 分析帕金森病(PD)患者并发异动症的危险因素,并构建列线图预测模型。方法 收集114例PD患者的临床资料,根据是否并发异动症分为异动症组(n=18)和非异动症组(n=96)。采用logistic回归模型分析PD患者并发异动症的独立危险因素并构建列线图预测模型,列线图模型的内部验证及预测效能分别用校正曲线、决策曲线评估。结果 异动症组发病年龄、维生素B12水平均低于非异动症组(t分别=-3.55、-2.57,P均<0.05),女性比例、病程、左旋多巴等效剂量(LEDD)、H-Y分级、帕金森病统一评分量表(UPDRS)评分、Beck抑郁量表(BDI)评分、Back焦虑量表(BAI)评分均高于非异动症组,差异均有统计学意义(χ²=6.15,t分别=3.80、2.44、4.74、2.41、3.91、2.72,P均<0.05)。ROC结果显示：发病年龄、病程、LEDD、H-Y分级、UPDRS评分、BDI评分、BAI评分、维生素B12的最佳截断值分别为65岁、8年、449 mg/d、3级、22分、17分、20分、323.48 pmol/L。多元logisti...     

神经外科手术部位感染危险因素及列线图风险预测模型

摘要 目的 探讨神经外科手术部位感染的危险因素,并建立及验证列线图风险预测模型。方法 收集山东省某三甲医院2020年1月1日—12月31日在神经外科接受手术治疗的1 487例患者为研究对象。单因素分析采用χ2检验/Fisher确切概率法,多因素分析采用二元logistic回归,基于回归分析结果建立列线图预测模型,采用Bootstrap法进行内部验证,通过受试者工作特征曲线下面积、校准曲线、Hosmer-Lemeshow检验评估模型的区分度和校准度。结果 神经外科手术部位感染率为12.71%;手术时间≥4 h(OR=3.156,95%CI 2.210~4.507)等5个因素是手术部位感染的独立危险因素,而预防性抗菌药物(OR=0.163,95%CI 0.080~0.331)和激素(OR=0.126,95%CI 0.078~0.203)是手术部位感染的保护因素;建模组ROC曲线下面积为0.825,预测值同实际值基本一致。结论 本研究构建的列线图预测模型具有较好的区分度和校准度。     

孕妇分娩恐惧风险列线图预测模型的构建及验证

目的 构建并验证孕妇分娩恐惧风险列线图预测模型。方法 采用便利抽样法选取2022年7月至9月河北省唐山市某三级甲等医院675名产检孕妇为建模组,2022年10月至12月唐山市某二级甲等医院290名产检孕妇为验证组。通过Logistic回归分析确定危险因素,采用R 4.1.2软件绘制列线图。结果 共6个预测因子进入模型：包括产前教育、文化程度、抑郁、妊娠并发症、焦虑和倾向分娩方式。建模组、验证组受试者工作特征曲线下面积分别为0.834、0.806,最佳临界值分别为0.113、0.200,灵敏度分别为67.2%、77.1%,特异度分别为87.3%、74.0%,约登指数分别为0.545、0.511;建模组、验证组校准图显示实际曲线和理想曲线重合度较好,Hosmer-Lemeshow拟合优度检验结果分别为χ²=6.541(P=0.685)、χ²=5.797(P=0.760),Brier得分分别为0.096、0.117;建模组、验证组决策曲线分析显示当分娩恐惧发生的阈值概率处于0.00～0.70、0.00～0.70时,具有临床实用价值。结论 构建的列线...     

中青年患者发生复杂性阑尾炎的列线图预测模型

目的 研究中青年急性阑尾炎(AA)患者中发生复杂性阑尾炎(CA)的危险因素,并建立和验证列线图预测模型。方法 对2022年1月至12月贵州省人民医院收治的252例接受腹腔镜阑尾切除术的中青年AA患者临床资料进行回顾性分析。根据术中探查结果CA患者101例,UA患者151例,分别作为CA组和UA组。并按照3∶1的比例将252例中青年AA患者随机分配为训练集(n=189)和验证集(n=63)。收集患者的临床资料[白细胞计数(WBC)、中性粒细胞计数(Neu)、中性粒细胞百分比(Neu%)、淋巴细胞计数(Lym)、血小板计数、C反应蛋白(CRP)、总胆红素、入院体温及腹痛时长病史],并计算中性粒细胞/淋巴细胞比值(NLR)及血小板/淋巴细胞比值(PLR)。在训练集中,使用Logistic回归分析影响AA患者发生CA的因素,并构建中青年AA患者发生CA的列线图预测模型,应用受试者工作特征(ROC)曲线评价预测模型的预测效能,使用校准曲线对预测模型进行一致性评价,并在验证集中进行内部验证。结果 在训练集中,CA组患者Neu、Neu%、CRP、入院体温、腹痛时长及NLR、PLR均高于UA组,Lym...     

烧伤康复期患者睡眠障碍风险列线图预测模型的构建及验证

目的 探讨烧伤康复期患者发生睡眠障碍的危险因素,在此基础上建立睡眠障碍风险列线图预测模型,并验证。方法 选取2020年2月-2022年10月在我科治疗的烧伤康复期患者共150例。根据患者有无发生睡眠障碍,分为无睡眠障碍组(n=46)和有睡眠障碍组(n=100)。采用二分类logistic回归筛选发生睡眠障碍的风险因素,并据此构建发生睡眠障碍风险预测模型,绘制受试者工作特征曲线(ROC),计算最佳阈值及曲线下面积(AUC),对列线图模型预测的区分度进行评价。同时通过Bootstrap方法进行抽样验证,使用一致性系数对模型的预测性能进行评价,评估模型的预测误差。结果 最终进入模型的预测因子为每日关注体像时间(OR=1.76)、疲劳症状影响生活活动能力严重度(OR=1.36)、社会支持总分(OR=0.79)、创伤后应激障碍量表(PCL-C)总分ROC曲线结果显示：所有独立危险因素联合对于烧伤康复期住院患者睡眠障碍的AUC值最大,为0.946(OR=1.90,95%CI:0.93～0.99),灵敏度和特异度分别为0.95和0.87。发生睡眠障碍风险预测模型列线图校准曲线显示,校正前后的一致性相...     

学龄前儿童呼吸道感染的危险因素分析及列线图预测模型的构建

目的 分析学龄前儿童呼吸道感染的主要危险因素,并建立定量列线图预测模型.方法 采用横断面调查、分层整群随机抽样的方法选择3所幼儿园2208例学龄前儿童作为研究对象.根据反复呼吸道感染、上呼吸道感染和下呼吸道感染的诊断标准对患者进行诊断.分析学龄前儿童呼吸道感染的主要危险因素.结果 2208例学龄前儿童共诊断出反复呼吸道...     

老年高血压患者发生衰弱的影响因素分析及列线图预测模型构建

目的 分析老年高血压患者发生衰弱的影响因素并构建列线图预测模型。方法 随机选取老年高血压患者380例作为研究对象,根据患者是否发生衰弱将患者分为衰弱组(120例)和非衰弱组(260例)。比较两组患者的临床资料,通过ROC曲线分析获取各因素的最佳截断值,构建预测老年高血压患者发生衰弱的影响因素的列线图模型,并采用决策曲线评估列线图模型的预测效能。结果 衰弱组患者的年龄、高血压病程、合并症数量、同型半胱氨酸(Hcy)水平、白细胞介素-6(IL-6)水平、单核细胞趋化蛋白-1(MCP-1)水平、可溶性细胞黏附因子-1(slCAM-1)水平和营养状态不良情况比例均高于非衰弱组,差异均有统计学意义(t分别=-8.12、-40.45、-41.19、-24.77、-36.21、-25.63、-14.53,χ²=10.77,P均<0.05)。年龄(≥75岁)、高血压病程(≥5年)、合并症数量(≥4个)、Hcy(≥15μmol/L)、IL-6(≥250 ng/ml)、MCP-1(≥30 pg/ml)、slCAM-1(≥3 pg/ml)是老年高血压患者发生衰弱的影响因素(OR分...     

儿童轮状病毒肠炎并发惊厥的危险因素及列线图预测模型构建

目的 分析儿童轮状病毒肠炎并发惊厥的危险因素并构建其风险预测模型。方法 采取回顾性分析,选取2019年7月至2021年6月海南省人民医院儿科收治的150例轮状病毒肠炎患儿为研究对象。根据住院期间是否并发惊厥,将患儿分为惊厥组(n=30)和未惊厥组(n=120)。收集患儿临床资料(性别、年龄、血生化、呕吐次数、腹泻次数等指标),采用Logistic回归分析探讨儿童轮状病毒肠炎发生惊厥的独立风险因素,并构建儿童轮状病毒肠炎并发惊厥的风险预测模型,应用受试者工作特征(ROC)曲线评价预测模型的预测效能。结果 150例患儿,30例并发惊厥,惊厥发生率为20.00%。惊厥组发热次数、腹泻次数及肌酸激酶同工酶(CK-MB)为70.00%、(11.23±3.54)次/d、(78.94±20.59) mmol/L,高于未惊厥组[48.33%、(8.22±2.48)次/d、(60.87±15.31) mmol/L],血钙、血糖、二氧化碳结合力(CO₂CP)为(2.21±0.42)、(4.26±0.98)、(12.96±3.47) mmol/L,均低于未惊厥组[(2.48±0.44)...     

Development and validation of a user-friendly risk nomogram for the prediction of catheter-associated urinary tract infection in neuro-intensive care patients

ObjectiveThis study aimed to develop a user-friendly nomogram model to evaluate the risk of catheter-associated urinary tract infections in neuro-critically ill patients.MethodsA retrospective cohort analysis was conducted on 537 patients with indwelling catheters admitted to the neuro-intensive care unit. Patients’ general information, laboratory examination findings, and clinical characteristics were collected. Multivariate regression analysis was applied to develop the nomogram for the prediction of catheter-associated urinary tract infections in this group of patients. The discriminative capacity, calibration ability, and clinical effectiveness of the nomogram were evaluated.ResultsThe occurrence of catheter-associated urinary tract infections was 3.91 % and Escherichia coli was the major causative pathogen. Multivariate regression analysis showed that age ≥ 60 years (odds ratio: 35.2, 95 % confidence interval: 2.3–550.8), epilepsy (39.3, 5.1–301.4), a length of neuro-intensive care stay > 30 days (272.2, 8.3–8963.5), and low albumin levels (<35 g/L) (12.1, 2.1–69.9) were independent risk factors associated with catheter-associated urinary tract infection in neuro-intensive care patients. The nomogram demonstrated good calibration and discrimination in both the training and the validation sets. The model exhibited good clinical use since the decision curve analysis covered a large threshold probability.ConclusionsWe developed a user-friendly nomogram to predict catheter-associated urinary tract ibfection in neuro-intensive care patients. The nomogram incorporated clinical variables collected on admission (age, admission diagnosis, and albumin levels) and the length of stay and enabled the effective prediction of the likelihood of catheter-associated urinary tract infections.     

468例泌尿道感染患儿临床特点分析

目的 分析不同年龄段小儿泌尿道感染的临床特点、致病菌分布及影像学检查情况.方法 选取468例泌尿道感染患儿为研究对象,将其分为婴儿组(1个月～1岁)、幼儿组(＞1～3岁)及儿童组(＞3岁),分析3组的临床资料.结果 小儿泌尿道感染以婴幼儿多见,婴儿组中以发热为首发症状的患儿比率为52.15％,高于幼儿组(17.27％)及儿童组(5.23％),差异有统计学意义(P＜0.05);儿童组中尿路刺激征患儿比率为63.37％,高于婴儿组(8.60％)及幼儿组(41.82％),差异有统计学意义(P＜0.05);婴儿组中合并泌尿系发育异常者比率为32.80％,与幼儿组(21.82％)及儿童组(17.44％)比较,差异有统计学意义(P＜0.05).468例患儿中段尿培养检出病原菌共105例(22.43％),其中革兰阴性菌71例(67.62％),以大肠埃希菌为主;革兰阳性菌31例(29.52％),其中以屎肠球菌为主.结论 婴儿泌尿道感染患儿以男童多见,临床症状缺乏特异性,多以发热为临床表现,局部症状不明显,应注意尿常规检查.随着年龄的增长,女童泌尿道感染比率逐渐升高,临床以尿路刺激症状为主要表现的患儿比率也逐渐上升.泌尿道感染的病原菌仍以革兰阴性菌为主,大肠埃希菌占比最高,而革兰阳性菌中屎肠球菌的检出率也相对较高.     

468例泌尿道感染患儿临床特点分析

目的 分析不同年龄段小儿泌尿道感染的临床特点、致病菌分布及影像学检查情况.方法 选取468例泌尿道感染患儿为研究对象,将其分为婴儿组(1个月～1岁)、幼儿组(＞1～3岁)及儿童组(＞3岁),分析3组的临床资料.结果 小儿泌尿道感染以婴幼儿多见,婴儿组中以发热为首发症状的患儿比率为52.15％,高于幼儿组(17.27％)及儿童组(5.23％),差异有统计学意义(P＜0.05);儿童组中尿路刺激征患儿比率为63.37％,高于婴儿组(8.60％)及幼儿组(41.82％),差异有统计学意义(P＜0.05);婴儿组中合并泌尿系发育异常者比率为32.80％,与幼儿组(21.82％)及儿童组(17.44％)比较,差异有统计学意义(P＜0.05).468例患儿中段尿培养检出病原菌共105例(22.43％),其中革兰阴性菌71例(67.62％),以大肠埃希菌为主;革兰阳性菌31例(29.52％),其中以屎肠球菌为主.结论 婴儿泌尿道感染患儿以男童多见,临床症状缺乏特异性,多以发热为临床表现,局部症状不明显,应注意尿常规检查.随着年龄的增长,女童泌尿道感染比率逐渐升高,临床以尿路刺激症状为主要表现的患儿比率也逐渐上升.泌尿道感染的病原菌仍以革兰阴性菌为主,大肠埃希菌占比最高,而革兰阳性菌中屎肠球菌的检出率也相对较高.     

Work-up of urinary tract infection in infants and children

Urinary tract infection (UTI) in infants and children demands rapid differentiation between upper UTI (pyelonephritis) and lower UTI (cystitis) for prompt treatment to be initiated so that renal damage is minimized. This pictorial review presents a wide gamut of structural and functional abnormalities of the urinary tract that may predispose infants and children to UTI, including vesicoureteral reflux, upper urinary tract obstruction (ureteropelvic junction obstruction), lower urinary tract obstruction (primary megaureter, ureterovesical junction obstruction, posterior urethral valve, ectopic ureterocele with or without associated duplex collecting system), neurogenic problems (dysfunctional voiding), calculi, and parenchymal scars. Sonography (ultrasound [US]) is the imaging modality of choice for assessment of renal size, growth (serial sonograms), texture, and blood flow. Other modalities used to work-up UTI in the pediatric patient include fluoroscopic voiding cystourethrogram, nuclear voiding cystourethrogram, and nuclear renal scintigraphy (NRS). Excretory urography is no longer recommended in the routine evaluation of childhood UTI because information regarding anatomy and function (qualitative and quantitative) can be better assessed with US and NRS, respectively. Computed tomography and magnetic resonance imaging are primarily reserved for complex cases in which a definitive diagnosis cannot be made with routine imaging. Algorithms for work-up of UTI in various pediatric age groups are presented.     

Diagnosis and management of urinary tract infection in children

Urinary tract infection (UTI) causes significant illness, particularly in the first two years of life, and has the potential to cause permanent renal damage. Diagnosis of UTI in children is dependent on the collection of an uncontaminated freshly voided urine sample, which is key to the future management and follow-up of these patients. Prevention of possible long-term renal damage remains a priority.     

Asian guidelines for urinary tract infection in children

The followings are the level of evidence (LE) and grade of recommendation (GR) on pediatric UTI in Asia. Classification according to the sites of infection (lower versus upper tract), the number of episode (first versus recurrent), the severity (simple versus severe), or the existence of complicating factor (uncomplicated versus complicated) is useful to differentiate children with UTI whether they are at risk of renal damage or not (LE: 2, GR: B). Diagnosis of UTI requires both urinalysis that suggests infection and positive urine culture (LE:3, GR B). For pre-toilet trained children, urine specimen for culture should be collected by urethral catheterization or suprapubic aspiration. For toilet trained children, midstream clean catch urine is reliable (LE: 3, GR: A). Urine culture is considered positive if it demonstrates growth of a single bacterium with the following colony counts: (1) any growth by suprapubic aspiration, (2) >5 × 104 CFU/ml by urethral catheterization, or (3) >100,000 CFU/ml by midstream clean catch (LE:3, GR: B). For children with febrile UTI, renal and bladder ultrasonography (RBUS) should be routinely performed as soon as possible (LE: 3, GR: C). RBUS should be followed up 6 months later in children with acute pyelonephritis and/or VUR (LE: 3, GR: C). Acute DMSA scan can be performed when severe acute pyelonephritis or congenital hypodysplasia is noted on RBUS or when the diagnosis of UTI is in doubt by the clinical presentation (LE: 3, GR: C). Late DMSA scan (>6 months after the febrile UTI) can be performed in children with severe acute pyelonephritis, high-grade VUR, recurrent febrile UTIs, or abnormal renal parenchyma on the follow-up RBUS (LE: 3, GR: C). Top-down or bottom-up approach for febrile UTI is suggested for the diagnosis of VUR. For top-down approach, VCUG should not be performed routinely for children after the first febrile UTI. VCUG is indicated when abnormalities are apparent on either RBUS or DMSA scan or both (LE: 2, GR: B). VCUG is also suggested after a repeat febrile UTI (LE:2, GR: B).Appropriate antibiotic should be given immediately after urine specimen for culture has been obtained (LE:2, GR: A). Initiating therapy with oral or parenteral antibiotics is equally efficacious for children (>3 months) with uncomplicated UTI (LE: 2: GR: A). The choice of empirical antibiotic agents is guided by the expected pathogen and the local resistance patterns (LE: 2, GR: A). For children with febrile UTI, the total course of antibiotic therapy should be 7–14 days (LE: 2, GR: B). Circumcision may, but not definitively, reduce the risk of febrile UTI in males and breakthrough febrile UTI in males with VUR. Circumcision should be offered to uncircumcised boys with febrile UTI and VUR in countries where circumcision is accepted by the general population (LE: 3, GR: B), while in countries where childhood circumcision is rarely performed, other measures for febrile UTI/VUR should be the preferred choice (LE: 4, GR: C). Bladder bowel dysfunction (BBD) is one of the key factors of progression of renal scarring (LE: 2). Early recognition and management of BBD are important in prevention of UTI recurrence (LE:2, GR: A). Antibiotic prophylaxis to prevent recurrent febrile UTI is indicated in children with moderate to high grade (III–V) VUR (LE: 1b, GR: A). Surgical intervention may be used to treat VUR in the setting of recurrent febrile UTI because it has been shown to decrease the incidence of recurrent pyelonephritis (LE: 2, GR: B).     

Bacteremic vs nonbacteremic urinary tract infection in children

Aim

Bacteremia is an uncommon complication of urinary tract infection (UTI). The aim of this study was to identify risk factors for bacteremic UTI in pediatric patients.

Cranberry juice for urinary tract infection in children

Question Several children in my clinic are recovering from urinary tract infections (UTI). A mother of one of the children asked me if I recommended cranberry juice for children to prevent future episodes of UTI. She was given cranberry juice after she suffered from a UTI several months ago.Answer Cranberry juice has been shown to be effective in preventing adhesion of bacteria such as Escherichia coli to the bladder epithelium. Current evidence supports the use of cranberry juice for prevention of UTI in adult women, but no such evidence exists at this time for the prevention of UTI in children. While cranberry juice is very safe for most children, its acidity reduces palatability among children. The dose of cranberry juice to prevent UTI in children has also yet to be determined.