先天性膈疝患儿产后五种评分模型的初步探索

目的探索先天性膈疝(congenital diaphragmatic hernia,CDH)患儿产后5种评分模型对预后的评估效能及其应用。方法回顾性分析1992年9月至2018年2月首都儿科研究所附属儿童医院收治的先天性膈疝新生儿共126例,均经产前超声、产后X线影像、手术或病理确诊,其中>28 d入院的CDH患儿45例,产前诊断后引产或流产患儿16例,此61例患儿不纳入本研究,余65例符合入组标准,纳入研究,入组65例。将入组患儿根据预后情况分为存活组和死亡组。收集所有入组患儿产后临床指标数据,代入5种评分模型中(包括SNAP-Ⅱ、Brindle、CDHSG、WHSRpf和BOI-d1评分),分别对整体分值、分度病情和两两联合三部分内容进行统计学分析,选出最适合的评估模型。结果整体分值:SNAP-Ⅱ在这5个评分模型中准确性及拟合度最高(AUC为0.813)。病情分度:SNAP-Ⅱ和Brindle评估准确性较好(AUC分别为0.803和0.725),SNAP-Ⅱ准确性高于Brindle。两两联合:SNAP-Ⅱ+Brindle联合模型的准确性和拟合度最好(AUC为0.841,H-Lp值为0.737)。结论产后5种评分模型中SNAP-Ⅱ的评估效能最好,其次为Brindle,可用于目前CDH患儿的预后评估,进而指导临床诊疗。

Primary study of five predictive outcome scores for neonatal congenital diaphragmatic hernia

Objective To explore the efficacy and application of five predictive outcome scores for neonatal congenital diaphragmatic hernia(CDH).Methods Clinical data were reviewed for 65 CDH neonates from September 1992 to February 2018.They were divided into survival and death groups based upon the prognosis.Postpartum variables were collected and compared by five scores.The overall scores,degree of illness and combination models were statistically analyzed for selecting the optimal evaluation model.Results Overall scores:SNAP-Ⅱyielded the best performance(AUC=0.813).Degree of illness:SNAP-Ⅱand Brindle obtained decent outcomes(AUC=0.803&0.725).However,SNAP-Ⅱfared better.Combination models:SNAP-Ⅱ+Brindle proved to be the best one(AUC=0.841).Conclusions SNAP-Ⅱachieves the best performance among five predictive outcome scores.And the second one is Brindle.Both may be used for guiding clinical practice for CDH neonates nowadays.