脐血胆红素水平结合高风险因素构建ABO新生儿溶血病发生高胆红素血症风险的预测模型与效能验证

doi:10.3969/j.issn.1006-5725.2023.20.018

Abstract

Abstract:

Objective To construct and verify a predictive model based on bilirubin levels in umbilical cord blood and clinical risk factors to predict the risk of hyperbilirubinemia in ABO neonatal hemolysis disease. Methods A total of 500 ABO-HDN children were selected as the modeling set. 100 ABO-HDN children served as the verification set. Depending on whether neonatal hyperbilirubin was occurring， they were divided into hyperbilirubinemia group and non-hyperbilirubin group（Non-HB）. The bilirubin level in umbilical cord blood was detected and the general and clinical data of children and mothers were collected. Multivariate Logistic regression analysis and ROC curve were used to evaluate the prediction efficiency of the prediction model of bilirubin levels in umbilical cord blood combined with clinical risk factors for the risk of NHB in ABO-HDN. Results There were 225 cases of NHB of the 500 ABO-HND children in the modeling set with an incidence of 45%. Unifactorial analysis showed that influencing factors were maternal age， premature rupture of membranes， pregnancy with hypertension， diabetes， thyroid disease and anemia， intrauterine distress， cranial hematoma， infection， gestational age， neonatal asphyxia， feeding patterns， low birth weight， intracranial hemorrhage， and respiratory distress（P < 0.05）. Multivariate Logistic regression analysis showed that the independent risk factors were premature birth， neonatal asphyxia， infection， G-6-PD deficiency，intracranial hemorrhage and respiratory distress（OR = 2.377， 7.457， 54.438， 45.487， 2.788，5.407， all P < 0.05）. Three models of bilirubin levels in umbilical cord blood，clinical risk factors and bilirubin levels in umbilical cord blood combined with clinical risk factors predicted the occurrence risk of NHB in ABO-HDN. And the area AUC values under ROC curve were 0.817（95%CI： 0.776 ~ 0.859）， 0.876（95%CI： 0.845 ~ 0.907） and 0.944（95%CI： 0.921 ~ 0.966）， respectively， all P < 0.05. The prediction model of bilirubin levels in umbilical cord blood combined with clinical risk factors was used to verify the practical efficacy of 100 ABO-HDN children in the verification set. The area AUC value under ROC curve was 0.951（95%CI： 0.776 ~ 0.859），P < 0.05. Conclusion The prediction model of bilirubin levels in umbilical cord blood combined with clinical risk factors can ccurately predicted the occurrence risk of NHB in ABO-HDN. It could provide objective reference for prevention， diagnosis， treatment and standardized management of NHB in ABO-HDN.

Key words: hyperbilirubinemia, ABO?hemolysis disease of newborn, umbilical blood bilirubin, prediction model, efficacy verification

CLC Number:

R711.18

Xiaoling FU,Xingdan ZHAO,Yazhou WANG,Xiang CAO,Linjing ZHANG,Fen. CHEN. Construction and verification of a risk predictive model for hyperbilirubinemia in ABO neonatal hemolysis disease by the level of umbilical blood bilirubin combined with high risk factors[J]. The Journal of Practical Medicine, 2023, 39(20): 2658-2663.

Figures/Tables 8

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References 24

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项目	观察组（n = 225）	对照组（n = 275）	χ²/t值	P值
性别			0.069	0.792
男	127（56.44）	155（56.36）
女	98（43.56）	114（43.64）
出生体质量（g）	2 991.56 ± 621.26	2 876.80 ± 459.94	2.340	0.020
胎龄（周）	37.37 ± 2.55	37.67 ± 2.32	-1.406	0.160

脐血胆红素水平	例数	观察组（n = 225）	对照组（n = 275）
< 30 μmol/L	186	18（9.68）	168（90.32）
30 ~ 40 μmol/L	132	49（37.12）	83（62.88）
40 ~ 50 μmol/L	95	73（76.84）	22（23.16）
50 ~ 60 μmol/L	64	62（96.88）	2（3.12）
> 60 μmol/L	23	23（100）	0（0）

因素	观察组（n = 225）	对照组（n = 275）	χ²值	P值
母亲年龄			17.40	< 0.001
≥ 35岁	98（43.56）	71（25.81）
< 35岁	127（56.44）	204（74.18）
分娩方式			0.939	0.332
剖宫产	88（39.11）	96（34.91）
自然分娩	137（60.89）	179（65.09）
产次			0.928	0.335
初产妇	112（49.78）	125（45.45）
经产妇	113（50.22）	150（54.54）
胎儿数量			0.302	0.583
单胎	203（90.22）	252（91.64）
双胎	22（9.78）	23（8.36）
母亲妊娠期合并高血压	32（14.22）	12（4.36）	14.986	< 0.001
母亲妊娠期合并糖尿病	66（29.33）	35（12.73）	21.170	< 0.001
母亲妊娠期合并甲状腺疾病	15（6.66）	5（1.82）	7.576	0.006
母亲妊娠期合并贫血	40（17.78）	25（9.09）	8.257	0.004
胎膜早破	123（54.67）	217（78.91）	33.422	< 0.001
宫内窘迫	40（17.78）	19（6.91）	14.046	< 0.001
胎龄			33.655	< 0.001
≥ 37周	122（54.22）	172（62.55）
35 ~ 37周	27（12.00）	66（24.00）
< 35周	76（33.33）	37（13.45）
出生体质量			34.052	< 0.001
≥ 2 500 g	147（65.33）	240（87.27）
< 2 500 g	78（34.67）	35（12.73）
喂养方式			72.920	< 0.001
母乳喂养	41（18.22）	107（38.91）
混合喂养	128（56.88）	124（45.09）
人工喂养	56（24.89）	44（16.00）
新生儿窒息	64（28.44）	27（9.82）	28.838	< 0.001
头颅血肿	38（16.89）	11（4.00）	23.258	< 0.001
感染	130（57.78）	86（31.27）	33.440	< 0.001
G-6-PD酶缺乏	34（15.11）	35（12.73）	0.591	0.442
颅内出血	78（34.67）	43（15.64）	24.432	< 0.001
呼吸窘迫	37（16.44）	26（9.45）	5.490	0.019

因素	B	SE	OR值	95% CI	Wald χ²值	P值
早产	0.866	0.324	2.377	1.259 ~ 4.485	7.138	0.008
新生儿窒息	2.009	0.567	7.457	2.457 ~ 22.636	12.577	0.000
感染	3.997	0.669	54.438	14.673 ~ 201.976	35.705	0.000
G-6-PD缺乏	3.817	0.68	45.487	12.005 ~ 172.351	31.548	0.000
颅内出血	1.025	0.455	2.788	1.142 ~ 6.806	5.071	0.024
呼吸窘迫	1.688	0.857	5.407	1.009 ~ 28.987	3.881	0.049

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Construction and verification of a risk predictive model for hyperbilirubinemia in ABO neonatal hemolysis disease by the level of umbilical blood bilirubin combined with high risk factors

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