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浙江大学学报(医学版)  2022, Vol. 51 Issue (1): 73-78    DOI: 10.3724/zdxbyxb-2021-0217
原著     
不同新生儿危重评分对超低体重儿死亡风险的预测价值比较
杨洋1,2,池霞1,童梅玲1,*,周晓玉2,程锐2,潘晶晶3,陈筱青3
1.南京医科大学附属妇产医院儿童保健科,江苏 南京 210004
2.南京医科大学附属儿童医院新生儿科,江苏 南京 210008
3.南京医科大学第一附属医院妇幼分院新生儿科,江苏 南京 210036
Comparison of different neonatal illness severity scores in predicting mortality risk of extremely low birth weight infants
YANG Yang1,2,CHI Xia1,TONG Meiling1,*,ZHOU Xiaoyu2,CHENG Rui2,PAN Jingjing3,CHEN Xiaoqing3
1. Department of Child Healthcare, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China;
2. Department of Neonatology, Children’s Hospital of Nanjing Medical University, Nanjing 210008, China;
3. Department of Neonatology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
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摘要:

目的:比较不同危重评分对超低体重儿死亡风险的预测价值。方法:收集2019年1月1日至2020年1月1日南京医科大学附属儿童医院、南京医科大学附属妇产医院、南京医科大学第一附属医院新生儿科收治的所有超低体重儿,排除入院年龄1?h及以上、胎龄37周及以上、各项评分所需资料不全者。收集患儿的临床资料,计算患儿新生儿危重病例评分(NCIS)、新生儿急性生理学评分Ⅱ(SNAP-Ⅱ)、新生儿急性生理学评分围产期补充Ⅱ(SNAPPE-Ⅱ)、新生儿临床危险指数(CRIB)和新生儿临床危险指数Ⅱ(CRIB-Ⅱ)。比较死亡组与存活组的各项危重评分,采用受试者操作特征曲线评估各项危重评分对超低体重儿死亡风险的预测价值,并采用Pearson相关分析法分析各项危重评分与超低体重儿出生体重和胎龄的相关性。结果:共纳入192例超低体重儿,其中存活114例,死亡78例。死亡组与存活组出生体重、胎龄及阿普卡评分差异均有统计学意义(均P<0.01)。死亡组与存活组NCIS、SNAP-Ⅱ、SNAPPE-Ⅱ、CRIB和CRIB-Ⅱ评分差异均有统计学意义(均P<0.01),但CRIB对患儿死亡风险的预测价值相对较高,其曲线下面积为0.787,敏感度为0.678,特异度为0.804,约登指数为0.482。各评分与超低体重儿出生体重和胎龄均存在一定的相关性(均P<0.05),其中CRIB-Ⅱ和CRIB与超低体重儿出生体重和胎龄的相关系数较大,而NCIS与超低体重儿出生体重和胎龄的相关系数在五种评分中均最小(分别为0.191和0.244)。结论:五种危重评分中,CRIB对于超低体重儿的死亡风险预测价值更高,而我国主导推广的NCIS的敏感度及特异度相对较低,需要进一步修订以适应临床需要。

关键词: 新生儿超低体重儿危重疾病评分死亡风险预测    
Abstract:

Objective:To compare different illness severity scores in predicting mortality risk of extremely low birth weight infants (ELBWI). Methods:From January 1st, 2019 to January 1st, 2020, all ELBWI admitted in the Children’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital and the First Affiliated Hospital of Nanjing Medical University were included in the study. ELBWI with admission age ≥1?h, gestational age ≥37 weeks and incomplete data required for scoring were excluded. The clinical data were collected, neonatal critical illness score (NCIS), score for neonatal acute physiology version Ⅱ (SNAP-Ⅱ), simplified version of the score for neonatal acute physiology perinatal extension (SNAPPE-Ⅱ), clinical risk index for babies (CRIB) and CRIB-Ⅱ were calculated. The scores of the fatal group and the survival group were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the above illness severity scores for the mortality risk of ELBWI. Pearson correlation analysis was used to analyze the correlation between illness scores and birth weight, illness scores and gestational age. Results:A total of 192 ELBWI were finally included, of whom 114 cases survived (survival group) and 78 cases died (fatal group). There were significant differences in birth weight, gestational age and Apgar scores between fatal group and survival group (all P<0.01). There were significant differences in NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ between fatal group and survival group (allP<0.01). The CRIB had a relatively higher predictive value for the mortality risk. Its area under the ROC curve (AUC) was 0.787, the sensitivity was 0.678, the specificity was 0.804, and the Youden index was 0.482. The scores of NCIS, SNAP-Ⅱ, SNAPPE-Ⅱ, CRIB and CRIB-Ⅱ were significantly correlated with birth weight and gestational age (allP<0.05). The correlation coefficients of CRIB-Ⅱ and CRIB with birth weight and gestational age were relatively large, and the correlations coefficients of NCIS with birth weight and gestational age were the smallest (0.191 and 0.244, respectively).Conclusion:Among these five illness severity scores, CRIB has better predictive value for the mortality risk in ELBWI. NCIS, which is widely used in China, has relatively lower sensitivity and specificity, and needs to be further revised.

Key words: Neonate    Extremely low birth weight infant    Illness severity score    Death    Risk prediction
收稿日期: 2021-08-03 出版日期: 2022-05-17
CLC:  R722  
基金资助: 南京市卫生科技发展专项(YKK20127)
通讯作者: 童梅玲   
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杨洋
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周晓玉
程锐
潘晶晶
陈筱青

引用本文:

杨洋,池霞,童梅玲,周晓玉,程锐,潘晶晶,陈筱青. 不同新生儿危重评分对超低体重儿死亡风险的预测价值比较[J]. 浙江大学学报(医学版), 2022, 51(1): 73-78.

YANG Yang,CHI Xia,TONG Meiling,ZHOU Xiaoyu,CHENG Rui,PAN Jingjing,CHEN Xiaoqing. Comparison of different neonatal illness severity scores in predicting mortality risk of extremely low birth weight infants. J Zhejiang Univ (Med Sci), 2022, 51(1): 73-78.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0217        https://www.zjujournals.com/med/CN/Y2022/V51/I1/73

组别

n

入院年龄

(h)

出生体重

(g)

胎龄

(周)

性别

(男/女)

羊水性质

(正常/异常)

孕母感染

(有/无)

1?min阿普卡评分

5?min阿普卡评分

存活组

114

0.28(0.18,0.59)

864±103

27.6±2.0

48/66

90/24

33/81

7.1±2.1

8.4±1.4

死亡组

78

0.36(0.20,0.62)

799±131

26.5±2.0

42/36

63/15

28/50

5.7±2.5

7.8±1.7

Z/t′/t/χ2

–1.254

3.663

3.679

2.564

0.095

1.032

4.147

2.935

P

>0.05

<0.01

<0.01

>0.05

>0.05

>0.05

<0.01

<0.01

表 1  超低体重儿死亡组与存活组基线资料比较

组别

n

NCIS

SNAP-Ⅱ

SNAPPE-Ⅱ

CRIB

CRIB-Ⅱ

存活组

114

94±7

9(5,17)

26.00(17.00,36.25)

3.00(1.00,5.00)

9.89±2.37

死亡组

78

89±6

16(7,29)

39.50(22.00,56.75)

7.00(2.75,10.25)

11.79±2.83

Z/t

4.082

–3.313

–3.546

–5.624

–5.056

P

<0.01

<0.01

<0.01

<0.01

<0.01

表 2  超低体重儿死亡组与存活组各危重评分比较
图 1  各危重评分预测超低体重儿结局的受试者操作特征曲线SNAP-Ⅱ:新生儿急性生理学评分Ⅱ;SNAPPE-Ⅱ:新生儿急性生理学评分围产期补充Ⅱ;CRIB:新生儿临床危险指数;NCIS:新生儿危重病例评分.

危重评分名称

敏感度

特异度

约登指数

AUC

AUC(95%CI

标准误

P

NCIS

0.390

0.856

0.246

0.667(0.580~0.753)

0.044

<0.01

SNAP-Ⅱ

0.373

0.897

0.270

0.653(0.561~0.744)

0.047

<0.01

SNAPPE-Ⅱ

0.593

0.784

0.377

0.688(0.596~0.780)

0.047

<0.01

CRIB

0.678

0.804

0.482

0.787(0.712~0.862)

0.038

<0.01

CRIB-Ⅱ

0.559

0.794

0.353

0.730(0.647~0.813)

0.042

<0.01

表 3  各危重评分预测超低体重儿结局的受试者操作特征曲线分析结果比较

危重评分名称

与出生体重的相关性

与出生胎龄的相关性

r

P

r

P

NCIS

0.191

<0.05

0.244

<0.01

SNAP-Ⅱ

0.307

<0.01

0.290

<0.01

SNAPPE-Ⅱ

0.488

<0.01

0.396

<0.01

CRIB

0.576

<0.01

0.805

<0.01

CRIB-Ⅱ

0.701

<0.01

0.520

<0.01

表 4  各危重评分与超低体重儿出生体重、胎龄的相关性分析结果
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