血糖变异系数和SNAPPE-II与危重新生儿预后的相关性

doi:10.12372/jcp.2023.22e0086

摘要/Abstract

摘要：

目的探讨血糖变异系数（CV）、新生儿急性生理学评分围生期补充Ⅱ（SNAPPE-Ⅱ）与危重新生儿预后的关系。方法回顾性分析2018年8月至2020年9月新生儿重症监护室（NICU）住院的危重新生儿的临床资料。新生儿根据预后情况分为死亡组和存活组，比较两组间临床特征差异，采用二分类logistic回归模型分析危重新生儿预后不良的危险因素，采用受试者工作特征（ROC）曲线分析评估CV、SNAPPE-Ⅱ对于危重新生儿预后不良的诊断价值。结果共纳入385例新生儿，男228例、女157例。中位入院年龄1.0（1.0~24.0）h，平均胎龄（35.3±4.1）周，平均体质量（2 456.6±860.3）g。低血糖患儿85例，高血糖115例。死亡组80例，入NICU至死亡中位天数5.0（2.0~10.3）d。二分类logistic回归分析显示，CV，SNAPPE-Ⅱ，胎龄，体质量，主要诊断为肺出血、新生儿败血症与危重新生儿死亡相关（P<0.05）。CV诊断危重新生儿死亡的ROC曲线下面积（AUC）为0.72，SNAPPE-Ⅱ的AUC为0.85。当CV≥0.31时，其诊断危重新生儿死亡的灵敏度为0.75，特异度为0.59；当SNAPPE-Ⅱ≥18.50时，其诊断危重新生儿死亡的灵敏度为0.68，特异度为0.93。结论 CV与SNAPPE-Ⅱ对危重新生儿的不良预后均有一定预测价值。

关键词: 危重新生儿, 血糖变异系数, SNAPPE-II评分, 预后

Abstract:

Objective To explore the association of coefficient of glycemic variation (CV) and score for neonatal acute physiology with perinatal extension-Ⅱ (SNAPPE-Ⅱ) with prognosis in critically ill neonates. Methods The clinical data of critically ill neonates admitted to the neonatal intensive care unit (NICU) from August 2018 to September 2020 were retrospectively analyzed. According to the prognosis, they were divided into death group and survival group, and the difference of clinical features between the two groups was compared. Binary logistic regression model was used to analyze the risk factors of poor prognosis in critically ill neonates. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of CV and SNAPPE-Ⅱ in poor prognosis of critically ill neonates. Results A total of 385 critically ill newborns were included, including 228 boys and 157 girls. The median age of admission was 1.0 (1.0-24.0) hours, the mean gestational age was (35.3±4.1) weeks, and the mean weight was (2456.6±860.3) grams. There were 85 hypoglycemic and 115 hyperglycemic patients. There were 80 patients in the death group, and the median time from NICU admission to death were 5.0 (2.0-10.3) days. Binary logistic regression analysis showed that CV, SNAPPE-Ⅱ, gestational age, weight, the main diagnosis of pulmonary hemorrhage and neonatal sepsis were correlated with death of critically ill neonates (P<0.05). The area under curve (AUC) of CV predicting death of critically ill neonates was 0.72, and the AUC of SNAPPE-Ⅱwas 0.85. When CV≥0.31, the sensitivity and specificity for the diagnosis of critical neonatal death were 0.75 and 0.59. When SNAPPE-Ⅱ≥18.50, the sensitivity and specificity for the diagnosis of critical neonatal death were 0.68 and 0.93. Conclusions Both CV and SNAPPE-Ⅱ have certain predictive values for the poor prognosis of critically ill neonates.

Key words: critically ill neonate, coefficient of glycemic variation, score for neonatal acute physiology with perinatal extension-Ⅱ, prognosis

向超, 章容, 康兰, 雷小平, 刘兴琴, 董文斌. 血糖变异系数和SNAPPE-II与危重新生儿预后的相关性[J]. 临床儿科杂志, 2023, 41(6): 430-435.

XIANG Chao, ZHANG Rong, KANG Lan, LEI Xiaoping, LIU Xingqing, DONG Wenbin. Association of coefficient of glycemic variation and SNAPPE-Ⅱ with prognosis in critically ill neonates[J]. Journal of Clinical Pediatrics, 2023, 41(6): 430-435.

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项目	存活组(n=305)	死亡组(n=80)	统计量	P
男性[n(%)]	182(59.7)	46(57.5)	χ²=0.12	0.725
胎龄(x±s)/周	35.8±3.6	33.4±5.2	t=3.86	<0.001
体质量(x±s)/g	2555.2±796.8	2080.7±986.7	t=3.97	<0.001
CV[M(P₂₅~P₇₅)]	0.27(0.17~0.43)	0.41(0.31~0.64)	Z=5.94	<0.001
中位血糖[M(P₂₅~P₇₅)]/mmol·L^-1	4.68(4.17~5.30)	5.51(4.31~7.02)	Z=4.26	<0.001
初始血糖[M(P₂₅~P₇₅)]/mmol·L^-1	3.40(2.70~4.40)	3.60(2.38~6.05)	Z=1.95	0.052
低血糖[n(%)]	60(19.7)	25(31.2)	χ²=4.94	0.026
高血糖[n(%)]	62(20.3)	53(66.2)	χ²=63.80	<0.001
SNAPPE-Ⅱ[M(P₂₅~P₇₅)]	0.0(0.0~7.0)	29.5(8.5~44.0)	Z=10.46	<0.001
住院或死亡天数[M(P₂₅~P₇₅)]/d	9.0(6.0~15.0)	5.0(2.0~10.3)	Z=5.68	<0.001
机械通气天数[M(P₂₅~P₇₅)]/d	0.0(0.0~0.0)	2.0(0.0~5.0)	Z=13.81	<0.001
入院年龄[M(P₂₅~P₇₅)]/h	1.0(1.0~24.0)	3.0(1.0~14.0)	Z=3.40	0.001
妊娠期糖尿病[n(%)]	37(12.1)	7(8.8)	χ²=0.72	0.398
绒毛膜羊膜炎[n(%)]	14(4.6)	7(8.8)	χ²=1.40	0.237
主要诊断或死亡主要诊断
NRDS[n(%)]	153(50.2)	31(38.8)	χ²=3.31	0.069
新生儿窒息[n(%)]	59(19.3)	21(26.2)	χ²=1.84	0.175
新生儿败血症[n(%)]	42(13.8)	27(33.8)	χ²=17.20	<0.001
肺出血[n(%)]	3(1.0)	13(16.2)	χ²=33.35	<0.001
颅内出血[n(%)]	7(2.3)	3(3.8)	χ²=0.11	0.739
坏死性小肠结肠炎[n(%)]	8(2.6)	6(7.5)	χ²=3.02	0.082

变量	偏回归系数	标准误	χ²值	P	OR(95%CI)
截距	6.81	3.50	3.79	0.052	-
CV	2.00	1.00	4.01	0.045	7.36(1.04~51.96)
SNAPPE- II	0.09	0.01	46.23	<0.001	1.10(1.07~1.13)
胎龄	-0.25	0.11	5.18	0.023	0.78(0.63~0.97)
体质量	-0.00	0.00	3.89	0.049	1.00(1.00~1.00)
肺出血	2.90	0.97	8.96	0.003	18.09(2.72~120.47)
颅内出血	-0.43	1.08	0.16	0.689	0.65(0.08~5.36)
坏死性小肠结肠炎	0.95	0.69	1.89	0.169	2.57(0.67~9.90)
NRDS	-1.01	1.22	0.68	0.410	0.37(0.03~4.02)
新生儿窒息	1.97	1.09	3.29	0.070	7.17(0.85~60.25)
新生儿败血症	2.77	1.09	6.43	0.011	15.95(1.87~135.67)