[1]刁洋洋,张禹泰,李超然,等.新生儿生发基质-脑室内出血继发脑积水的危险因素分析[J].临床小儿外科杂志,2026,(02):111-117.[doi:10.3760/cma.j.cn101785-20251029-00026]
　Diao Yangyang,Zhang Yutai,Li Chaoran,et al.Risk factor analysis of secondary hydrocephalus after neonatal germinal matrix-intraventricular hemorrhage[J].Journal of Clinical Pediatric Surgery,2026,(02):111-117.[doi:10.3760/cma.j.cn101785-20251029-00026]
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新生儿生发基质-脑室内出血继发脑积水的危险因素分析

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 期数: 2026年02 页码: 111-117 栏目: 专题·新生儿脑出血的外科治疗 出版日期: 2026-02-28
Title:
Risk factor analysis of secondary hydrocephalus after neonatal germinal matrix-intraventricular hemorrhage
作者:
刁洋洋;  张禹泰;  李超然;  梁平;  纪文元
重庆医科大学附属儿童医院神经外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿童神经发育与认知障碍重庆市重点实验室, 重庆 401122
Author(s):
Diao Yangyang;  Zhang Yutai;  Li Chaoran;  Liang Ping;  Ji Wenyuan
Department of Neurosurgery, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key; Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child; Neurodevelopment and Cognitive Disorders, Chongqing 401122, China
关键词:
婴儿; 新生; 生发基质-脑室内出血; 脑积水; 危险因素; 列线图
Keywords:
Infant;  Newborn; Germinal Matrix-Intraventricular Hemorrhage; Hydrocephalus; Risk Factors; Nomograms
DOI:
10.3760/cma.j.cn101785-20251029-00026
摘要:
目的 探讨新生儿生发基质-脑室内出血继发脑积水的独立危险因素,构建个体化风险预测列线图模型。方法 采用单中心病例对照研究设计,纳入2020年11月至2025年6月重庆医科大学附属儿童医院收治的136例新生儿生发基质-脑室内出血患儿,根据是否继发脑积水分为脑积水组(34例)和非脑积水组(102例),通过倾向性评分匹配(1∶3)平衡两组基线特征。采用LASSO回归筛选预测变量,经贝叶斯逻辑回归确定独立危险因素,据此构建列线图模型,通过Bootstrap法重复抽样进行内部验证,评估模型区分度、校准度及临床实用性。结果 贝叶斯逻辑回归分析显示,Papile分级为Ⅲ/Ⅳ级(OR=3733.64,95%CI:185.28~190951.05,P<0.001)、合并颅内感染(OR=62.81,95%CI:6.21~1137.87,P<0.001)、出生体重≥1 500 g(OR=23.46,95%CI:2.03~448.89,P=0.007)是新生儿生发基质-脑室内出血继发脑积水的独立危险因素,动脉导管未闭是其保护因素(OR=0.06,95%CI:0.00~0.54,P=0.008)。列线图模型内部验证C-index为0.986,受试者操作特征曲线下面积为0.984,校准曲线与决策曲线分析均显示模型具有良好的区分度、校准度及临床实用性。结论 本研究构建的列线图模型可有效预测新生儿生发基质-脑室内出血继发脑积水的风险,有助于临床早期识别高危患儿,为个体化干预提供量化工具。
Abstract:
Objective To investigate the independent risk factors for secondary hydrocephalus after neonatal germinal matrix-intraventricular hemorrhage and to construct an individualized risk prediction nomogram model. Methods A single-center retrospective study was conducted including neonates with germinal matrix-intraventricular hemorrhage admitted to the Children’s Hospital of Chongqing Medical University between November 2020 and June 2025. According to the occurrence of secondary hydrocephalus,patients were divided into a hydrocephalus group (34 cases) and a non-hydrocephalus group (102 cases). Propensity score matching (1∶3) was applied to balance baseline characteristics between the two groups. Least absolute shrinkage and selection operator (LASSO) regression was applied to screen predictive variables,and Bayesian logistic regression was subsequently used to identify independent risk factors. A nomogram prediction model was constructed based on these factors,and internal validation was performed using bootstrap resampling to evaluate the model’s discrimination,calibration,and clinical utility. Results Bayesian logistic regression analysis showed that Papile grade Ⅲ/Ⅳ (OR=3733.64,95%CI:185.28-190951.05,P<0.001),concomitant intracranial infection (OR=62.81,95%CI:6.21-1137.87,P<0.001),and birth weight ≥1 500 g (OR=23.46,95%CI:2.03-448.89,P=0.007) were independent risk factors for secondary hydrocephalus after neonatal germinal matrix-intraventricular hemorrhage,whereas patent ductus arteriosus was a protective factor (OR=0.06,95%CI:0.00-0.54,P=0.008). The nomogram model constructed based on these factors demonstrated a concordance index (C-index) of 0.986 on internal validation,an area under the receiver operating characteristic (ROC) curve (AUC) of 0.984,and calibration and decision curve analyses indicating good discrimination,calibration,and clinical utility. Conclusions The nomogram model constructed in this study effectively predicts the risk of secondary hydrocephalus after neonatal germinal matrix-intraventricular hemorrhage,facilitating early identification of high-risk neonates and providing a quantitative tool for individualized intervention.

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备注/Memo

收稿日期:2025-10-29。
通讯作者:纪文元,Email:282207152@qq.com

更新日期/Last Update: 1900-01-01