基于血便、肠系膜淋巴结肿大及鞘部厚度的儿童急性肠套叠复发预测模型构建

Construction of a Prediction Model for Recurrence of Acute Intussusception in Children Based on Hematochezia, Mesenteric Lymph Node Enlargement, and Sheath Thickness

摘要: 目的：探讨儿童急性肠套叠复发的危险因素，构建并验证列线图预测模型。方法：选取2019年1月至2023年12月威海市立医院收治的200例肠套叠复位成功患儿，按7:3比例分为训练集(140例)与测试集(60例)。通过单因素及多因素logistic回归分析筛选危险因素，构建列线图模型，采用ROC曲线、校准曲线及决策曲线评估模型效能。结果：血便、肠系膜淋巴结肿大(淋巴结纵径 > 10 mm，短径 > 5 mm)、鞘部厚度(>6.4 mm)为复发独立危险因素(P < 0.05)。训练集模型AUC为0.882 (95% CI: 0.817~0.931)，敏感度88.00% (68.8%~97.5%)，特异度78.26% (69.60%~85.40%)；验证集AUC为0.886 (95% CI: 0.778~0.954)，敏感度76.92% (46.20%~95.00%)，特异度85.11% (71.70%~93.80%)。结论：基于三因素构建的列线图模型对肠套叠复发具有良好预测能力。

Abstract: Objective: To explore the risk factors for the recurrence of acute intussusception in children, and to construct and validate a nomogram prediction model. Method: A total of 200 children with successful intussusception reduction admitted to Weihai Municipal Hospital from January 2019 to December 2023 were selected and divided into a training set (140 cases) and a test set (60 cases) at a ratio of 7:3. Univariate and multivariate logistic regression analyses were used to screen for risk factors, a nomogram model was constructed, and the receiver operating characteristic curve (ROC), calibration curve, and decision curve were used to evaluate the efficacy of the model. Results: Hematochezia, mesenteric lymph node enlargement (longitudinal diameter of lymph nodes > 10 mm, short diameter > 5 mm), and sheath thickness (>6.4 mm) were independent risk factors for recurrence (P < 0.05). The area under the curve (AUC) of the model in the training set was 0.882 (95% CI: 0.817~ 0.931), with a sensitivity of 88.00% (68.8%~97.5%) and a specificity of 78.26% (69.60%~85.40%); the AUC in the validation set was 0.886 (95% CI: 0.778~0.954), with a sensitivity of 76.92% (46.20%~95.00%) and a specificity of 85.11% (71.70%~93.80%). Conclusion: The nomogram model constructed based on these three factors has a good predictive ability for intussusception recurrence.