【摘要】 目的 探讨新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)并发肠穿孔的危险因素，并构建列线图风险预测模型，为NEC并发肠穿孔的防治提供参考依据。方法 选取2019年1月～2024年12月于山西省儿童医院收治的31例NEC并发肠穿孔患儿为病例组，按1∶3匹配同期93例Bell’s分期≥Ⅱ期非穿孔NEC患儿为对照组。对比分析两组一般资料、围生期资料、实验室指标、NEC前临床情况及NEC后至穿孔前合并症。采用单因素分析结合多因素Logistic回归筛选肠穿孔独立危险因素，据此构建预测列线图模型并进行内部验证评估性能。结果 单因素分析结果显示，两组胎龄、窒息史、母孕期感染、血红蛋白浓度、抗生素使用、败血症、休克、凝血功能障碍及肾功能损害比较，差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示，窒息史(OR=3.86,95%CI:1.24～12.05)、败血症(OR=2.51,95%CI:1.06～5.94)、休克(OR=3.32,95%CI:1.01～10.93)是NEC肠穿孔的独立危险因素；高胎龄(OR=0.89,95%CI:0.79～0.99)、高血红蛋白浓度(OR=0.98,95%CI:0.96～0.99)为保护因素。列线图提示总分与穿孔风险正相关。模型验证：AUC=0.873，校准曲线拟合良好；决策曲线分析显示10%～85%风险阈值内具净收益。结论 列线图模型构建为预防NEC并发肠穿孔的临床决策提供支持，其价值在于促进高危病例的早期识别。更多还原

【Abstract】 Objective To investigate the risk factors of intestinal perforation in neonates with necrotizing enterocolitis(NEC) and establish a nomogram risk prediction model,providing a reference for the prevention and treatment of NEC-associated intestinal perforation.Methods A total of 31 infants with NEC complicated by intestinal perforation admitted to Shanxi Provincial Children’s Hospital from January 2019 to December 2024 were selected as the case group,93 controls comprising infants diagnosed with non-perforated NEC at Bell’s stage Ⅱ or higher matched at a ratio of 1∶3 during the same period were selected as control group. Comparative analyses were performed on general characteristics,perinatal data,laboratory parameters,clinical status preceding NEC diagnosis,and comorbidities occurring after NEC onset but prior to perforation. Univariate analysis combined with multivariate Logistic regression was employed to identify independent risk factors for intestinal perforation. Based on these factors,a predictive nomogram model was constructed,and the model’s performance was subsequently evaluated through internal validation using bootstrap resampling.Results Univariate analysis results revealed statistically significant differences between the two groups in gestational age,history of birth asphyxia,maternal infection during pregnancy,hemoglobin concentration,antibiotic use,sepsis,shock,coagulopathy,and renal impairment(P<0.05). Multivariate Logistic regression results showed that history of birth asphyxia(OR = 3.86, 95% CI:1.24-12.05), sepsis(OR = 2.51, 95% CI:1.06-5.94),and shock(OR = 3.32, 95% CI:1.01-10.93) were independent risk factors of intestinal perforation in NEC,higher gestational age(OR =0.89, 95% CI: 0.79-0.99) and higher hemoglobin concentration(OR = 0.98, 95% CI: 0.96-0.99) were protective factors(P<0.05). The nomogram indicated a positive correlation between the total points score and the risk of perforation. Model validation demonstrated an area under the curve of 0. 873. The calibration curve showed good fit. Decision curve analysis indicated net benefit within a risk threshold range of 10% to 85%.Conclusion The constructed nomogram model serves to support clinical decision-making for the prevention of intestinal perforation complicating NEC in neonates. Its clinical value lies in enhancing the early identification of high-risk infants.更多还原