造血干细胞移植患儿口腔黏膜炎风险预测模型的构建及验证

doi:10.3761/j.issn.0254-1769.2023.05.011

摘要/Abstract

摘要：

目的分析造血干细胞移植患儿口腔黏膜炎的危险因素，构建风险预测模型，并验证其预测效果。方法采用便利抽样法，选取2019年1月—2022年6月于重庆市某三级甲等儿童专科医院行异基因造血干细胞移植的286例患儿作为调查对象，回顾性分析相关资料，通过Logistic回归分析筛选其口腔黏膜炎的危险因素，应用R 3.6.1软件绘制列线图，并进行验证。结果 Logistic回归分析结果显示，BMI<16、口腔pH值≤6.5、口腔清洁度评分为2~3分、预处理方案为减低强度或清髓性预处理、使用甲氨蝶呤、中性粒细胞计数<1.5 × 10⁹ /L是造血干细胞移植患儿口腔黏膜炎的危险因素（P<0.05）。Hosmer-Lemeshow检验结果提示，该风险预测模型具有较好的拟合度（ χ²=0.969，P=0.998）。模型验证结果显示，该模型的受试者操作特征曲线下面积为0.881，最佳临界值为0.7，准确度为80.36%，灵敏度为83.59%，特异度为74.88%；预测口腔黏膜炎的一致性指数为0.881，校正一致性指数为0.862。结论该研究构建的风险预测模型具有良好的区分度与准确度，可为临床护理人员预测造血干细胞移植患儿口腔黏膜炎的发生风险、尽早制订个体化预防策略提供参考。

关键词: 儿童, 造血干细胞移植, 口腔黏膜炎, 危险因素, 预测模型, 儿科护理学

Abstract:

Objective To explore the influencing factors of oral mucositis in children undergoing hematopoietic stem cell transplantation（HSCT），and to develop a nomogram model to predict these risks. Methods A total of 286 children who underwent allogeneic HSCT were recruited between January 2019 and June 2022 in a tertiary A children’s hospital in Chongqing. Multivariate logistic regression was conducted to identify independent risk factors of oral mucositis in children undergoing HSCT. A nomogram was developed by R 3.6.1 software and validated to predict the risk of oral mucositis in children undergoing HSCT. Results Logistic regression analysis showed that body mass index<16，oral pH≤6.5，oral cleanliness score（2~3 points），myeloablative or reduced intensity in conditioning regimen，standard methotrexate dose GVHD prophylaxis and neutrophil count<1.5×10⁹ /L were inde-pendent risk factors of oral mucositis after HSCT in children（P<0.05）. The model passed Hosmer-Lemeshow goodness of fit test（ χ²=0.969，P=0.998）and the area under the ROC curve of this model was 0.881，with the optimal critical value of 0.7，accuracy of 80.36%，sensitivity of 83.59% and the specificity of 74.88%. The concordance index for predicting oral mucositis was 0.881，and the adjusted concordance index was 0.862. Conclusion The risk prediction model constructed in this study has good discrimination and accuracy. It can be used to predict the risk of oral mucositis in children undergoing HSCT，providing the reference for management and preventative intervention strategies for high-risk children.

Key words: Children, Hematopoietic Stem Cell Transplantation, Oral Mucositis, Risk Factors, Prediction Model, Pediatric Nursing

潘小容, 张世群, 郭小利, 莫霖, 张小琴, 李沁霞. 造血干细胞移植患儿口腔黏膜炎风险预测模型的构建及验证[J]. 中华护理杂志, 2023, 58(5): 587-594.

PAN Xiaorong, ZHANG Shiqun, GUO Xiaoli, MO Lin, ZHANG Xiaoqin, LI Qinxia. Establishment and validation of a risk prediction model for oral mucositis in children undergoing hematopoietic stem cell transplantation[J]. Chinese Journal of Nursing, 2023, 58(5): 587-594.

图/表 4

表1 造血干细胞移植患儿的一般资料及口腔黏膜炎危险因素的单因素分析结果（n=286）

Table 1 The general information and results of single factor analysis of risk factors associated with oral mucositis in children undergoing hematopoietic stem cell transplantation（n=286）

表2 造血干细胞移植患儿口腔黏膜炎危险因素的Logistic回归分析结果

Table 2 Multivariate logistic regression analysis of oral mucositis in children undergoing hematopoietic stem cell transplantation between 2 groups

图1 造血干细胞移植患儿口腔黏膜炎风险预测模型的受试者操作特征曲线

Figure 1 Receiver operator characteristic curve for predictive models of oral mucositis in children undergoing hematopoietic stem cell transplantation

图2 造血干细胞移植患儿口腔黏膜炎风险预测模型列线图

Figure 2 Nomogram for predicting oral mucositis in children undergoing hematopoietic stem cell transplantation

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