
新生儿ABO溶血病所致高胆红素血症再入院危险因素分析及风险预测模型构建
Risk factors and construction of a risk prediction model for readmission due to hyperbilirubinemia in neonates with ABO hemolytic disease of the newborn
目的 探讨新生儿ABO溶血病(ABO-hemolytic disease of the newborn, ABO-HDN)高胆红素血症再入院率和危险因素,并构建再入院风险预测模型。 方法 回顾性选取2021年1月—2023年12月新生儿科住院的ABO-HDN高胆红素血症新生儿为研究对象。根据再入院情况将新生儿分为再入院组和对照组,分析高胆红素血症相关的临床情况及再入院风险因素,进一步构建再入院预测模型,并对模型的预测效果进行评估。 结果 过敏性哮喘患儿组与对照组之间共鉴定出差异表达的130个circRNA、40个miRNAs和802个mRNAs,并建立由12个circRNAs、7个miRNAs和75个mRNAs组成的调控网络。GO分析发现差异基因主要调节生长发育等。KEGG结果显示其主要参与mTOR信号通路等。CIBERSORT分析发现患儿组中的CD8+ T细胞和静息NK细胞高于健康组,而静息CD4+记忆T细胞和活化肥大细胞低于健康组。Pearson分析发现6个关键mRNA与免疫细胞浸润呈正相关性。 结论 光疗开始年龄、光疗时间、反跳性高胆红素血症的发生、出院时血清总胆红素和间接胆红素水平是新生儿ABO-HDN高胆红素血症再入院的影响因素,对于此类新生儿应在出院和随访管理时密切关注以降低再入院率。
Objective To investigate the readmission rate and risk factors for readmission due to hyperbilirubinemia in neonates with ABO hemolytic disease of the newborn (ABO-HDN), and to construct a risk prediction model for readmission. Methods Neonates diagnosed with hyperbilirubinemia due to ABO-HDN and hospitalized in the neonatal department between January 2021 and December 2023 were enrolled. Based on readmission status, neonates were divided into a readmission group and a control group. Clinical characteristics related to hyperbilirubinemia and risk factors for readmission were analyzed. Subsequently, a prediction model for readmission was constructed, and its predictive performance was evaluated. Results A total of 483 neonates with hyperbilirubinemia due to ABO-HDN were included. The readmission rate was 13.0% (63 cases). Multivariate logistic regression analysis revealed that earlier age at phototherapy initiation, longer duration of phototherapy, occurrence of rebound hyperbilirubinemia, and higher levels of serum total bilirubin and indirect bilirubin at discharge were independent risk factors for hyperbilirubinemia readmission in ABO-HDN neonates (OR=2.373, 4.840, 6.475, 5.033, 1.336 respectively; P<0.05). A risk prediction model for ABO-HDN hyperbilirubinemia readmission was constructed based on these 5 risk factors. Model evaluation demonstrated good predictive performance. Conclusions Age at phototherapy initiation, duration of phototherapy, occurrence of rebound hyperbilirubinemia, and serum total bilirubin and indirect bilirubin levels at discharge are significant influencing factors for readmission due to hyperbilirubinemia in neonates with ABO-HDN. Close monitoring during discharge planning and follow-up management for such neonates is crucial to reduce readmission rates.
ABO溶血病 / 高胆红素血症 / 再入院 / 危险因素 / 新生儿
ABO hemolytic disease / Hyperbilirubinemia / Readmission / Risk factor / Neonate
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