预测口服补液盐对小儿血管迷走性晕厥的治疗效果。
Predicting therapeutic efficacy of oral rehydration salts in children with vasovagal syncope.
作者信息
Du Xiaojuan, Tao Chunyan, Li Xueying, Du Junbao, Liao Ying, Jin Hongfang
机构信息
Department of Pediatrics, Peking University First Hospital, Beijing, China.
Department of Statistics, Peking University First Hospital, Beijing, China.
出版信息
Front Pediatr. 2023 Apr 13;11:1164304. doi: 10.3389/fped.2023.1164304. eCollection 2023.
OBJECTIVE
This study was designed to develop an easy-to-perform and inexpensive measure to predict efficacy of the oral rehydration salts (ORS) in children with vasovagal syncope (VVS).
MATERIALS AND METHODS
Children diagnosed with VVS and treated with ORS for a median of 3 months at the Peking University First Hospital, China, were enrolled and followed up. Demographic data, clinical hemodynamic parameters, and variables related to red blood cells were collected at the baseline. On the basis of changes in symptom scores after treatment, participants were divided into effective or ineffective groups at the end of the follow-up. Logistic regression analysis was used to investigate parameters related to therapeutic efficacy of ORS and a predictive model of ORS effectiveness was created. The predictive efficiency was evaluated using the receiver operating characteristic curve. The accuracy/consistency was evaluated by the Hosmer-Lemeshow test and calibration curve. Internal validation was done using the bootstrap approach.
RESULTS
Totally 97 pediatric participants were included in the study and 4 (4.1%) were lost during the follow-up. ORS therapy was effective in 46 children and ineffective in 47 children. Children in the effective group had higher baseline red blood cell count, hemoglobin, and hematocrit than those in the ineffective group ( < 0.01). Through logistic regression analysis, the baseline hematocrit and body mass index (BMI) were included in predictive model for the response to ORS treatment. The predictive efficacy of the model showed an area under the curve of 0.77 ( < 0.01). The predicted probability cut-off value of 0.5 was found to be optimal, with a resulting sensitivity of 67.4% and specificity of 80.9%. In the Hosmer-Lemeshow test, -value was 0.75, and the calibration plot showed a good model fitness. Internal validation was performed using the bootstrap approach ( = 1,000), showing 95% confidence interval of 0.67-0.86.
CONCLUSION
Hemoglobin combined with BMI was useful for predicting the therapeutic efficacy of ORS in children with VVS.
目的
本研究旨在开发一种易于实施且成本低廉的方法，以预测口服补液盐（ORS）对血管迷走性晕厥（VVS）患儿的疗效。
材料与方法
纳入在中国北京大学第一医院诊断为VVS并接受ORS治疗中位时间为3个月的患儿，并进行随访。在基线时收集人口统计学数据、临床血流动力学参数以及与红细胞相关的变量。根据治疗后症状评分的变化，在随访结束时将参与者分为有效组或无效组。采用逻辑回归分析研究与ORS治疗效果相关的参数，并建立ORS有效性的预测模型。使用受试者工作特征曲线评估预测效率。通过Hosmer-Lemeshow检验和校准曲线评估准确性/一致性。采用自抽样法进行内部验证。
结果
本研究共纳入97名儿科参与者，4名（4.1%）在随访期间失访。ORS治疗对46名儿童有效，对47名儿童无效。有效组儿童的基线红细胞计数、血红蛋白和血细胞比容高于无效组儿童（<0.01）。通过逻辑回归分析，基线血细胞比容和体重指数（BMI）被纳入ORS治疗反应的预测模型。该模型的预测效能显示曲线下面积为0.77（<0.01）。发现预测概率截断值为0.5时最佳，灵敏度为67.4%，特异度为80.9%。在Hosmer-Lemeshow检验中，P值为0.75，校准图显示模型拟合良好。采用自抽样法（=1000）进行内部验证，显示95%置信区间为0.67-0.86。
结论
血红蛋白联合BMI有助于预测ORS对VVS患儿的治疗效果。
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