儿童泌尿系统炎症性疾病的慢性预测

H. O. Lezhenko, N. A. Zakharchenko
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摘要

背景。目的是对导致儿童泌尿系统炎症性疾病的慢性因素进行分层,并建立一个预测其病程的数学模型。材料和方法。研究组共97例儿童,平均年龄- 10.0±1.3岁。主要分组分为急性尿路感染患儿43例,慢性尿路感染患儿34例。对照组为条件健康儿童20例。采用免疫酶分析方法研究了1,25(OH)2D3、维生素d结合蛋白、诱导型一氧化氮合酶(NOS2)、胱抑素C、抗菌肽、肝磷脂、乳铁蛋白、白细胞介素6,15的含量。采用因子分析和聚类分析评价因子特征对UTI慢性化过程的影响。采用logistic回归方程预测发生慢性尿路感染的概率。通过模型的敏感性和特异性评估模型的质量,并采用受试者操作特征(ROC)分析。结果。结果发现,尿路功能障碍因素、合并症因素、保护因素、免疫因素、疾病的慢性病灶、NOS2因素6个因素的意义最大。根据logistic回归结果,预测儿童慢性UTI发生概率的模型为包含6个变量(疾病早期表现、维生素D水平、膀胱输尿管反流、代谢异常肾病、神经源性膀胱、母亲儿童期UTI)的方程形式。根据训练样本的数据确定模型的分类能力为75.0%。该模型的敏感性为78.3%,特异性为76.5%。与我们的数学模型相对应的ROC曲线下的面积等于0.776。基尼系数为55.2%,说明模型质量较好。结论。儿童泌尿系统炎症过程的慢性过程是在一些病理因素相互作用的条件下发生的。慢性炎症过程的主要危险因素是尿路功能障碍的存在、疾病的早期表现、维生素D水平、肠道功能障碍以及母亲在儿童期存在尿路感染。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prediction of the chronicity of inflammatory diseases of the urinary system in children
Background. The purpose was stratification of factors that lead to the chronicity of inflammatory diseases of the urinary system in children, as well as creation of a mathematical model for predicting their course. Materials and methods. The research group consisted of 97 children (average age — 10.0 ± 1.3 years). The main group was divided into subgroups: the first one — 43 children with acute urinary tract infections (UTIs), the second one — 34 patients with chronic UTIs. The control group consisted of 20 conditionally healthy children. The content of 1,25(OH)2D3, vitamin D-binding protein, inducible nitric oxide synthase (NOS2), cystatin C, cathelicidin, hepcidin, lactoferrin, interleukins 6, 15 was investigated by immunoenzymatic analysis. The impact of factor characteristics on the process of UTI chronicity was evaluated using factor and cluster analyses. A logistic regression equation was used to predict the probability of developing chronic UTIs. The quality of the constructed model was assessed by its sensitivity and specificity, and receiver operator characteristic (ROC) analysis was also used. Results. It was found that 6 factors had the greatest significance: the factor of functional disorders of the urinary tract, the factor of comorbid conditions, the protective factor, the immune factor, chronic foci of the disease, and the NOS2 factor. According to the results of logistic regression, the model for predicting the probability of developing chronic UTI in children had the form of an equation that included 6 variables (early manifestation of the disease, vitamin D level, vesicoureteral reflux, dysmetabolic nephropathy, neurogenic bladder, UTI in the mother in childhood). The classification ability of the model was determined based on the data of the training sample and was 75.0 %. The sensitivity of the model was 78.3 %, and the specificity was 76.5 %. The area under the ROC curve that corresponded to our mathematical model was equal to 0.776. The Gini index was 55.2 %, which corresponds to the good quality of the model. Conclusions. The process of chronicity of the inflammatory process in the urinary system in children occurs under the conditions of the interaction of some pathological factors. The leading risk factors for the chronicity of the inflammatory process are the presence of functional disorders of the urinary tract, early manifestation of the disease, the level of vitamin D, intestinal dysfunction, and the presence of UTI in the mother in childhood.
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