中国实用儿科杂志

中国实用儿科杂志 ›› 2022, Vol. 37 ›› Issue (10): 776-781.DOI: 10.19538/j.ek2022100614

• 论著 • 上一篇    下一篇

基于儿童血清多种维生素水平构建儿童抽动障碍预测模型及其临床价值分析

  

  1. 1.首都儿科研究所附属儿童医院  a 神经内科，b 健康大数据研究中心，c 保健科，北京  100020；2.北京协和医学院研究生院，北京  100010；3.首都医科大学附属北京儿童医院神经内科，北京  100045
  • 出版日期:2022-10-06 发布日期:2022-11-11
  • 通讯作者: 王珺，电子信箱：colalawang@sina.cn
  • 基金资助:
    北京市卫生系统高层次卫生技术人才培养计划（2015-3-084）；首都临床特色应用研究（Z131107002213159）

Prediction model of tic disorder in children based on multiple vitamin level and analysis of its clinical value

  1. *Department of Neurology，Children's Hospital Affiliated to Capital Institute of Pediatrics，Beijing  100020，China
  • Online:2022-10-06 Published:2022-11-11

摘要： 目的　探讨血清中多种维生素浓度与抽动障碍（TD）相关性，从而为临床实践提供更系统全面的循证学依据。方法　回顾2018年7月至2021年6月就诊首都儿科研究所附属儿童医院神经内科的1089例TD患儿临床资料；对照同期医院保健科健康体检的753例儿童相关资料，分析两组儿童血清多种维生素水平。随机按7：3的比例分为训练集和验证集，采用R软件中的caret包，在训练集中比较维生素A（VA）、维生素B1（VB1）、维生素B2（VB2）、维生素B6（VB6）、维生素B9（VB9）、维生素B12（VB12）、维生素C（VC）、维生素D（VD）、维生素E（VE）的水平并构建预测模型。并对其进行可靠性验证。结果　训练集儿童Logistic回归风险模型提示：儿童血清VA、VB1、VB2、VB6、VB12、VD的水平、男性和年龄是影响TD发生的独立危险因素。结合Logistic模型，绘制列线图。可视化列线图提示：年龄在4～10岁、男性、以及VA、VB1、VB2、VB6、VD不足或缺乏儿童的赋分高。列线图训练集一致性指数C-index为0.761（95% CI：0.708～ 0.813），证实列线图模型达到中上等区分度，有临床价值。训练集受试者工作特征曲线（ROC）结果显示曲线下面积（AUC）=0.737，校准曲线和决策曲线分析法（DCA）分析显示模型的可靠性较好，验证集中的ROC结果显示AUC=0.726，表明该模型具有一定的临床参考价值。结论　儿童血清VA、VB1、VB2、VB6、VB12、VD的水平、男性和年龄是影响TD发生的独立危险因素。由列线图可见4~10岁的男性儿童不足或缺乏VA、VB1、VB2、VB6和VD更易出现抽动障碍，因此，抽动障碍患儿血清VA、VB1、VB2、VB6和VD的水平与抽动障碍之间存在显著的相关性，对于抽动障碍儿童应常规评估维生素营养状况，为TD的治疗奠定基础。

关键词: 抽动障碍, 维生素, 儿童, 预测模型

Abstract: Objective　To explore the correlation between serum multivitamin concentration and TD，in order to provide a more systematic and comprehensive evidence-based evidence for clinical practice. Methods　The clinical data of 1，089 children with TD diagnosed in Children's Hospital of Capital Institute of Pediatrics from July 2018 to June 2021 were retrospectively collected （TD group）；753 patients who received health examination during the same period were selected as the control group.The serum multivitamin levels of the two groups were analyzed. The caret package of R software was used to randomly divide the two groups of children into training set and verification set in a ratio of 7：3.The levels of vitamin A（VA），vitamin B1（VB1），vitamin B2（VB2），vitamin B6（VB6），vitamin B9（VB9），vitamin B12（VB12），vitamin C（VC），vitamin D（VD）and vitamin E（VE）were compared in the training set. Construct the prediction model and verify its reliability. Results　The logistic regression risk model for children in the training set suggested that the levels of serum VA，VB1，VB2，VB6，VB12 and VD in children，male and age were independent risk factors for the occurrence of TD. Combined with the Logistic regression risk model，a visual Nomogram  was drawn. Visual nomogram suggested that age between 4-10 years old，male，and deficiency in VA，VB1，VB2，VB6 and VD had the high scores.In the training set of children's data，the C-index was 0.761（95% CI：0.708- 0.813）. It is was confirmed that the nomogram model had achieved middle and upper distinction and had clinical value. The results of Receiver Operating Characteristic curve（ROC）in the training set showed that Area Under Curve（AUC） was 0.737. Calibration Curve and Decision Curve Analysis（DCA） showed that the model had good reliability，and the ROC results in the verification set showed AUC was 0.726，indicating that the model had certain clinical reference value. Conclusion　Serum levels of VA，VB1，VB2，VB6，VB12 and VD in the children，male and age are independent risk factors for TD. It can be seen from the nomogram that male children aged 4 to 10 years old was more prone to tic disorders with insufficient or lack of VA，VB1，VB2，VB6 and VD. Therefore，the levels of  the VA，VB1，VB2，VB6 and VD in TD children are significantly related to TD；vitamin levels should should be assessed routinely in TD children in order to lay the foundation for the treatment of TD.

Key words: tic disorder, vitamin, child, prediction model