目的 分析学龄前儿童功能性便秘的危险因素,并建立其风险预测模型。方法 选取2020年9月—2021年5月在青岛大学附属医院儿童保健科门诊就诊的108例功能性便秘儿童为研究对象,同时选取本院正常体检的324例健康儿童作为对照组,采用Logistic回归分析影响儿童功能性便秘发生的风险因素;应用R软件建立预测其发生风险的列线图模型,采用ROC曲线和Hosmer-Lemeshow拟合优度检验评价模型。结果 母亲或父母均有便秘病史(OR=2.708、11.493)、有时、经常或总是挑食偏食(OR=4.176、7.097、9.204)、不良排便习惯(OR=3.465)、排便不顺利时责备儿童(OR=7.067)、有时或经常有家庭冲突(OR=4.807、6.543)为学龄前儿童功能性便秘发生的危险因素(P＜0.05),儿童不容易生气、父子互动时间＞3 h为保护性因素(OR＝0.213、0.107,P＜0.05);该预测模型ROC曲线下面积为0.893,拟合优度检验显示模型拟合良好(P=0.986),绘制列线图的校准曲线为斜率接近1的直线。结论 基于遗传、儿童生活习惯以及社会心理因素所构建的风险预测模型简单、直观,具有良好的区分度与准确度,对早期识别功能性便秘高风险儿童,制定针对性干预措施具有指导意义。
Abstract
Objective To explore the risk factors of functional constipation in preschoolers, and to establish a personalized risk prediction model.Methods Totally 108 preschoolers with functional constipation, who were admitted to the Children's Health Care Clinic of the Affiliated Hospital of Qingdao University from September 2020 to May 2021, were selected as study subjects. Meanwhile 324 healthy children who had normal physical examinations were enrolled in the control group. Logistic regression analysis was used to analyze the influencing factors of functional constipation in preschoolers. Nomogram model was established by R software to predict the risk of functional constipation, and the model was evaluated using ROC curve and Hosmer-Lemeshow goodness-of-fit test.Results Maternal or parental history of constipation(OR=2.708, 11.493), picky eating (sometimes, often, always)(OR=4.176, 7.097, 9.204), bad defecation habit(OR=3.465), blaming children(OR=7.067), family conflict (sometimes, often) were risk factors (OR= 4.807, 6.543) were risk factors for functional constipation of children(P＜0.05). Children who are not irritable and the time of father-son interaction >3 h were protective factors of functional constipation in preschoolers (OR= 0.213, 0.107, P<0.05). The area under the curve of ROC was 0.893, the goodness-of-fit test showed that the model fit well (P=0.986), and the calibration curve of nomogram was a straight line with slope close to 1. Conclusion The risk prediction model based on genetic, children's living habits and social psychological factors is simple and intuitive, with good differentiation and accuracy, which is significant for identifying children at high risk of functional constipation and making targeted intervention measures.
关键词
功能性便秘 /
学龄前儿童 /
列线图 /
风险预测
Key words
functional constipation /
preschoolers /
nomogram /
risk prediction
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