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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (4): 267-271.DOI: 10.3969/j.issn.1673-5501.2023.04.004

• 论著 • 上一篇    下一篇

应用GAMLSS方法构建1~16岁儿童青少年扰动系数参考值的横断面调查

幸奠伟1,周硕彦1,王宸浩1,蒋文良2,金萍3,石艳4,赵安玲5,王道聪6,方芳1,符跃强1,许峰1   

  1. 1 重庆医科大学附属儿童医院重症医学科，儿童发育疾病研究教育部重点实验室，国家儿童健康与疾病临床医学研究中心，儿童发育重大疾病国家国际科技合作基地，儿科学重庆市重点实验室重庆，400014；2 重庆市大足区人民医院重庆，402360；3 深圳市宝安区妇幼保健院深圳，518133；4 凉山彝族自治州第一人民医院四川，615000；5 重庆市江津区第二人民医院重庆，402289；6 巫溪县人民医院重庆，405800


  • 收稿日期:2023-05-30 修回日期:2023-08-09 出版日期:2023-08-25 发布日期:2023-08-25
  • 通讯作者: 许峰

Reference value of disturbance coefficient of children and adolescents aged 1 to 16 years by GAMLSS: A cross-sectional survey

XING Dianwei1, ZHOU Shuoyan1, WANG Chenhao1, JIANG Wenliang2, JIN Ping3, SHI Yan4, ZHAO Anling5, WANG Daocong6, FANG Fang1, FU Yueqiang1, XU Feng1#br#

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  1. 1 Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing 400014, China; 2 The People's Hospital of Dazu, Chongqing, Chongqing 402360, China; 3 Shenzhen Maternity & Child Healthcare Hospital, Shenzhen 518133, China; 4 The First People's Hospital of Liangshan Yi Autonomous Prefecture，Sichuan 615000, China; 5 The Second People's Hospital of Jiangjin, Chongqing, Chongqing 402289, China; 6 Wuxi County People's Hospital, Chongqing 405800, China

  • Received:2023-05-30 Revised:2023-08-09 Online:2023-08-25 Published:2023-08-25
  • Contact: XU Feng, email: xufeng9899@163.com

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摘要： 背景：扰动系数（DC）是无创脑水肿动态监测仪的主要技术参数，国内外尚无儿童青少年正常参考值。 目的：建立1~16岁儿童青少年DC的参考值区间。 设计：多中心前瞻性横断面调查。 方法：2020年3月至2023年3月于重庆市、四川省和深圳市6家医院、2所幼儿园和小学招募1~16岁无颅脑损伤的儿童青少年为研究对象，采用无创脑水肿动态监护仪连续监测15 min，取监测均值为受试者的最终DC值。基于位置、尺度、形状广义的可加模型(GAMLSS)绘制不同年龄DC的P1、P5、P10、P25、P50、P75、P90、P95、P99百分位数及百分位数曲线。采用独立样本t检验分析不同性别DC均值的差异，通过方差分析比较各年龄组DC均值及差异，通过绘制散点图及Loess局部加权非参数回归曲线探索DC随年龄、体重、头围增加的变化特点。 主要结局指标：DC。 结果：研究期间1 247名无颅脑损伤儿童青少年纳入本文分析，男787名（63.1%），女460名。拟合不同年龄儿童青少年DC百分位数曲线，DC水平随年龄增长而增长，在5岁后增长放缓并逐渐停止增长。在总体人群中，男、女性DC水平差异无统计学意义（P=0.051）；各年龄组不同性别儿童青少年DC差异均无统计学意义。相关性分析显示，当年龄<5岁、体重<18.0 kg和头围<51.0 cm时，DC与年龄、体重和头围均存在显著正相关（r分别为0.663、0.454和0.474）；反之，当年龄≥5岁、体重≥18.0 kg和头围≥51.0 cm时，DC变化不明显，逐渐稳定于107。 结论：本研究构建了1~16岁儿童青少年DC的百分位数曲线图，当年龄<5岁时，DC随年龄增长而增长；当年龄≥5岁时，DC逐渐稳定于107。

关键词: 儿童青少年, 扰动系数, 参考值, 百分位数曲线, GAMLSS

Abstract: Background：The disturbance coefficient(DC) is the main technical parameter of noninvasive brain edema dynamic monitoring instruments, and there is no normal reference value for children and adolescents at home abroad. Objective：To establish the reference intervals of DC for children and adolescents aged 116 years. Design：Multicenter prospective crosssectional survey. Methods：From March 2020 to March 2023, children and adolescents aged 116 years without craniocerebral injury were recruited from 6 hospitals 2 kindergarten and primary schools in Chongqing, Sichuan and Shenzhen. The noninvasive brain edema dynamic monitor was used for continuous monitoring for 15 minutes, and the monitoring average was taken as the final DC value of the subjects. Generalized Additive Models for Location, Scale, and Shape (GAMLSS) were used to draw P1, P5, P10, P25, P50, P75, P90, P95, P99 percentile values and percentile curves for disturbance coefficients of different ages. Independent sample ttest was used to analyze the difference of DC between boys and girls, and analysis of variance was used to calculate the DC mean value in different age groups and the difference of DC in different age groups. The changes of DC with age, weight and head circumference were explored by drawing scatter plots and Loess local weighted nonparametric regression curves. Main outcome measures：Disturbance coefficient. Results：A total of 1 247 children and adolescents with no cranial injuries were included in the study, including 787 males (63.1%) and 460 females. The observed fitted percentile curves of disturbance coefficients for children and adolescents of different ages showed that the level of disturbance coefficients gradually increased with age, and the growth of disturbance coefficient curves slowed down and eventually stopped after 5 years of age. In the overall population, there was no significant difference in DC levels between males and females (P>0.05), and there was no significant difference in DC among children and adolescents of different ages and genders. Correlation analysis showed that when age＜5 years old, body weight<18.0 kg and head circumference<51.0 cm, DC was significantly positively correlated with age, body weight and head circumference (r=0.663, 0.454 and 0.474, respectively). On the contrary, when age≥5 years old, body weight≥18.0 kg and head circumference≥51.0 cm, DC did not change significantly and gradually stabilized at 107. Conclusions：The study constructed the percentile curve of DC in children and adolescents aged 1 to 16 years old. When the age was ＜5 years old, the DC increased with age, and when the age was ≥5 years old, the DC gradually stabilized at 107.

Key words: Children and adolescents, Disturbance coefficient, Reference value, Percentile curve, GAMLSS