恶性肿瘤患儿化疗后医院感染发生风险预测模型的构建及验证

doi:10.3761/j.issn.1672-9234.2025.06.018

摘要/Abstract

摘要：

目的分析恶性肿瘤患儿化疗后发生医院感染的危险因素，构建风险预测模型，并验证其预测效果。方法采用回顾性研究设计，便利选取2023年6月—2024年5月在郑州市某三级甲等医院住院的恶性肿瘤化疗的320例患儿为建模组，通过电子病历系统收集资料。采用前瞻性研究设计于2024年6月—2024年11月选取140例恶性肿瘤化疗患儿为验证组。通过Logistic回归分析筛选发生医院感染的危险因素，应用R4.3.3软件构建列线图预测模型，并进行验证。结果 Logistic回归分析结果显示，住院时间≥11 d、有侵袭性操作、白细胞计数≤4×10⁹/L、中性粒细胞计数≤2×10⁹/L、血清白蛋白<35 g/L是恶性肿瘤患儿化疗后发生医院感染的危险因素（P<0.05）。Hosmer-Lemeshow检验结果显示P=0.943，受试者操作特征曲线下面积为0.868，最佳临界值为0.400，灵敏度为0.902，特异度为0.697。模型验证结果显示，受试者操作特征曲线下面积为0.873，反映出风险预测模型拟合效果良好。结论该研究构建的风险预测模型具有良好的区分度与准确度，为临床医护人员预测恶性肿瘤患儿化疗后发生医院感染风险、尽早制订个体化的防控策略提供参考。

关键词: 儿童, 恶性肿瘤, 化学疗法, 医院感染, 预测模型

Abstract:

Objective To explore the influencing factors of nosocomial infection in children with malignant tumor after chemotherapy，and to develop a nomogram model to predict these risks. Methods A retrospective study design was adopted. A total of 320 children undergoing chemotherapy for malignant tumors were conveniently selected as the modeling group between June 2023 and May 2024 in a tertiary A hospital in Zhengzhou. Data were collected through the electronic medical record system. Then，a prospective study design was used to select 140 children with malignant tumors undergoing chemotherapy from June 2024 to November 2024 as the validation group. Logistic regression analysis was used to determine the risk factors of nosocomial infection. A nomogram was developed by R4.3.3 software and validated to predict the risk of nosocomial infection in children with malignant tumor after chemotherapy. Results Logistic regression analysis showed that hospital stays≥11 d，white blood cell count≤4 × 10⁹/L，neutrophil count≤2 × 10⁹/L，serum albumin<35 g/L were independent risk factors of nosocomial infection in children with malignant tumor after chemotherapy（P<0.05）. The Hosmer-Lemeshow test of the model was P=0.943，the area under the ROC curve was 0.868，the best cutoff value was 0.400，the sensitivity was 0.902，the specificity was 0.697. The model validation results showed that the area under the ROC curve was 0.873，reflecting a good fitting effect of the risk prediction model. Conclusion The risk prediction model constructed in this study has good discrimination and accuracy. It can be used to predict the risk of nosocomial infection in children with malignant tumor after chemotherapy，providing the reference for management and preventative intervention strategies for high-risk children.

Key words: Children, Malignant neoplasms, Chemotherapy, Nosocomial infection, Prediction model

王慧萍, 高峰, 徐晖, 向明丽. 恶性肿瘤患儿化疗后医院感染发生风险预测模型的构建及验证[J]. 中华护理教育, 2025, 22(6): 751-757.

WANG Huiping, GAO Feng, XU Hui, XIANG Mingli. Construction and validation of a risk prediction model for nosocomial infection in children with malignant tumor after chemotherapy[J]. Chinese Journal of Nursing Education, 2025, 22(6): 751-757.

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