儿童诺如病毒感染风险列线图模型的构建及验证

doi:10.19871/j.cnki.xfcrbzz.2025.05.009

摘要/Abstract

摘要： 目的通过临床症状和常规血生化指标建立儿童诺如病毒（norovirus, NoV）感染的风险列线图模型,并进行预测效能验证,为临床早期、快速进行NoV感染筛查提供参考依据。方法回顾性纳入2023年1月至2024年10月张家港市第三人民医院诊断急性病毒性胃肠炎患儿（3个月至16岁）共412例,以4∶1随机分为建模组330例与内部验证组82例。另选取2023年10月至2024年6月苏州大学附属儿童医院202例急性病毒性胃肠炎患儿（3个月至16岁）作为外部验证组。采用实时定量聚合酶链反应（real-time quantitative PCR, rq-PCR）确诊NoV感染,比较建模组NoV阳性与阴性患儿的临床症状及血生化指标,通过多因素Logistic回归筛选预测因子并构建列线图模型,采用受试者操作特征曲线评估模型在内部（82例）及外部验证组（202例）的预测效能。结果单因素比较发现,阳性患儿白细胞（white blood cell, WBC）计数、中性粒细胞（neutrophil, NE）与淋巴细胞（lymphocyte, LY）绝对值、血小板（platelet count, PLT）计数明显高于阴性患儿,呕吐、腹泻和上呼吸道感染症状增多,合并临床症状和治疗方式增多（P< 0.05）。多因素Logistic回归分析显示,呕吐（ OR = 1.859,95%CI = 1.325~2.253,P = 0.001 ）、上呼吸道感染（ OR = 1.234,95%CI = 1.052~1.564,P= 0.007）、WBC（ OR =2.325,95%CI=1.857~2.659,P<0.001）、LY≥3.42×109/L（OR = 1.425,95%CI=1.124~1.865,P=0.003）和 PLT（OR=3.023,95%CI=2.425~3.756,P< 0.001）是NoV感染的预测因子。基于上述因子构建的列线图模型总计220分,在内部验证组中预测NoV感染的曲线下面积（area under the curve, AUC）为 0.842（95%CI=0.768~0.899, P<0.001）, 敏感度78.9 %,特异度75.0%;在外部验证组中AUC为0.896（95%CI=0.845~0.943,P<0.001）,敏感度83.3%,特异度81.9%。结论根据急性病毒性胃肠炎患儿的临床症状和常规血生化建立的列线图模型诊断NoV感染有较好的应用潜力,辅助临床快速、针对性进行NoV筛查。

关键词: 诺如病毒, 急性病毒性胃肠炎, 危险因素, 列线图, 临床症状, 血生化指标

Abstract: Objective To establish the risk nomogram model for norovirus (NoV) infection in children through clinical symptoms and routine blood biochemical indicators, and verify the predictive efficacy, so as to provide a reference for early and rapid screening of NoV infection in clinical practice. Method A total of 412 children (3 months to 16 years old) diagnosed with acute viral gastroenteritis in the Third People's Hospital of Zhangjiagang City from January 2023 to October 2024 were retrospectively included as a training set, and were randomly divided into a modeling group (330 cases) and an internal validation group (82 cases) at a ratio of 4:1. In addition, 202 children with acute viral gastroenteritis from the Children's Hospital of Soochow University between October 2023 to June 2024 were selected as the external validation group. Real-time quantitative PCR (rq-PCR) was used to confirm NoV infection. The clinical symptoms and blood biochemical indicators were compared between NoV-positive and NoV-negative children in the modeling group. Multivariate Logistic regression was used to screen predictors and construct a nomogram model. The receiver operating characteristic curve was used to evaluate the predictive efficacy of the model in the internal validation group (n=82) and external validation group (n=202). Result Single-factor comparison showed that white blood cell count (WBC), absolute counts of neutrophils and lymphocytes (NE and LY), and platelet count (PLT) in positive children were significantly higher than those in negative children,vomiting, diarrhea, and upper respiratory tract infection symptoms were were more common, and clinical symptoms and treatment methods were more complicated as well, too(P<0.05). Multivariate logistic regression analysis showed that vomiting (OR=1.859, 95%CI=1.325-2.253, P=0.001), upper respiratory tract infection (OR=1.234, 95%CI=1.052-1.564, P=0.007), WBC (OR=2.325, 95%CI=1.857-2.659, P<0.001), LY ≥3.42×109/L (OR=1.425, 95%CI=1.124-1.865, P=0.003) and PLT (OR=3.023, 95%CI=2.425-3.756, P<0.001) were the predictive factors ot NoV infection. The nomogram model constructed based on the above factors had a total score of 220. In the internal validation group, the area under the curve (AUC) for predicting NoV infection was 0.842 (95%CI=0.768-0.899, P<0.001) with a sensitivity of 78.9% and specificity of 75.0%. In the external validation group, the AUC was 0.896 (95%CI=0.845-0.943, P<0.001) with a sensitivity of 83.3% and specificity of 81.9%. Conclusion The nomogram model established based on clinical symptoms and routine blood biochemistry of children with acute viral gastroenteritis shows good potential for diagnosing NoV infection, and can assist in rapid and accurate clinical screening of NoV.

Key words: Norovirus, Acute viral gastroenteritis, Risk factors, Nomogram, Clinical symptoms, Blood biochemical indicators

中图分类号:

R511
R725.1

施林燕, 孟蓓, 周敏萍. 儿童诺如病毒感染风险列线图模型的构建及验证[J]. 新发传染病电子杂志, 2025, 10(5): 47-52.

Shi Linyan, Meng Bei, Zhou Minping. Construction and verification of norovirus infection risk nomogram model in children[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(5): 47-52.

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