超声评分与血清SDC-1、ANGPTL-4联合预测NRDS预后的价值分析-东南大学学报医学版

超声评分与血清SDC-1、ANGPTL-4联合预测NRDS预后的价值分析

单位：乐山市人民医院超声医学科, 四川乐山 614000

关键词：新生儿呼吸窘迫综合征超声评分多配体蛋白聚糖-1 血管生成素样蛋白-4 预后

分类号：R445.1

出版年·卷·期（页码）：2026·45·第四期（602-611）

摘要：

目的:探讨基于超声评分、血清多配体蛋白聚糖-1(SDC-1)、血管生成素样蛋白-4(ANGPTL-4)构建模型预测新生儿呼吸窘迫综合征(NRDS)预后的价值。方法:前瞻性选取2023年1月至2024年12月乐山市人民医院收治的283例NRDS患儿(建模集),根据治疗后30 d情况分为预后不良组(n=62)和预后良好组(n=221)。比较两组一般资料、治疗前超声评分以及血清SDC-1、ANGPTL-4水平,分析NRDS患儿预后不良的影响因素,应用超声评分、SDC-1、ANGPTL-4构建Logistic回归方程(LR)模型,分析LR模型预测NRDS患儿预后不良的价值。按照7:3比例,另选2025年1月至10月乐山市人民医院收治的121例NRDS患儿,对LR模型进行时间分组样本验证。结果:预后不良组治疗前超声评分和血清SDC-1、ANGPTL-4、C-反应蛋白(CRP)水平高于预后良好组,胎龄、治疗前新生儿危重评分(NCIS)低于预后良好组(P＜0.05);超声评分、SDC-1、ANGPTL-4、胎龄、NCIS、血清CRP均为NRDS患儿预后不良的独立影响因素(P＜0.05),校正胎龄、NCIS、血清CRP后,超声评分、SDC-1、ANGPTL-4仍为NRDS患儿预后不良的独立影响因素(P＜0.05);LR模型预测NRDS患儿预后不良的曲线下面积(AUC)为0.920(95%CI:0.883~0.949);LR模型的精确度-召回率曲线下面积(PR-AUC)为0.810;LR模型的预测结果与实际结果贴合度Dxy值为0.841,Hosmer-Lemeshow检验显示P=0.723;LR模型在阈值概率区间为0.21~0.87时可获得明显正向净获益;时间分组样本验证显示,LR模型预测NRDS患儿预后不良的AUC为0.913(95%CI:0.851~0.957),PR-AUC为0.789,预测结果与实际结果贴合度Dxy值为0.838,Hosmer-Lemeshow检验显示P=0.710,LR模型在阈值概率区间为0.23~0.86时可获得明显正向净获益。结论:超声评分与血清SDC-1、ANGPTL-4联合对NRDS患儿预后有较好预测价值。

Objective: To explore the predictive value of a model combining lung ultrasound score, serum syndecan-1(SDC-1) and angiopoietin-like protein-4(ANGPTL-4) for the prognosis of neonatal respiratory distress syndrome(NRDS). Methods: A total of 283 neonates diagnosed with NRDS admitted to Leshan People's Hospital between January 2023 and December 2024 were prospectively recruited as the modeling cohort. All subjects were stratified into a poor prognosis group(n=62) and a favorable prognosis group(n=221) based on clinical outcomes at 30 days after treatment. Baseline clinical data, pretreatment lung ultrasound scores, and serum levels of SDC-1 and ANGPTL-4 were compared between the two groups. Multivariate analysis was performed to identify independent risk factors for adverse prognosis in NRDS neonates. A Logistic regression(LR) predictive model was established incorporating lung ultrasound score, serum SDC-1 and ANGPTL-4, and its predictive performance for poor prognosis was evaluated. An additional 121 NRDS neonates hospitalized from January 2025 to October 2025 were enrolled as the temporal validation cohort following a 7:3 splitting ratio to externally verify the LR model. Results: Compared with the favorable prognosis group, the poor prognosis group exhibited significantly higher pretreatment lung ultrasound scores, serum SDC-1, ANGPTL-4 and C-reactive protein(CRP) levels, as well as lower gestational age and neonatal critical illness score(NCIS)(all P<0.05). Lung ultrasound score, serum SDC-1, ANGPTL-4, gestational age, NCIS and serum CRP were independent predictors of adverse prognosis in NRDS neonates(P<0.05). After adjusting for gestational age, NCIS and serum CRP, lung ultrasound score, serum SDC-1 and ANGPTL-4 still remained independent risk factors for poor prognosis(P<0.05). In the modeling cohort, the LR model yielded an area under the receiver operating characteristic curve(AUC) of 0.920(95%CI: 0.883-0.949) for predicting poor NRDS prognosis, with a precision-recall AUC(PR-AUC) of 0.810. The Dxy statistic for consistency between predicted and actual outcomes was 0.841, and the Hosmer-Lemeshow test suggested good model calibration(P=0.723). Decision curve analysis demonstrated that the model maintained favorable clinical net benefit within the risk threshold of 0.21-0.87. Temporal external validation confirmed stable performance: the LR model had an AUC of 0.913(95%CI: 0.851-0.957), PR-AUC of 0.789, Dxy of 0.838, and Hosmer-Lemeshow P=0.710, with positive clinical net benefit across the threshold range of 0.23-0.86. Conclusion: The combination of lung ultrasound score, serum SDC-1 and ANGPTL-4 possesses satisfactory predictive efficacy for adverse prognosis in neonates with NRDS.

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