肾病综合征患儿焦虑抑郁症的风险预测模型构建-现代医学

肾病综合征患儿焦虑抑郁症的风险预测模型构建

单位：南京医科大学附属儿童医院肾内科, 江苏南京 210000

分类号：R725

出版年·卷·期（页码）：2026·54·第二期（219-227）

摘要：

目的： 探讨肾病综合征患儿发生焦虑抑郁症的风险因素并建立预测模型。方法： 采用回顾性分析，纳入2023年9月至2025年1月在本院确诊为肾病综合征的患儿280例。采用儿童中文版医院焦虑抑郁量表评估患儿焦虑抑郁症状，收集患儿的社会人口学、疾病和实验室资料变量；采用多因素Logistic回归分析患儿发生焦虑和抑郁的危险因素并建立预测模型。绘制受试者工作特征(ROC)曲线评估模型的预测价值。结果： 肾病综合征患儿中焦虑和抑郁阳性率分别为33.2%和40.7%。Logistic回归分析显示心率≥93次·min^-1(OR=3.029，95%CI 1.977～4.641)和激素抵抗(OR=3.519，95%CI 1.883～6.578)是患儿焦虑的危险因素(均P＜0.001)；疾病持续时间(OR=2.094，95%CI 1.276～3.436)、复发次数(OR=2.278，95%CI 1.217～4.263)、复杂性激素依赖(OR=3.944，95%CI 2.497～6.230)及大量尿蛋白(OR=5.255，95%CI 2.472～11.171)是患儿抑郁的危险因素(均P＜0.001)。焦虑和抑郁预测模型的ROC曲线下面积分别为0.902和0.911，预测准确率分别为85.3%和86.8%。结论： 儿童肾病综合征焦虑与抑郁的发生率较高；本研究预测模型有助于临床工作人员对高危患儿做出准确的区分，开展有针对性的护理措施，改善肾病综合征患儿的心理健康和临床结局。

Objective: To explore the risk factors of anxiety and depression in children with nephrotic syndrome and to establish risk prediction models. Methods: A retrospective study was conducted including 280 children diagnosed with nephrotic syndrome at our hospital between September 2023 and January 2025. Anxiety and depressive symptoms were assessed using the Chinese version of the Hospital Anxiety and Depression Scale for children. Sociodemographic characteristics, disease-related variables, and laboratory indicators were collected. Multivariate Logistic regression analysis was performed to identify risk factors for anxiety and depression and to construct prediction models. Draw the receiver operating characteristic(ROC) curve to evaluate the predictive value of the model. Results: The positive rates of anxiety and depression among children with nephrotic syndrome were 33.2% and 40.7%, respectively. Multivariate Logistic regression analysis showed that heart rate ≥93 beats·min^-1(OR=3.029,95%CI 1.977-4.641) and steroid resistance(OR=3.519,95%CI 1.883-6.578) were risk factors of anxiety(all P＜0.001). Disease duration(OR=2.094,95%CI 1.276-3.436), frequency of relapse(OR=2.278,95%CI 1.217-4.263), Complex hormone dependence(OR=3.944,95%CI 2.497-6.230), and massive proteinuria(OR=5.255,95%CI 2.472-11.171) were risk factors of depression(all P＜0.001). The areas under ROC curves for the anxiety and depression prediction models were 0.902 and 0.911, respectively, with prediction accuracies of 85.3% and 86.8%. Conclusion: Anxiety and depression are common in children with nephrotic syndrome. The predictive model has a good predictive value for both anxiety and depression, which would help clinical nurses to make intuitive assessment for risk patients.

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