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目的:探讨2岁及以下儿童原发性肠套叠非手术复位失败的危险因素及预测模型构建。方法:收集2021年6月至2022年6月于武汉儿童医院确诊并行非手术复位的2岁及以下的肠套叠住院患儿281例的临床资料，其中男195例，女86例，年龄为（16.46±10.97）个月。根据灌肠复位结果将其分为成功组234例和失败组47例。分析人口统计学、临床表现、实验室检查、超声征象及灌肠复位方式等临床数据资料。对两组数据行独立样本 t检验、 χ2检验、Mann-Whitney U检验等单因素分析，将两组比较差异有统计学意义的指标作为自变量纳入多因素二元logistic回归分析，筛选出肠套叠患儿非手术复位失败的危险因素，构建列线图预测模型，绘制受试者工作特征曲线（receiver operating characteristic curve，ROC），以曲线下面积（area under the curve，AUC）进行效能评价，并运用验证集数据对模型进行验证。 结果:单因素分析结果显示，失败组患儿中年龄<1岁、病程≥48 h、呕吐、血便、腹胀、发热、包块位于左侧腹、腹腔积液、肠壁血流信号异常、水灌肠复位比例和C反应蛋白水平、套入长度均高于成功组，血红蛋白、血钠水平均低于成功组，差异均有统计学意义（均 P<0.05）。二元logistic回归分析结果显示，年龄<1岁（ OR=27.70，95% CI：6.06~126.62）、呕吐（ OR=0.05，95% CI：0.01~0.28）、腹胀（ OR=0.11，95% CI：0.02~0.70）、血红蛋白降低（ OR=1.06，95% CI：1.01~1.10）、包块位于左侧腹（ OR=0.04，95% CI：0.01~0.20）和套入长度长（ OR=0.49，95% CI：0.32~0.76）是肠套叠患儿非手术复位失败的危险因素（均 P<0.05）。预测模型预测肠套叠患儿非手术复位失败的ROC曲线的AUC为0.975（95% CI：0.957~0.995， P<0.001），灵敏度为94.9%，特异度为87.2%；验证集中预测模型预测肠套叠患儿非手术复位失败的ROC曲线AUC为0.966（95% CI：0.937~0.995， P<0.001），灵敏度为90.0%，特异度为95.7%。 结论:年龄<1岁、呕吐、腹胀、血红蛋白降低、包块位置位于左侧腹、套入长度是2岁及以下肠套叠非手术复位失败的危险因素。建立的列线图模型显示出良好的预测能力。

Objective:To explore the risk factors for nonsurgical reduction failure and to construct a clinical prediction model in children with intussusception.Methods:From June 2021 to June 2022, retrospective analysis was performed for 281 hospitalized children with intussusception aged 2 years and below undergoing nonsurgical reduction. There were 195 boys and 86 girls with a mean age of (16.46±10.97) months. Based upon the results of enema reduction, they were assigned into two groups of success (n=234) and failure (n=47). Demographic profiles, clinical manifestations, laboratory tests, ultrasonic signs and enema reduction modes were recorded. The clinical data of two groups were statistically analyzed with one-way analysis of independent sample t, chi-square and Mann-Whitney U tests. Parameters with statistically significant inter-group differences were included as variables for multivariate logistic regression analysis to screen out the risk factors of nonsurgical reduction failure. And a nomogram was constructed for establishing a prediction model. The validation dataset was utilized for validating the model. Receiver operating characteristic (ROC) curve for predicting nonsurgical reduction failure by the prediction model was plotted and area under the ROC curve (AUC) calculated. Results:Univariate analysis indicated that proportion of age, duration of symptoms, vomiting, hematochezia, abdominal distension, fever, location of mass, peritoneal fluid, abnormal blood flow signal on ultrasonic scans, proportion of enema reduction, level of C-reactive protein (CRP) and length of intestinal invagination were all higher in failure group than those in success group while the levels of hemoglobin (Hb) and sodium (Na) were lower than those in success group (all P<0.05). Binary logistic regression analysis showed that age under 1 year ( OR=27.70, 95% CI: 6.06-126.62), vomiting ( OR=0.05, 95% CI: 0.01-0.28), abdominal distension ( OR=0.11, 95% CI: 0.02-0.70), lower Hb ( OR=1.06, 95% CI: 1.01-1.10), left-sided mass ( OR=0.04, 95% CI: 0.01-0.20) and longer intestinal invagination ( OR=0.49, 95% CI: 0.32-0.76) were risk factors for nonsurgical reduction failure (all P<0.05). AUC of ROC curve of the prediction model for nonsurgical reduction failure was 0.975 (95% CI: 0.957-0.995, P<0.001) with a sensitivity of 94.9% and a specificity of 87.2%. AUC of ROC curve predicting nonsurgical reduction failure in tvalidated concentrated prediction model was 0.966 (95% CI: 0.937-0.995, P<0.001) with a sensitivity of 90.0% and a specificity of 95.7%. Conclusion:Age <1 year, vomiting, abdominal distension, lower Hb, left-sided mass and longer intestinal invagination are risk factors for failed nonsurgical reduction of intussusception in children aged 2 years and below. And the established nomogram model has demonstrated decent predictive capability.