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乙型肝炎肝硬化门静脉高压患者经颈静脉肝内门体分流术后显性肝性脑病风险预测模型的构建

王澜静 秦建平 姚欣 其七 刘林 汤善宏

引用本文:
Citation:

乙型肝炎肝硬化门静脉高压患者经颈静脉肝内门体分流术后显性肝性脑病风险预测模型的构建

DOI: 10.12449/JCH240613
基金项目: 

四川省中医药管理局项目 (2023MS458)

伦理学声明: 本研究方案于2014年4月30日经由西部战区总医院(原成都军区总医院)伦理委员会审核,批号:2014科研03。患者及其家属均充分知情并签署手术同意书。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:王澜静负责拟定写作思路,数据收集,统计分析,绘制图表,论文撰写及修改;秦建平负责拟定写作思路,指导撰写文章及论文修改;姚欣负责指导撰写文章及论文修改;其七负责数据收集;刘林负责指导论文修改;汤善宏负责指导撰写文章,论文修改及最后定稿。
详细信息
    通信作者:

    汤善宏, tangshanhong@swjtu.edu.cn (ORCID: 0000-0001-6652-2942)

Construction of a risk prediction model for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with hepatitis B cirrhosis and portal hypertension

Research funding: 

Project of Sichuan Provincial Administration of Traditional Chinese Medicine (2023MS458)

More Information
  • 摘要:   目的  探索乙型肝炎肝硬化患者经颈静脉肝内门体分流术(TIPS)术后显性肝性脑病(OHE)的影响因素,并构建个体化风险预测模型。  方法  选取2017年1月—2021年12月于西部战区总医院消化内科行TIPS治疗的乙型肝炎肝硬化患者302例,按术后是否发生OHE分为无OHE组(237例)和OHE组(65例)。比较两组患者术前的一般资料、实验室检查指标、CTP评分、MELD-Na评分及ALBI评分等。计量资料的两组间比较采用成组t检验或Mann-Whitney U检验,计数资料两组间比较采用χ2检验。采用单因素及多因素Logistic回归分析筛选乙型肝炎肝硬化患者TIPS术后OHE的影响因素,应用独立影响因素构建Nomogram模型,受试者工作特征曲线(ROC曲线)及校准曲线评价模型的区分度及校准度,决策曲线及临床影响曲线评估模型的临床有效性。  结果  年龄(OR=1.035,95%CI:1.004~1.066)、WBC/PLT(OR=33.725,95%CI:1.220~932.377)、INR(OR=5.149,95%CI:1.052~25.207)、前白蛋白(OR=0.992,95%CI:0.983~1.000)是乙型肝炎肝硬化患者TIPS术后OHE发生的独立预测因素(P值均<0.05)。基于年龄、WBC/PLT、INR、前白蛋白构建的Nomogram模型ROC曲线下面积为0.716(95%CI:0.649~0.781),敏感度为78.5%,特异度为56.1%。  结论  基于年龄、WBC/PLT、INR、PAB建立Nomogram模型,有助于临床预测乙型肝炎肝硬化患者TIPS术后OHE发生风险。

     

  • 图  1  Nomogram模型

    Figure  1.  The Nomogram model

    图  2  Nomogram模型、CTP评分、ALBI评分及MELD-Na评分的ROC曲线

    Figure  2.  The ROC curves of Nomogram model, CTP, ALBI and MELD-Na scores

    图  3  Nomogram模型的校准曲线

    Figure  3.  The calibration curve of Nomogram model

    图  4  Nomogram模型的DCA

    Figure  4.  The DCA curve of Nomogram model

    图  5  Nomogram模型的CIC

    Figure  5.  The CIC curve of Nomogram model

    表  1  2组患者一般资料比较

    Table  1.   General data of patients

    指标 非OHE组(n=237) OHE组(n=65) 统计值 P
    年龄(岁) 45.00(40.00~53.50) 48.00(45.00~55.50) Z=-2.348 0.019
    性别[例(%)] χ2=1.706 0.220
    187(78.90) 56(86.15)
    50(21.10) 9(13.85)
    WBC/PLT 0.06(0.04~0.09) 0.07(0.05~0.11) Z=-2.614 0.009
    血红蛋白(g/L) 80.00(69.50~97.50) 85.00(68.50~100.50) Z=-0.702 0.483
    INR 1.24(1.13~1.39) 1.33(1.20~1.46) Z=-3.805 <0.001
    前白蛋白(mg/L) 99.60(77.35~135.25) 81.90(57.10~109.75) Z=-3.562 <0.001
    总胆红素(μmmol/L) 25.00(16.69~36.42) 28.90(17.10~37.35) Z=-0.973 0.330
    直接胆红素(μmmol/L) 8.90(6.03~12.97) 9.80(6.00~13.75) Z=-0.662 0.508
    间接胆红素(μmmol/L) 15.70(10.47~22.66) 16.70(10.70~23.50) Z=-0.808 0.419
    谷丙转氨酶(U/L) 27.70(20.15~40.40) 38.60(25.45~55.75) Z=-3.606 <0.001
    谷草转氨酶(U/L) 37.30(31.10~56.15) 49.10(35.60~66.95) Z=-2.927 0.003
    尿素(mmol/L) 5.22(3.94~7.10) 5.40(4.20~7.09) Z=-0.773 0.440
    血清肌酐(μmmol/L) 70.00(55.70~80.40) 65.10(55.35~83.70) Z=-0.649 0.517
    血清钠(mmol/L) 138.30(136.00~140.10) 137.50(135.00~139.80) Z=-1.779 0.075
    甲胎蛋白(ng/mL) 3.81(2.40~16.08) 5.58(2.60~16.08) Z=-1.501 0.133
    MELD评分(分) 7.97(5.39~10.44) 8.89(5.76~11.11) Z=-1.445 0.149
    CTP评分(分) 6(5~7) 7(6~8) Z=-3.150 0.002
    MELD-Na评分(分) 9.50(5.76~12.60) 12.01(7.19~14.71) Z=-2.327 0.020
    ALBI评分(分) -0.76±0.60 -0.46±0.62 t=-3.627 <0.001
    腹水[例(%)] χ2=4.481 0.044
    无或少量 151(63.71) 32(49.23)
    中或大量 86(36.29) 33(50.77)
    胸水[例(%)] χ2=0.123 0.847
    200(84.39) 56(86.15)
    37(15.61) 9(13.85)
    急诊手术[例(%)] χ2=0.030 0.851
    199(83.97) 54(83.08)
    38(16.03) 11(16.92)
    下载: 导出CSV

    表  2  单因素Logistic 回归分析

    Table  2.   Univariate logistic regression analyses

    指标 B SE Wald OR(95%CI P
    年龄(岁) 0.028 0.014 4.087 1.029(1.001~1.057) 0.043
    WBC/PLT 4.411 1.707 6.674 82.313(2.899~2 336.962) 0.010
    INR 2.242 0.708 10.019 9.410(2.348~37.712) 0.002
    前白蛋白(mg/L) -0.013 0.004 12.188 0.987(0.979~0.994) <0.001
    谷丙转氨酶(U/L) 0.003 0.002 1.869 1.003(0.999~1.008) 0.172
    谷草转氨酶(U/L) 0.004 0.003 2.129 1.004(0.999~1.010) 0.145
    血清钠(mmol/L) -0.084 0.037 5.190 0.919(0.855~0.988) 0.023
    腹水 0.594 0.282 4.417 1.811(1.041~3.150) 0.036
    CTP评分(分) 0.273 0.082 11.140 1.314(1.119~1.542) <0.001
    MELD-Na评分(分) 0.069 0.028 6.110 1.071(1.014~1.131) 0.013
    ALBI评分(分) 0.852 0.245 12.075 2.343(1.450~3.788) <0.001
    下载: 导出CSV

    表  3  多因素Logistic 回归分析

    Table  3.   Multivariate logistic regression analyses

    指标 B SE Wald OR(95%CI P
    年龄(岁) 0.034 0.015 4.881 1.035(1.004~1.066) 0.027
    WBC/PLT 3.518 1.694 4.315 33.725(1.220~932.377) 0.038
    INR 1.639 0.810 4.090 5.149(1.052~25.207) 0.043
    前白蛋白(mg/L) -0.008 0.004 3.893 0.992(0.983~1.000) 0.048
    血清钠(mmol/L) -0.054 0.040 1.806 0.947(0.876~1.025) 0.179
    腹水(中或大量) 0.160 0.319 0.251 1.173(0.628~2.194) 0.616
    下载: 导出CSV

    表  4  Nomogram模型、CTP评分、ALBI评分及MELD-Na评分对TIPS术后OHE的预测价值

    Table  4.   The predictive value of Nomogram model, CTP, ALBI and MELD-Na scores for OHE occurrence after TIPS

    指标 AUC OR(95%CI cut-off 特异度(%) 敏感度(%) 约登指数 P
    Nomogram模型 0.716 0.649~0.781 0.190 56.1 78.5 0.346 <0.001
    CTP评分 0.626 0.548~0.703 7.500 78.5 43.1 0.216 0.002
    ALBI评分 0.633 0.556~0.710 -0.575 62.9 60.0 0.229 0.001
    MELD-Na评分 0.594 0.513~0.675 11.955 69.6 52.3 0.219 0.020
    下载: 导出CSV
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