摘要
目的探索乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者住院期间新发显性肝性脑病(OHE)的影响因素,并构建个体化风险预测模型。方法选取福建医科大学孟超肝胆医院2016年12月-2020年12月收治的310例HBV-ACLF患者,按入院后是否发生OHE分为无肝性脑病组(n=236)、肝性脑病组(n=74)。比较两组患者的一般资料、实验室检查指标及终末期肝病模型(MELD)评分等,采用单因素及多因素logistic回归分析HBV-ACLF患者入院后新发OHE的影响因素;采用独立影响因素构建Nomogram模型,受试者工作特征(ROC)曲线及校准曲线评价模型的区分度及校准度,决策曲线分析法(DCA)评估模型的临床有效性。结果与无肝性脑病组比较,肝性脑病组的国际标准化比值[2.71(2.20,3.44)vs.1.98(1.70,2.55)]、谷丙转氨酶[987.50(450.50,1538.00)U/L vs.561.00(191.00,1090.50)U/L]、谷草转氨酶[830.00(257.75,1518.25)U/L vs.381.00(153.50,872.00)U/L]、血浆氨[71.75(57.75,109.50)μmol/L vs.57.00(41.80,79.60)μmol/L]、白细胞计数[7.93(6.43,9.74)×10^(9)/L vs.6.62(5.33,8.16)×10^(9)/L]、血红蛋白[136.50(126.25,151.50)g/L vs.126.00(115.00,143.00)g/L]及中晚期患者占比(56.8%vs.23.3%)均较高,差异有统计学意义(P<0.001),甲胎蛋白水平较低[56.33(23.61~139.03)ng/L vs.88.25(31.32~216.88)ng/L],差异有统计学意义(P=0.033)。多因素logistic回归分析结果显示,国际标准化比值(OR=2.56,95%CI 1.61~4.30,P<0.001)、年龄(OR=1.06,95%CI 1.02~1.10,P=0.003)、血浆氨(OR=1.02,95%CI 1.01~1.03,P=0.005)、白细胞计数(OR=1.24,95%CI 1.07~1.43,P=0.003)、血红蛋白(OR=1.03,95%CI 1.00~1.05,P=0.026)是HBV-ACLF患者出现新发OHE的独立影响因素。本研究建立的Nomogram模型的ROC曲线下面积(AUC)为0.848(95%CI 0.798~0.897),MELD模型的AUC为0.723(95%CI 0.654~0.793)。Nomogram模型与理想模型的最大偏倚(Emax)=0.143,最小偏倚(Eavg)=0.041,模型有良好的区分度,S:p=0.676>0.05,通过校准度检验,模型预测值与实际值结果的�
Objective To explore the factors influencing hospitalized new-onset overt hepatic encephalopathy(OHE)in hospitalized patients with hepatitis B-associated acute-on-chronic liver failure(HBV-ACLF),and to construct an individualized risk prediction model.Methods A total of 310 HBV-ACLF patients admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from December 2016 to December 2020 were selected,and divided into non-hepatic encephalopathy group(n=236),hepatic encephalopathy group(n=74)according to whether OHE occurred after admission.The general data,laboratory test indicators,and model of end-stage liver disease(MELD)scores were compared between the two groups;univariate and multivariate logistic regressions were used to analyze the factors influencing the hospitalized new-onset OHE in HBV-ACLF patients after admission.A nomogram model was constructed with the influencing factors.The receiver operating characteristic(ROC)curve and the calibration curve was used to evaluate the discrimination and calibration of the model,and decision curve analysis(DCA)was used to evaluate the clinical validity of the model.Results Compared with the non-hepatic encephalopathy group,the baseline international normalized ratio[2.71(2.20,3.44)vs.1.98(1.70,2.55)],serum alanine aminotransferase[987.50(450.50,1538.00)U/L vs.561.00(191.00,1090.50)U/L],blood aspartate aminotransferase[830.00(257.75,1518.25)U/L vs.381.00(153.50,872.00)U/L],plasma Ammonia[71.75(57.75,109.50)μmol/L vs.57.00(41.80,79.60)μmol/L],white blood cell count[7.93(6.43,9.74)×10^(9)/L vs.6.62(5.33,8.16)×10^(9)/L],hemoglobin[136.50(126.25,151.50)g/L vs.126.00(115.00,143.00)g/L],and the proportion of patients in intermediate and advanced stages(56.8%vs.23.3%)of the hepatic encephalopathy group were higher,the difference was statistically significant;the alpha-fetoprotein level was lower[56.33(23.61,139.03)ng/L vs.88.25(31.32,216.88)ng/L,P=0.033],the difference was statistically significant(P<0.001).The results of multivariate logistic regression ana
作者
林建辉
陈丽霞
蓝丽琴
谢文国
翁钘钘
许镇额
陈敏
俞晓玲
刘海钰
Lin Jian-Hui;Chen Li-Xia;Lan Li-Qin;Xie Wen-Guo;Weng Xing-Xing;Xu Zhen-E;Chen Min;Yu Xiao-Ling;Liu Hai-Yu(Department of Critical Care Medicine,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou,Fujian 350001,China;Department of Pharmacy,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou,Fujian 350001,China;Union Medical College of Fujian Medical University,Fuzhou,Fujian 350001,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2022年第12期1232-1240,共9页
Medical Journal of Chinese People's Liberation Army
基金
福建省自然科学基金(面上)项目(2021J011293)
北京肝胆相照公益基金会人工肝专项基金(RGGJJ-2021-006)。
