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预测两型肝包虫病肝切除术后并发症列线图的建立及评价

郭兵 庞明泉 许晓磊 韩军伟 王海久

郭兵,庞明泉,许晓磊,等. 预测两型肝包虫病肝切除术后并发症列线图的建立及评价[J]. 临床肝胆病杂志, 2021, 37(11): 2626-2631. DOI: 10.3969/j.issn.1001-5256.2021.11.027
引用本文: 郭兵,庞明泉,许晓磊,等. 预测两型肝包虫病肝切除术后并发症列线图的建立及评价[J]. 临床肝胆病杂志, 2021, 37(11): 2626-2631. DOI: 10.3969/j.issn.1001-5256.2021.11.027
GUO B, PANG MQ, XU XL, et al. Establishment and evaluation of a nomogram for predicting post-hepatectomy complications in two types of hepatic echinococcosis[J]. J Clin Hepatol, 2021, 37(11): 2626-2631. DOI: 10.3969/j.issn.1001-5256.2021.11.027
Citation: GUO B, PANG MQ, XU XL, et al. Establishment and evaluation of a nomogram for predicting post-hepatectomy complications in two types of hepatic echinococcosis[J]. J Clin Hepatol, 2021, 37(11): 2626-2631. DOI: 10.3969/j.issn.1001-5256.2021.11.027

预测两型肝包虫病肝切除术后并发症列线图的建立及评价

DOI: 10.3969/j.issn.1001-5256.2021.11.027
基金项目: 

国家重点研发计划项目 2017YFC0909900

青海省科技厅项目 2020-ZJ-Y01

2018年青海省卫生系统指导性计划课题 2018-wjzdx-118

详细信息
    通讯作者:

    王海久,wanghaijiuqy@126.com

  • 中图分类号: R657.3; R532.32

Establishment and evaluation of a nomogram for predicting post-hepatectomy complications in two types of hepatic echinococcosis

Research funding: 

National Key Research and Development Program 2017YFC0909900

Qinghai Science and Technology Department Project 2020-ZJ-Y01

2018 Qinghai Province Health System Guiding Plan Project 2018-wjzdx-118

  • 摘要:   目的  通过分析两型肝包虫病肝切除术后并发症(PHC)的相关危险因素,建立预测肝包虫病PHC发生风险的列线图,并评价其临床使用价值。  方法  收集青海大学附属医院2015年1月—2020年8月收治的263例两型肝包虫病行肝切除手术患者的临床资料,并进行回顾性分析,263例患者中PHC组93例,对照组170例。非正态分布的计量资料2组间比较采用Mann-Whitney U秩和检验,正态性计量资料2组间比较采用独立样本t检验;计数资料2组间比较采用χ2检验和Fisher确切概率法。通过单因素和多因素logistic回归筛选出两型肝包虫病PHC的独立危险因素。根据独立危险因素所占权重,构建列线图预测风险模型。采用Bootstrap重采样法进行模型的内部验证、构建受试者工作特征曲线对模型的区分度进行评价、使用校准曲线和Hosmer-Lemeshow检验对模型的一致性进行评价、绘制临床决策曲线分析(DCA) 验证模型的临床有效性。  结果  ALBI评分(OR=3.694, 95%CI:1.860~7.336)、手术时间(OR=2.848,95%CI:1.384~5.859)、术中出血量(OR=4.832, 95%CI: 2.384~9.793)、包虫直径(OR=3.073,95%CI: 1.528~6.177)是两型肝包虫发生PHC的独立危险因素(P值均<0.05)。基于上述4个独立危险因素所占权重构建列线图风险预测模型,模型的受试者工作特征曲线下面积为0.877(95%CI:0.831~0.923);Bootstrap重采样法进行内部验证的一致性指数(C-index)为0.871,表明模型的区分度良好。校准曲线观测值和实际值贴合,Hosmer-Lemeshow检验(P=0.905)均显示列线图风险预测模型的预测值与实际观测值一致性良好。当阈概率为35.6%时,DCA显示的临床净获益为22%;在8%~89%阈概率区间内有较好的临床适用性。  结论  ALBI评分、手术时间、术中出血量、包虫直径是两型肝包虫病患者发生PHC的独立危险因素,以此为基础构建的列线图风险预测模型具有较好的准确度、一致性及临床实用性。

     

  • 图  1  预测两型肝包虫病PHC发生风险的列线图

    图  2  预测模型的ROC曲线

    图  3  预测模型的校准图

    图  4  预测模型的决策曲线分析

    注:黑色横线表示患者术后均无并发症且无治疗措施,灰色斜线表示患者术后均有并发症且给予治疗。阈值在8%~89%区间内,患者受益曲线(黑色虚线)高于两条异常曲线(黑色横线和灰色斜线)。

    表  1  两型肝包虫病PHC组和对照组资料比较

    指标 对照组(n=170) PHC组(n=93) 统计值 P
    年龄(岁) 37.04±13.11 38.73±12.98 t=-1.003 0.317
    BMI(kg/m2) 21.61±4.31 21.39±3.36 t=0.427 0.670
    APRI 0.23(0.19~0.38) 0.27(0.17~0.49) Z=-0.837 0.403
    ALBI评分 -2.66(-2.91~-2.39) -2.31(-2.66~-1.87) Z=-5.333 <0.001
    手术时间(min) 250(210~286) 330(287~402) Z=-8.120 <0.001
    术中出血量(mL) 400(200~800) 1400(900~2100) Z=-9.310 <0.001
    包虫直径(cm) 8.50(6.43~11.07) 11.98(10.02~14.24) Z=-7.227 <0.001
    切除段数(例) χ2=38.941 <0.001
      <3 79 8
      ≥3 91 85
    切除部位(例) 0.746
      非肝中叶切除 164 89
      肝中叶切除 6 4
    胆道介入(例) χ2=39.866 <0.001
      否 167 68
      是 3 25
    乙型肝炎(例) χ2=0.782 0.377
      否 139 80
      是 31 13
    手术方式(例) 0.103
      开腹肝切除 160 92
      腹腔镜肝切除 10 1
    阻断方式(例) χ2=0.637 0.425
      Pringle阻断 79 48
      区域阻断 91 45
    下载: 导出CSV

    表  2  两型肝包虫病PHC的单因素logistic回归分析结果

    指标 β 标准误 Wald值 OR 95%CI P
    年龄 0.010 0.010 1.006 1.010 0.991~1.030 0.316
    BMI -0.014 0.033 0.183 0.986 0.925~1.051 0.669
    APRI 0.471 0.257 3.369 1.602 0.969~2.651 0.066
    ALBI 2.093 0.292 51.210 8.108 4.571~14.383 <0.001
    手术时间 2.087 0.302 47.786 8.058 6.898~23.144 <0.001
    术中出血量 2.536 0.309 67.463 12.635 6.898~23.144 <0.001
    包虫直径 2.076 0.297 48.839 7.969 4.453~14.264 <0.001
    切除段数 2.222 0.401 30.773 9.224 4.207~20.222 <0.001
    切除部位 0.206 0.659 0.098 1.228 0.338~4.468 0.755
    胆道介入 3.019 0.628 23.127 20.466 5.980~70.039 <0.001
    乙型肝炎 -0.317 0.359 0.778 0.729 0.361~1.473 0.378
    手术方式 -1.749 1.057 2.739 0.174 0.022~1.380 0.098
    阻断方式 -0.206 0.258 0.636 0.814 0.491~1.350 0.425
    下载: 导出CSV

    表  3  两型肝包虫病PHC的多因素logistic回归分析结果

    指标 β 标准误 Wald值 OR 95%CI P
    ALBI 1.307 0.350 13.939 3.694 1.860~7.336 <0.001
    手术时间 1.046 0.368 8.082 2.848 1.384~5.859 0.004
    术中出血量 1.575 0.360 19.103 4.832 2.384~9.793 <0.001
    包虫直径 1.123 0.356 9.928 3.073 1.528~6.177 0.002
    常量 -3.122 0.367 72.444 0.044 <0.001
    下载: 导出CSV
  • [1] MA L, CHEN DC, ZOU SY, et al. Epidemiological characteristics of hepatic echinococcosis, concurrent cerebral echinococcosis, and pulmonary echinococcosis in Ganzi County, Sichuan Province, China[J]. Medicine (Baltimore), 2020, 99(15): e19753. DOI: 10.1097/MD.0000000000019753.
    [2] MCMANUS DP, GRAY DJ, ZHANG W, et al. Diagnosis, treatment, and management of echinococcosis[J]. BMJ, 2012, 344: e3866. DOI: 10.1136/bmj.e3866.
    [3] CEHN L, LI Y. The risk factors and prediction systems for posthepatectomy complications[J]. J Clin Hepatol, 2019, 35(1): 217-221. DOI: 10.3969/j.issn.1001-5256.2019.01.048.

    陈龙, 李钺. 肝切除术后并发症的危险因素及预测评分系统[J]. 临床肝胆病杂志, 2019, 35(1): 217-221. DOI: 10.3969/j.issn.1001-5256.2019.01.048.
    [4] KOCH M, GARDEN OJ, PADBURY R, et al. Bile leakage after hepatobiliary and pancreatic surgery: A definition and grading of severity by the International Study Group of Liver Surgery[J]. Surgery, 2011, 149(5): 680-688. DOI: 10.1016/j.surg.2010.12.002.
    [5] RAHBARI NN, GARDEN OJ, PADBURY R, et al. Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS)[J]. Surgery, 2011, 149(5): 713-724. DOI: 10.1016/j.surg.2010.10.001.
    [6] RAHBARI NN, GARDEN OJ, PADBURY R, et al. Post-hepatectomy haemorrhage: A definition and grading by the International Study Group of Liver Surgery (ISGLS)[J]. HPB (Oxford), 2011, 13(8): 528-535. DOI: 10.1111/j.1477-2574.2011.00319.x.
    [7] National Health commission of the People's Republic of China. Diagnostic criteria for nosocomial infections(proposed)[J]. Natl Med J China, 2001, 81(5): 314-320. DOI: 10.3760/j:issn:0376-2491.2001.05.027.

    中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志, 2001, 81(5): 314-320. DOI: 10.3760/j:issn:0376-2491.2001.05.027.
    [8] BELLOMO R, RONCO C, KELLUM JA, et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group[J]. Crit Care, 2004, 8(4): R204-R212. DOI: 10.1186/cc2872.
    [9] Chinese Doctor Association, Chinese College of Surgeons (CCS), Chinese Committee for Hadytidology (CCH). Expert consensus on diagnosis and treatment of hepatic cystic and alveolar echinococcosis (2019 edition)[J]. Chin J Dig Surg, 2019, 18(8): 711-721. DOI: 10.3760/cma.j.issn.1673-9752.2019.08.002.

    中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18(8): 711-721. DOI: 10.3760/cma.j.issn.1673-9752.2019.08.002.
    [10] YANG X, QIU Y, WANG W, et al. Risk factors and a simple model for predicting bile leakage after radical hepatectomy in patients with hepatic alveolar echinococcosis[J]. Medicine (Baltimore), 2017, 96(46): e8774. DOI: 10.1097/MD.0000000000008774.
    [11] NAKAGAWA K, TANAKA K, NOJIRI K, et al. Predictive factors for bile leakage after hepatectomy for hepatic tumors: A retrospective multicenter study with 631 cases at Yokohama Clinical Oncology Group (YCOG)[J]. J Hepatobiliary Pancreat Sci, 2017, 24(1): 33-41. DOI: 10.1002/jhbp.411.
    [12] SADAMORI H, YAGI T, MATSUDA H, et al. Intractable bile leakage after hepatectomy for hepatocellular carcinoma in 359 recent cases[J]. Dig Surg, 2012, 29(2): 149-156. DOI: 10.1159/000337313.
    [13] ISHII H, OCHIAI T, MURAYAMA Y, et al. Risk factors and management of postoperative bile leakage after hepatectomy without bilioenteric anastomosis[J]. Dig Surg, 2011, 28(3): 198-204. DOI: 10.1159/000324042.
    [14] YIN TS, YI YY, MAO XX et al. Meta-analysis of risk factors for posthepatectomy liver failure in patients with hepatocellular carcinoma[J]. J Clin Hepatol, 2014, 30(10): 1009-1014. DOI: 10.3969/j.issn.1001-5256.2014.10.009.

    尹天圣, 易亚阳, 毛熙贤, 等. 肝癌肝切除术后肝衰竭危险因素的Meta分析[J]. 临床肝胆病杂志, 2014, 30(10): 1009-1014. DOI: 10.3969/j.issn.1001-5256.2014.10.009.
    [15] CHANG L, YU MC, YUAN YF, et al. Safety and effectiveness of hemihepatic blood flow occlusion versus pringle's maneuver during hepatectomy: A Meta-analysis[J]. Chin J Evid-based Med, 2014, 14(6): 743-751. DOI: 10.7507/1672-2531.20140125.

    常磊, 喻满成, 袁玉峰, 等. 半肝血流阻断法与Pringle法在肝切除术应用中安全性与有效性比较的Meta分析[J]. 中国循证医学杂志, 2014, 14(6): 743-751. DOI: 10.7507/1672-2531.20140125.
    [16] ZENG YC, DING HD, ZOU RY, et al. Research progress on the risk factors, prevention and therapy in posthepatectomy liver failure[J]. Chin J Hepatobiliary Surg, 2019, 25(9): 711-715. DOI: 10.3760/cma.j.issn.1007-8118.2019.09.020.

    曾勇超, 丁宏达, 邹若媱, 等. 肝切除术后肝功能衰竭危险因素与防治的研究进展[J]. 中华肝胆外科杂志, 2019, 25(9): 711-715. DOI: 10.3760/cma.j.issn.1007-8118.2019.09.020.
    [17] XU Y, LI JB, HU XL, et al. Research status of risk predictors and corresponding strategies of posthepatectomy liver failure[J]. Chin J Dig Surg, 2020, 19 (2): 220-224. DOI: 10.3760/cma.j.issn.1673-9752.2020.02.016.

    徐岩, 李江斌, 胡小玲, 等. 肝切除术后肝衰竭风险预测指标及应对策略的研究现状[J]. 中华消化外科杂志, 2020, 19 (2): 220-224. DOI: 10.3760/cma.j.issn.1673-9752.2020.02.016.
    [18] CHENG WL, QI YQ, CHEN YJ, et al. A meta-analysis of risk factors of postoperative infectious complications after liver resection for hepatocellular carcinoma[J]. Chin J Hepatobiliary Surg, 2016, 22(1): 5-8. DOI: 10.3760/cma.j.issn.1007-8118.2016.01.002.

    承文龙, 齐永强, 陈勇军, 等. 肝癌肝切除术后感染并发症相关危险因素的Meta分析[J]. 中华肝胆外科杂志, 2016, 22(1): 5-8. DOI: 10.3760/cma.j.issn.1007-8118.2016.01.002.
    [19] CHEN L, WANG YB, ZHANG YH, et al. Effective prediction of postoperative complications for patients after open hepatectomy: A simplified scoring system based on perioperative parameters[J]. BMC Surg, 2019, 19(1): 128. DOI: 10.1186/s12893-019-0597-2.
    [20] ZOU H, WEN Y, YUAN K, et al. Combining albumin-bilirubin score with future liver remnant predicts post-hepatectomy liver failure in HBV-associated HCC patients[J]. Liver Int, 2018, 38(3): 494-502. DOI: 10.1111/liv.13514.
    [21] ANDREATOS N, AMINI N, GANI F, et al. Albumin-Bilirubin Score: Predicting short-term outcomes including bile leak and post-hepatectomy liver failure following hepatic resection[J]. J Gastrointest Surg, 2017, 21(2): 238-248. DOI: 10.1007/s11605-016-3246-4.
    [22] TIAN F, LIU Y, GAO J, et al. Study on the association between TGF-β1 and liver fibrosis in patients with hepatic cystic echinococcosis[J]. Exp Ther Med, 2020, 19(2): 1275-1280. DOI: 10.3892/etm.2019.8355.
    [23] ZHANG C, WANG L, ALI T, et al. Hydatid cyst fluid promotes peri-cystic fibrosis in cystic echinococcosis by suppressing miR-19 expression[J]. Parasit Vectors, 2016, 9(1): 278. DOI: 10.1186/s13071-016-1562-x.
    [24] WANG Y, LIU XM, WANG B, et al. Preoperative aspartate transaminase and platelet ratio index(APRI)as a predictor of postoperative complications after hepatic resection for primary hepatocellular carcinoma[J]. Chin J Hepatobiliary Surg, 2016, 22(5): 289-293. DOI: 10.3760/cma.j.issn.1007-8118.2016.05.001.

    王越, 刘学民, 王博, 等. 术前天冬氨酸转氨酶/血小板比值指数对肝细胞癌患者手术切除后并发症的预测价值[J]. 中华肝胆外科杂志, 2016, 22(5): 289-293. DOI: 10.3760/cma.j.issn.1007-8118.2016.05.001.
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