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基于APRI和PALBI构建的列线图对肝硬化并发食管胃底静脉曲张破裂出血的预测价值

李欣忆 李娇娇 李莹莹 魏虹合 熊雨凡 张新驰 孙蔚 陈丽

引用本文:
Citation:

基于APRI和PALBI构建的列线图对肝硬化并发食管胃底静脉曲张破裂出血的预测价值

DOI: 10.12449/JCH240314
基金项目: 

“十三五”国家科技重大专项 (2017ZX10203201002-002)

苏州市卫生青年骨干人才“全国导师制”培训项目 (20190013990009)

天晴肝病研究基金 (TQGB20210134)

伦理学声明:本研究于2023年6月19日通过苏州大学附属第一医院伦理委员会批准,批号:2023伦研批第237号。所有患者均知情同意。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:陈丽负责课题设计,拟定写作思路及指导撰写文章;李欣忆负责资料分析及撰写论文;李娇娇、李莹莹、魏虹合、熊雨凡、张新弛负责收集分析数据;孙蔚负责修改论文并最后定稿。
详细信息
    通信作者:

    陈丽, 756355153@qq.com (ORCID: 0000-0001-6278-5438)

Establishment of a nomogram model for predicting liver cirrhosis with esophagogastric variceal bleeding based on aspartate aminotransferase-to-platelet ratio index and platelet-albumin-bilirubin score

Research funding: 

National Major Science and Technology Special Project of the 13th Five-Year Plan Period (2017ZX10203201002-002);

Suzhou Health Youth Backbone Talent“National Tutorial System” Training Project (20190013990009);

Tianqing Liver Disease Research Foundation (TQGB20210134)

More Information
    Corresponding author: CHEN Li, 756355153@qq.com (ORCID: 0000-0001-6278-5438)
  • 摘要:   目的  评估天冬氨酸转氨酶与血小板比值指数(APRI)和血小板-白蛋白-胆红素评分(PALBI)对肝硬化并发食管胃底静脉曲张破裂出血风险的预测价值。  方法  选取苏州大学附属第一医院于2021年5月—2022年6月收治的肝硬化患者119例,收集患者的临床资料、血常规、血清生化及血凝等检查结果。根据是否合并食管胃底静脉曲张破裂出血,将患者分为未出血组(n=59)和出血组(n=60),比较组间差异。正态分布的计量资料两组间比较采用独立样本t检验,非正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验或Fisher精确概率法。使用多因素Logistic回归分析,筛选肝硬化并发食管胃底静脉曲张破裂出血的独立危险因素,并构建列线图预测模型。  结果  出血组男性患者占75.00%,未出血组男性患者占40.68%,两组在性别构成方面,差异具有统计学意义(χ2=14.384,P<0.001)。出血组和未出血组患者病因均以慢性乙型肝炎为主(53.33% vs 38.98%),两者构成比差异无统计学意义(χ2=2.464,P=0.116)。出血组患者抗凝血酶原Ⅲ活性(AT-IIIA)水平高于未出血组(t=3.329,P=0.001),PLT、TBil、Ca、TC、TT水平则低于未出血组(P值均<0.05)。APRI和PALBI在出血组和未出血组之间比较,差异均有统计学意义(χ2值分别为6.175、19.532,P值均<0.05)。进一步二元Logistic回归分析发现,APRI(OR=0.309,95%CI:0.109~0.881,P=0.028)、PALBI(OR=7.667,95%CI:2.005~29.327,P=0.003)、Ca(OR=0.001,95%CI:0.000~0.141,P=0.007)、TC(OR=0.469,95%CI:0.226~0.973,P=0.042)和TT(OR=0.599,95%CI:0.433~0.830,P=0.002)是影响肝硬化并发食管胃底静脉曲张破裂出血的独立影响因素。基于以上因素建立列线图模型,一致性指数(C-index)为0.899,校准曲线拟合良好。  结论  APRI及PALBI对肝硬化并发食管胃底静脉曲张破裂出血具有良好的预测价值,基于本研究构建的列线图模型可以个体化预测肝硬化患者食管胃底静脉曲张破裂出血发生率。

     

  • 图  1  APRI及PALBI的ROC曲线

    Figure  1.  The receiver operating characteristic (ROC) curves of APRI and PALBI

    图  2  基于Logistics回归模型绘制的列线图

    Figure  2.  A nomogram column chart based on a Logistic regression model

    图  3  列线图模型的ROC曲线

    Figure  3.  The receiver operating characteristic (ROC) curve of the model

    图  4  列线图模型校准曲线

    Figure  4.  The calibration curve of the nomogram model

    图  5  列线图模型临床决策曲线

    Figure  5.  The decision curve analysis curve of the nomogram model

    表  1  肝硬化并发消化道出血患者临床特征

    Table  1.   Clinical characteristics of patients with liver cirrhosis complicated by gastrointestinal bleeding

    项目 出血组(n=60) 未出血组(n=59) 统计值 P
    性别[例(%)] χ2=14.384 <0.001
    45(75.00) 24(40.68)
    15(25.00) 35(59.32)
    年龄(岁) 58.00±14.48 62.29±14.29 t=-1.626 0.107
    肝硬化病因[例(%)]
    乙型肝炎 32(53.33) 23(38.98) χ2=2.464 0.116
    酒精性 7(11.67) 1(1.69) χ2=3.261 0.071
    血吸虫性 7(11.67) 13(22.04) χ2=2.287 0.130
    自身免疫性 1(1.66) 4(6.78) χ2=0.871 0.351
    其他 13(21.67) 18(30.51) χ2=0.464 0.496
    WBC(×109/L) 3.30(2.45~4.59) 3.03(2.36~4.20) Z=-0.460 0.646
    PLT(×109/L) 56.00(43.00~69.25) 65.00(50.00~84.00) Z=-2.318 0.020
    TBil(μmol/L) 19.15(12.35~25.93) 31.50(21.90~47.60) Z=-5.084 <0.001
    AST(U/L) 31.90(23.28~43.95) 36.80(28.00~47.90) Z=-1.629 0.103
    Alb(g/L) 31.18±3.63 30.92±6.23 t=-0.273 0.785
    APRI[例(%)] χ2=6.175 0.013
    ≤0.597 25(41.67) 38(64.41)
    >0.597 35(58.33) 21(35.59)
    PALBI[例(%)] χ2=19.532 <0.001
    ≤-1.932 49(81.67) 25(42.37)
    >-1.932 11(18.33) 34(57.63)
    Ca(mmol/L) 2.02±0.13 2.09±0.15 t=2.677 0.008
    TC(mmol/L) 2.92(2.47~3.51) 3.53(3.01~4.12) Z=-3.864 <0.001
    TG(mmol/L) 0.95(0.70~1.24) 0.81(0.68~1.05) Z=-1.414 0.157
    LDL(mmol/L) 1.63(1.20~2.03) 1.68(1.30~2.02) Z=-0.736 0.462
    PT(s) 15.65(14.43~17.08) 15.10(13.50~16.50) Z=-1.789 0.074
    APTT(s) 35.50±6.46 36.63±7.34 t=-0.894 0.373
    TT(s) 18.15(16.73~19.85) 19.80(18.70~21.20) Z=-4.490 <0.001
    AT-ⅢA(%) 62.55±14.99 52.42±18.03 t=3.329 0.001
    下载: 导出CSV

    表  2  影响肝硬化并食管胃底静脉曲张破裂出血的二元Logistic回归分析

    Table  2.   Binary Logistic regression analysis of factors affecting gastrointestinal bleeding in liver cirrhosis

    变量 B SE Wald P OR 95%CI
    APRI -1.173 0.534 4.830 0.028 0.309 0.109~0.881
    PALBI 2.037 0.684 8.857 0.003 7.667 2.005~29.327
    Ca -7.100 2.622 7.335 0.007 0.001 0.000~0.141
    TC -0.758 0.373 4.130 0.042 0.469 0.226~0.973
    TT -0.512 0.166 9.516 0.002 0.599 0.433~0.830
    AT-ⅢA 0.025 0.023 1.106 0.293 1.025 0.979~1.073
    注:APRI≤0.597赋值为0,APRI>0.597赋值为1;PALBI>-1.932赋值为0,PALBI≤-1.932赋值为1。
    下载: 导出CSV
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    杨磊, 阚全香, 高杰. PALBI、MELD及INR值与肝硬化患者合并上消化道出血患者预后的关系及多因素研究[J]. 临床和实验医学杂志, 2022, 21( 11): 1137- 1141. DOI: 10.3969/j.issn.1671-4695.2022.11.005.
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  • 收稿日期:  2023-06-25
  • 录用日期:  2023-07-31
  • 出版日期:  2024-03-20
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