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肝硬化门脉性肺动脉高压危险因素分析及预测模型构建

匡竞 滕双芩 申彤彤 闫怡然 王玮 申川 赵彩彦

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Citation:

肝硬化门脉性肺动脉高压危险因素分析及预测模型构建

DOI: 10.12449/JCH240914
伦理学声明:本研究于2023年4月27日经由河北医科大学第三医院伦理委员会审查通过,批号:科2023-047-1。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:匡竞负责查阅文献,分析数据,撰写文章;滕双芩、申彤彤、闫怡然负责查阅文献,收集数据;王玮负责论文修改及审校;申川、赵彩彦负责论文审校。
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    通信作者:

    王玮, wangwei_1211@126.com (ORCID: 0000-0002-3737-1492)

Risk factors for portopulmonary hypertension in liver cirrhosis and construction of a predictive model

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  • 摘要:   目的  探索肝硬化门脉性肺动脉高压(POPH)的危险因素,构建无创化预测模型。  方法  回顾性分析2013年1月—2022年8月在河北医科大学第三医院住院的310例肝硬化门静脉高压患者的临床资料,依据超声估测的肺动脉收缩压是否≥40 mmHg分为POPH组(n=31)和非POPH组(n=279)。符合正态分布的计量资料2组间比较采用成组t检验,不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验或Fisher确切概率法。应用二元Logistic回归分析筛选独立危险因素,并构建列线图预测模型,采用Bootstrap重抽样法进行内部验证,用C指数和校准曲线评价模型区分度和一致性。用rms包绘制列线图。  结果  与非POPH组相比,POPH组平均年龄偏小,女性、肝性脑病、Child-Pugh C级占比较高,DBil、MELD评分、ALBI评分、国际标准化比值、凝血酶原时间、FIB-4指数、LOK评分、Forns指数较高,但Alb、ALT、GGT、血红蛋白、总胆固醇、甘油三酯水平较低,差异均具有统计学意义(P值均<0.05)。多因素分析结果显示,性别(OR=0.172,95%CI:0.064~0.462,P<0.001)、年龄(OR=0.944,95%CI:0.901~0.989,P=0.016)、ALBI评分(OR=3.091,95%CI:1.100~8.687,P=0.032)和肝性脑病(OR=3.466,95%CI:1.331~9.031,P=0.011)是POPH的独立影响因素。基于以上危险因素建立的肝硬化POPH预测模型的C指数为0.796(95%CI:0.701~0.890),提示模型区分度良好,校准曲线显示模型校准能力较好,提示模型具有一定预测效能。  结论  年轻女性、ALBI评分升高、合并肝性脑病是肝硬化患者发生POPH的独立危险因素,基于上述因素建立的预测模型具有一定的临床应用价值。

     

  • 图  1  肝硬化POPH预测模型校准曲线

    Figure  1.  The calibration plot for the prediction model of POPH in liver cirrhosis

    图  2  预测肝硬化POPH发生的列线图

    Figure  2.  Prediction model nomogram of POPH with liver cirrhosis

    表  1  肝硬化POPH组和非POPH组基线特征

    Table  1.   Baseline characteristics of POPH and non-POPH in liver cirrhosis

    指标 POPH组(n=31) 非POPH组(n=279) 统计值 P
    性别[例(%)] χ2=12.03 0.001
    11(35.48) 187(67.03)
    20(64.52) 92(32.97)
    年龄(岁) 52.39±13.00 56.14±9.41 t=2.02 0.044
    Alb(g/L) 30.79(26.63~35.78) 33.90(29.46~38.06) U=3 004.00 0.005
    ALT(U/L) 23.00(18.00~32.00) 30.00(18.00~46.00) U=3 261.00 0.025
    DBil(μmol/L) 22.00(10.32~72.08) 14.36(7.72~32.34) U=3 137.00 0.012
    ALP(U/L) 100.00(69.00~152.00) 99.00(71.00~142.00) U=4 224.00 0.832
    GGT(U/L) 27.00(16.00~44.00) 39.00(24.00~89.00) U=3 210.00 0.019
    肌酸激酶(U/L) 64.60(43.00~84.80) 70.60(43.70~112.60) U=4 031.00 0.535
    乳酸脱氢酶(U/L) 219.25(188.00~261.91) 200.00(160.44~248.24) U=3 612.50 0.133
    总胆固醇(mmol/L) 2.64(1.72~3.23) 3.24(2.60~3.92) U=2 816.50 0.001
    甘油三酯(mmol/L) 0.63(0.51~1.13) 0.83(0.64~1.08) U=3 360.50 0.042
    白细胞计数(×109/L) 3.21(2.21~4.46) 3.47(2.46~4.93) U=3 993.50 0.484
    中性粒细胞百分比(%) 63.10(57.10~71.20) 62.53(55.20~72.10) U=4 047.00 0.558
    血红蛋白(g/L) 90.43±25.90 107.62±27.47 t=3.49 0.001
    血小板计数(×109/L) 46.70(26.00~84.30) 61.00(41.00~92.30) U=3 538.50 0.097
    国际标准化比值 1.65(1.24~1.84) 1.29(1.14~1.53) U=2 642.50 <0.001
    凝血酶原时间(g/L) 17.90(13.70~20.60) 14.50(12.70~17.20) U=2 769.50 0.001
    纤维蛋白原(g/L) 1.65(1.06~2.25) 1.84(1.44~2.33) U=3 572.50 0.112
    D-二聚体(mg/L) 1.20(0.60~2.20) 0.80(0.20~2.02) U=3 415.50 0.054
    MELD评分 17.00(9.00~21.00) 12.00(9.00~16.00) U=3 315.50 0.033
    ALBI评分 -1.45(-1.90~0.97) -1.79(-2.30~1.36) U=2 835.00 0.002
    APRI 2.06(1.07~3.44) 1.68(0.94~2.92) U=3 878.50 0.346
    FIB-4指数 10.32(5.04~17.49) 6.68(3.97~10.31) U=3 097.00 0.010
    S指数 0.68(0.44~1.06) 0.62(0.30~1.46) U=4 157.00 0.723
    LOK评分 4.77(2.93~6.52) 2.49(1.32~4.34) U=2 671.00 <0.001
    Forns指数 12.41±1.91 11.61±1.99 t=-2.21 0.033
    肝病病因[例(%)] χ2=14.06 0.061
    乙型肝炎 9(29.03) 157(56.27)
    丙型肝炎 3(9.68) 18(6.45)
    酒精性肝病 5(16.13) 33(11.83)
    自身免疫性肝病 4(12.90) 16(5.73)
    药物性肝炎 2(6.45) 5(1.79)
    隐源性肝硬化 8(25.81) 44(15.77)
    肝豆状核变性 0(0.00) 4(1.43)
    非酒精性脂肪性肝病 0(0.00) 2(0.72)
    Child-Pugh分级[例(%)] χ2=6.72 0.010
    B级 12(38.71) 175(62.72)
    C级 19(61.29) 104(37.28)
    肝性脑病[例(%)] χ2=10.05 0.002
    14(45.16) 56(20.07)
    17(54.84) 223(79.93)
    下载: 导出CSV

    表  2  肝硬化POPH独立影响因素

    Table  2.   Multivariable analysis of POPH in liver cirrhosis

    指标 B Wald OR 95%CI P
    性别(男) -1.761 0.504 0.172 0.064~0.462 <0.001
    年龄 -0.058 0.024 0.944 0.901~0.989 0.016
    ALBI评分 1.128 0.527 3.091 1.100~8.687 0.032
    肝性脑病(是) 1.243 0.489 3.466 1.331~9.031 0.011
    常量 3.273 2.603 26.402 0.209

    注:性别赋值,女=0,男=1;肝性脑病赋值,否=0,是=1。

    下载: 导出CSV
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  • 收稿日期:  2023-12-31
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