伏立康唑致肝损伤风险预测模型的构建与验证  

Construction and verification of risk prediction model of liver injury induced by voriconazole

作　　者：刘丽春 杨万枝[1] 彭杰成 胡章海 LIU Li-chun;YANG Wan-zhi;PENG Jie-cheng;HU Zhang-hai(Anqing First People's Hospital of Anhui Medical University,Anqing Anhui 246003)

机构地区：[1]安徽医科大学附属安庆第一人民医院,安徽安庆246003

出　　处：《中南药学》2022年第12期2906-2910,共5页Central South Pharmacy

基　　金：安徽省卫生健康委科研项目立项项目(No.AHWJ2021b103);安庆市第一人民医院2021年“三新”立项项目(No.Y2021030)。

摘　　要：目的分析伏立康唑致肝损伤的危险因素并建立预测模型,同时验证该模型的准确率。方法回顾分析2018年1月—2022年6月本院使用伏立康唑治疗的161例住院患者信息,按照3∶1的比例随机分配120例作为训练集,41例作为验证集。利用训练集患者临床信息筛选出伏立康唑致肝损伤的独立危险因素,建立预测模型并利用ROC曲线对模型进行评价,再利用验证集患者信息验证该模型的准确率。结果120例训练集患者中共有17例(14.17%)发生了药物性肝损伤。多因素Logistic回归分析显示用药前血浆白蛋白浓度(ALB)和估算的肾小球滤过率(eGFR)是伏立康唑致肝损伤的独立危险因素,利用ALB和eGFR构建联合预测因子(Y_(联合))计算公式,Y_(联合)=X_(eGFR)+14.574X_(ALB),计算120例患者的Y_(联合)值,绘制ROC曲线,其中联合预测因子ROC曲线下面积最大(0.848),Youden指数最大时(0.717),ROC曲线最佳临界值为540.21。利用41例验证集患者信息验证该模型准确率为85.37%。结论ALB和eGFR是伏立康唑致肝损伤的独立危险因素,临床用药过程中可以通过上述公式计算Y_(联合)值,当其小于540.21时,要加强用药期间肝肾功能指标监测,及时优化用药。Objective To determine the risk factors of voriconazole-induced liver injury,establish a prediction model,and verify the accuracy of the model.Methods The information of 161 inpatients treated with voriconazole in our hospital from January 2018 to June 2022 were retrospectively analyzed.At the 3∶1 ratio,120 patients were randomly assigned as the training set and the other 41 as the validation set.The independent risk factors of voriconazole-induced liver injury were screened out with the clinical information of the patients in the training set.A prediction model was established and evaluated with ROC curves.The information of validation set was used to verify the accuracy of this model.Results Totally 17(14.17%)of 120 patients in the training set developed druginduced liver injury.Multivariate Logistic regression analysis showed that pre-drug plasma albumin concentration(ALB)and estimated glomerular filtration rate(eGFR)were independent risk factors for voriconazole-induced liver injury.ALB and eGFR were used to construct the joint predictor(Ycombination)calculation formula,Y_(combination)=X_(eGFR)+14.574X_(ALB).This formula was used to calculate the Y_(combination)value of the 120 patients and obtain the ROC curves,in which the area of the joint predictors under the ROC curves was the largest(0.848).When the Youden index was the largest(0.717),the best critical value of the ROC curve was 540.21.The accuracy of the model was 85.37%with the information of the 41 patients in the validation set.Conclusion ALB and eGFR are independent risk factors for voriconazole-induced liver injury.The above formula can be used to calculate Y_(combination) in clinical medication.When less than 540.21,it is necessary to strengthen the monitoring of liver and kidney function indicators,and optimize medication scheme in time.

关 键 词：伏立康唑 肝损伤 危险因素 LOGISTIC回归 预测模型 

分 类 号：R969.5[医药卫生—药理学]