红细胞分布宽度与血小板计数比值和血小板-白蛋白-胆红素评分预测肝脏多房棘球蚴病术后并发症的列线图构建  

A nomogram based on preoperative red blood cell distribution width to platelet count ratio and platelet-albumin-bilirubin scoring to predict postoperative complications after radical resection of hepatic alveolar echinococcosis

作　　者：何宏材 苏鹏宇 侯立朝[1] 樊海宁[1] HE Hongcai;SU Pengyu;HOU Lizhao;FAN Haining(Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hospital of Qinghai University,Qinghai Province Key Laboratory for Echinococcosis,Xining 810001,P.R.China)

机构地区：[1]青海大学附属医院肝胆胰外科,青海省包虫病研究重点实验室,西宁810001

出　　处：《中国普外基础与临床杂志》2023年第7期795-801,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金项目(项目编号:81960576);青海科技厅2022年科技计划项目(青海省包虫病研究重点实验室)。

摘　　要：目的探讨术前红细胞分布宽度与血小板计数比值(red blood cell distribution width to platelet count ratio,RPR)和血小板-白蛋白-胆红素(platelet-albumin-bilirubin,PALBI)评分对肝脏多房棘球蚴病(hepatic alveolar echinococcosis,HAE)肝切除术后并发症发生的预测价值。方法根据纳入和排除标准,回顾性收集青海大学附属医院2018年1月至2022年10月期间确诊为HAE并行根治性肝切除患者的临床病理资料。通过单因素和多因素非条件logistic回归分析影响HAE肝切除术后并发症发生的风险因素,将风险因素模型可视化并绘制成列线图。采用受试者操作特征曲线评估列线图模型预测术后并发症发生的区分度,并使用Bootstrap内部1000次重采样验证且使用一致性指数评估;采用Kaplan-Meier法绘制的曲线计算列线图模型预测患者并发症发生概率和相应的实际的并发症发生概率并绘制校准曲线,通过Hosmer-Lemeshow拟合优度检验来评价列线图模型的校准能力;通过决策曲线分析评价列线图模型的临床获益。结果共纳入160例HAE肝切除患者,其中未发生并发症105例,发生并发症55例。多因素非条件logistic回归分析显示,手术时间≥207 min、术中出血量≥650 mL、白蛋白<38 g/L、RPR≥0.054、PALBI分级高(3级)均为HAE根治性肝切除术后并发症发生的危险因素(OR>1,P<0.05);以此构建的列线图预测并发症发生的受试者操作特征曲线下面积(95%CI)为0.873(0.808,0.937),最佳截断值为0.499;区分HAE肝切除术后并发症发生的一致性指数为0.855;校准曲线经Hosmer-Lemeshow检验显示列线图模型预测曲线和实际曲线与理想曲线贴合度良好(χ^(2)=3.193,P=0.363),具有较好的校准能力;决策曲线分析结果显示阈概率在11%~93%区间内有较好的临床适用性。结论本研究得出,术前RPR和PALBI评分为HAE根治性肝切除术后并发症的危险因素,包含这两个因素构建的列线图对HAE根治性肝�Objective To investigate the predictive value of preoperative red blood cell distribution width to platelet count ratio(RPR)and platelet-albumin-bilirubin(PALBI)scoring for postoperative complications after radical resection of hepatic alveolar echinococcosis(HAE).Methods According to the inclusion and exclusion criteria,the clinicopathologic data of patients diagnosed with HAE and underwent radical hepatectomy in the Affiliated Hospital of Qinghai University from January 2018 to October 2022 were retrospectively collected.The risk factors affecting postoperative complications after radical hepatectomy for HAE were analyzed by univariate and multivariate unconditional logistic regression analysis,which were used to construct the nomogram.The receiver operating characteristic curve was used to evaluate the value in predicting postoperative complications by nomogram model.The discrimination of the nomogram was evaluated using Bootstrap internal 1000 resampling and evaluated using a consistency index.The predicted postoperative complications probability by nomogram and actual postoperative complications probability were calculated by Kaplan-Meier method,and the calibration curve was drawn.The calibration ability of the nomogram model was evaluated by Hosmer-Lemeshow goodness-of-fit test.The decision curve analysis was used to evaluate clinical benefit of the nomogram model.Results A total of 160 patients with HAE radical hepatectomy were included,of which 105 had no postoperative complications and 55 had postoperative complications.The multivariate unconditional logistic regression analysis showed that the operation time≥207 min,intraoperative bleeding≥650 mL,and albumin<38 g/L,RPR≥0.054,and higher PALBI grading(3 levels)were the risk factors affecting postoperative complications after HAE radical hepatectomy(OR>1,P<0.05).Based on the risk factors,the nomogram was constructed.The area under the receiver operating characteristic curve(95%CI)predicted by the nomogram for the postoperative complications was 0.873

关 键 词：红细胞分布宽度与血小板计数比值 血小板-白蛋白-胆红素评分 肝脏多房棘球蚴病 术后并发症 列线图 

分 类 号：R657.3[医药卫生—外科学]