慢性乙型肝炎患者停用核苷(酸)类药物后并发慢加急性肝衰竭列线图预测模型的构建  

Establishment of nomogram prediction model for acute-on-chronic liver failure in chronic hepatitis B patients after discontinuation of nucleoside and nucleotide analogs

作　　者：丁军 DING Jun(Department of Pharmacy,Lu’an Hospital of Traditional Chinese Medicine,237006,China)

机构地区：[1]六安市中医院药剂科,237006

出　　处：《传染病信息》2023年第4期320-324,共5页Infectious Disease Information

摘　　要：目的构建预测慢性乙型肝炎(chronic hepatitis B,CHB)患者停用核苷(酸)类药物(nucleoside and nucleotide analogs,NAs)后并发慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)风险的列线图模型,并验证模型的预测能力。方法选取2018年3月—2022年10月我院收治的停用NAs后复发的CHB住院患者作为研究对象,收集患者临床资料,采用单因素和多因素Logistic回归分析其发生ACLF的危险因素,并建立列线图模型。结果停药持续时间长、HBe Ag阳性、总胆红素≥85.5μmol/L、凝血酶原活动度<50%、血小板计数<100×10^(9)/L和白蛋白<35 g/L是CHB患者停用NAs后并发ACLF的独立危险因素(P均<0.05)。模型验证结果显示,一致性指数为0.851(95%CI:0.819~0.883),校准曲线趋近于理想曲线,ROC曲线的AUC为0.847(95%CI:0.759~0.842),在2%~79%预测范围内,模型净获益。结论CHB患者停用NAs后并发ACLF的危险因素较多,基于危险因素建立的列线图模型对CHB患者停用NAs后并发ACLF风险具有良好的预测效能。Objective To construct a nomogram model to predict the risk of acute-on-chronic liver failure(ACLF)in patients with chronic hepatitis B(CHB)after discontinuing nucleoside and nucleotide analogs(NAs),and to verify the predictive ability of the model.Methods The CHB inpatients who had relapsed after discontinuing NAs in our hospital from March 2018 to October 2022 were selected as the research objects,the clinical data of patients were collected,and the risk factors of ACLF were analyzed by single factor and multi factor logistic regression,and a nomogram model was established.Results Longer drug withdrawal duration,HBeAg positive,and total bilirubin≥85.5μmol/L,prothrombin activity<50%,platelet count<100×10^(9)/L and albumin<35 g/L were independent risk factors of ACLF in CHB patients after discontinuing NAs(P<0.05).The model validation results showed that the C-index was 0.851(95%CI:0.819-0.883),the calibration curve was close to the ideal curve,and the AUC of the ROC curve was 0.847(95%CI:0.759-0.842).Within the prediction range of 2%-79%,the model had a net benefit.Conclusion There are many risk factors of ACLF in CHB patients after discontinuing NAs.The nomogram model based on risk factors has a good predictive effect on the risk of ACLF in CHB patients after discontinuing NAs.

关 键 词：慢性乙型肝炎 核苷(酸)类药物 停用药物 复发 慢加急性肝衰竭 危险因素 列线图 模型验证 一致性指数 

分 类 号：R512.62[医药卫生—内科学]