基于血清学相关指标构建预测慢性乙型肝炎患者发生肝硬化的列线图模型  

Constructing a nomogram model for predicting liver cirrhosis based on serological indexes in patients withchronic hepatitis B

作　　者：骆斌 周瑞芬 朱建光[1] Luo Bin;Zhou Ruifen;Zhu Jianguang(Department of Clinical Laboratory,Xianning Central Hospital,the First Affiliated Hospital of Hubei University of Science and Technology,Xianning 437100,China;Department of Blood Transfusion,Xianning Central Hospital,the First Affiliated Hospital of Hubei University of Science and Technology,Xianning 437100,China)

机构地区：[1]咸宁市中心医院、湖北科技学院附属第一医院检验科,咸宁437100 [2]咸宁市中心医院、湖北科技学院附属第一医院输血科,咸宁437100

出　　处：《中国医师进修杂志》2023年第9期791-798,共8页Chinese Journal of Postgraduates of Medicine

基　　金：咸宁市科技计划项目(2018-46)。

摘　　要：目的:分析血清学相关指标对慢性乙型肝炎患者发生肝硬化的影响并构建列线图模型。方法:回顾性分析2019年1月至2021年12月咸宁市中心医院220例慢性乙型肝炎患者的临床资料。其中,发生肝硬化42例(肝硬化组),未发生肝硬化178例(非肝硬化组)。清晨抽取患者空腹外周静脉血,检测血小板、红细胞、白细胞、空腹血糖、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、三酰甘油(TG)、总胆固醇(TC)、总胆红素(TBiL)、白蛋白、球蛋白、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)、凝血酶原时间(PT)、凝血酶时间(TT)、D-二聚体(D-D)、甲胎蛋白(AFP)、C反应蛋白(CRP)等。采用受试者工作特征(ROC)曲线分析各指标预测慢性乙型肝炎患者发生肝硬化的效能;采用多因素Logistic回归分析影响慢性乙型肝炎患者发生肝硬化的独立危险因素;采用R软件"rms"包构建预测慢性乙型肝炎患者发生肝硬化的列线图模型,校正曲线对预测模型进行内部验证,决策曲线评估预测模型的效能。结果:肝硬化组TBiL、ALP、GGT、PT、TT、D-D、AFP和CRP明显高于非肝硬化组[(50.57 ± 5.61)μmol/L比(46.69 ± 3.92)μmol/L、(105.23 ± 30.60)U/L比(75.14 ± 26.45)U/L、(68.73 ± 19.47)U/L比(50.39 ± 14.21)U/L、(13.88 ± 1.98)s比(13.01 ± 2.10)s、(18.88 ± 2.56)s比(15.98 ± 2.43)s、(2.62 ± 1.04)mg/L比(1.34 ± 0.63)mg/L、(4.19 ± 1.95)μg/L比(2.66 ± 1.21)μg/L和(8.54 ± 1.22)mg/L比(7.47 ± 0.79)mg/L],血小板、ALT、AST和白蛋白明显低于非肝硬化组[(129.63 ± 32.66)×10^(9)/L比(183.53 ± 56.31)×10^(9)/L、(131.27 ± 22.19)U/L比(157.57 ± 38.67)U/L、(112.76 ± 19.57)U/L比(125.16 ± 21.84)U/L和(29.79 ± 6.17)g/L比(33.52 ± 5.89)g/L],差异有统计学意义( P<0.01或<0.05);两组红细胞、白细胞、空腹血糖、TG、TC、球蛋白比较差异无统计学意义( P>0.05)。ROC曲线分析结果显示,AFP、血小板、ALT、AST、ALP、GGT、TBiL、白蛋白、D-D、CRObjective To analyze the influence of serological indexes on the liver cirrhosis(LC)in patients with chronic hepatitis B,and to construct a nomogram model.Methods The clinical data of 220 patients with chronic hepatitis B in Xianning Central Hospital from January 2019 to December 2021 were retrospectively analyzed.Among them,42 patients developed LC(LC group),and 178 cases did not develop LC(non-LC group).The patient's fasting peripheral venous blood was taken in the morning.The platelet,red blood cell,white blood cell,fasting blood glucose,alanine aminotransferase(ALT),aspartate aminotransferase(AST),triacylglycerol(TG),total cholesterol(TC),total bilirubin(TBiL),albumin,globulin,alkaline phosphatase(ALP),-glutamyltransferase(GGT),prothrombin time(PT),thrombin time(TT),D-dimer(D-D),alpha-fetoprotein(AFP)and C-reactive protein(CRP)were detected.Receiver operating characteristic(ROC)curve was used to analyze the efficacy of each index in predicting LC in patients with chronic hepatitis B.Multivariate Logistic regression was used to analyze the independent risk factors for LC in patients with chronic hepatitis B.The R software"rms"package was used to construct a nomogram model to predict the LC in patients with chronic hepatitis B,the correction curve was used to internally verify the prediction model,and the decision curve evaluated the efficacy of the prediction model.Results The TBiL,ALP,GGT,PT,TT,D-D,AFP and CRP in LC group were significantly higher than those in non-LC group:(50.57±5.61)μmol/L vs.(46.69±3.92)μmol/L(105.23±30.60)U/L vs.(75.14±26.45)U/L,(68.73±19.47)U/L vs.(50.39±14.21)U/L,(13.88±1.98)s vs.(13.01±2.10)s,(18.88±2.56)s vs.(15.98±2.43)s,(2.62±1.04)mg/L vs.(1.34±0.63)mg/L,(4.19±1.95)μg/L vs.(2.66±1.21)μg/L and(8.54±1.22)mg/L vs.(7.47±0.79)mg/L,the platelet,ALT,AST and albumin were significantly lower than those in the non-LC group:(129.63±32.66)×10^(9)/L vs.(183.53±56.31)×10^(9)/L,(131.27±22.19)U/L vs.(157.57±38.67)U/L,(112.76±19.57)U/L vs.(125.16±21.84)U/L and(29.79±6.1

关 键 词：慢性乙型肝炎 肝硬变 肝硬化 血清学 列线图 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]