多种预测抗病毒治疗HBV感染患者进展为肝细胞癌的模型验证  

Validation of multiple models to predict progression to hepatocellular carcinoma in patients with HBV on antiviral therapy

作　　者：许娟[1] 杜粉静[1] 闫涛涛 侯静涛[1] 秦丽君[1] XU Juan;DU Fenjing;YAN Taotao;HOU Jingtao;QIN Lijun(Department of Infection,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China)

机构地区：[1]西安交通大学第一附属医院感染科,陕西西安710061

出　　处：《胃肠病学和肝病学杂志》2024年第2期136-140,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：陕西省自然科学基础研究计划(2021JQ-404)。

摘　　要：目的评估4种常见的模型预测HBV感染患者在抗病毒治疗过程中进展为肝细胞癌(hepatocellular carcinoma,HCC)风险的性能。方法回顾性纳入2013年1月至2017年6月西安交通大学第一附属医院诊治的1376例接受抗病毒治疗的HBV感染患者,根据随访5年时是否继发HCC,分为试验组117例(8.50%)和对照组1259例(91.50%)。通过EMR系统收集所有患者的临床资料,计算CAMD、PAGE-B、APA-B、REAL-B评分。采用多因素Cox回归法分析HCC的危险因素。采用ROC曲线评估4种模型预测HCC的区分度。结果单因素分析显示,试验组患者年龄、糖尿病、肝硬化、血小板、红细胞分布宽度、甲胎蛋白水平及CAMD、PAGE-B、APA-B、REAL-B评分与对照组比较,差异有统计学意义(P<0.05)。多因素Cox回归分析显示,甲胎蛋白、肝硬化、CAMD、PAGE-B、APA-B、REAL-B是HCC的独立危险因素。ROC曲线显示,CAMD、PAGE-B、APA-B、REAL-B模型预测HBV患者抗病毒治疗过程中进展为HCC的AUC分别为0.719、0.710、0.758、0.879。结论4种模型对于抗病毒治疗的HBV感染者远期发生HCC均具有一定的预测能力,其中REAL-B模型的预测效果最好。Objective To evaluate the performance of 4 common models for predicting the risk of progression to hepatocellular carcinoma(HCC)in patients with HBV during antiviral therapy.Methods Four common models were retrospectively included from Jan.2013 to Jun.2017.A total of 1376 patients with HBV treated with antiviral therapy at the First Affiliated Hospital of Xi′an Jiaotong University from Jan.2013 to Jun.2017 were included.The patients were divided into 117 cases(8.50%)in the trial group and 1259 cases(91.50%)in the control group according to whether they had secondary HCC at 5 years of follow-up.The clinical data of all patients were collected by EMR system and CAMD,PAGE-B,APA-B and REAL-B scores were calculated.Risk factors for HCC were analyzed using multivariate Cox regression method.The ROC curve was used to assess the 4 models for predicting HCC in terms of zone.The ROC curves were used to assess the 4 models to predict the degree of HCC.Results Univariate analysis showed that age,diabetes mellitus,cirrhosis,platelets,erythrocyte width of distribution,alpha-fetoprotein levels and CAMD,PAGE-B,APA-B,REAL-B scores were statistically significant(P<0.05).Multivariate Cox regression analysis showed that the differences in the levels of alpha-fetoprotein,cirrhosis,CAMD,PAGE-B,APA-B,REAL-B were independent risk factors for HCC.The ROC curves showed that the CAMD,PAGE-B,APA-B and REAL-B models predicted the risk of HBV patients′overtreatment with antiviral therapy.The AUCs for progression to HCC during antiviral therapy were 0.719,0.710,0.758 and 0.879,respectively.Conclusion The 4 models have a certain predictive ability for the long-term occurrence of HCC in HBV infected patients treated with antiviral therapy,and REAL-B model has the best predictive effect.

关 键 词：乙型病毒肝炎 抗病毒治疗 肝细胞癌 预测模型 

分 类 号：R735.7[医药卫生—肿瘤]