戊型肝炎病毒感染慢性肝病人群重症化早期临床预测模型的构建与应用  

Development of a prognostic model for early diagnosis of HEV infection in patients with chronic liver disease

作　　者：徐亚洲 陈文君 胡波[1] Xu Yazhou;Chen Wenjun;Hu Bo(Department of Laboratory Medicine,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510600,China)

机构地区：[1]中山大学附属第三医院检验科,广州510600

出　　处：《中华检验医学杂志》2024年第3期252-258,共7页Chinese Journal of Laboratory Medicine

基　　金：广东省自然科学基金(2023A1515010536)。

摘　　要：目的建立慢性肝病患者重叠感染戊型肝炎病毒(HEV)后的早期临床预测模型, 快速评估患者发生重症肝炎的概率。方法回顾分析2018年5月至2023年9月在中山大学附属第三医院住院治疗的抗-HEV IgG、抗-HEV IgM抗体双阳性的慢性肝病患者87例, 根据患者临床症状、病史资料、实验室检查等将患者分为重症组(TBIL>171 μmol/L且PTA<40%)53例与非重症组(TBIL<171 μmol/L且PTA>40%)34例。使用LASSO回归及最优子集建模等方法筛选影响重症肝炎发生的独立变量并绘制列线图评估重症肝炎发生概率。分别通过曲线下面积(AUC)及校准曲线的平均绝对误差等方法评估模型效果。结果重症组患者血清总胆汁酸[240.00(183.30, 268.70)μmol/L]水平高于非重症组患者[93.40(20.10, 271.70)μmol/L, U=269.00, P=0.002], 载脂蛋白A1[0.32(0.18, 0.48)g/L]、尿酸[156.15(117.00, 202.00)umol/L]水平显著低于非症重症组患者APOA1[0.77(0.63, 1.06)g/L, U=71.00, P<0.001]、UA[334.05(243.70, 401.00)μmol/L, U=83.00, P<0.001];载脂蛋白A1和尿酸为患者重症化的独立变量;为提高模型效果, 将两个独立变量联合总胆汁酸纳入模型绘制列线图, AUC为0.963(95%CI 0.927~0.998), 校准曲线的平均绝对误差为0.024。列线图临界值为129分, 阳性预测值和阴性预测值分别为94.0%和88.2%。结论通过回顾分析, 建立早期快速评估慢性肝病患者重叠感染HEV后重症化概率的列线图模型, 可准确有效的预测患者重症发生的风险。Objective To establish an early clinical prediction model for patients with chronic liver disease who are coinfected with hepatitis E virus(HEV),and quickly evaluate the probability of severe hepatitis in patients.Methods A retrospective analysis was conducted on 87 patients with chronic liver diseases who were hospitalized at the Third Affiliated Hospital of Sun Yat-sen University from May 2018 to September 2023.Clinical features and laboratory indexes were analyszed and patients were classified to severe(TBIL>171μmol/L with PTA<40%)and non-severe(TBIL<171μmol/L with PTA>40%)groups.and Independent factors identified using LASSO regression were incorporated into a novel nomogram to identify patients at high risk of severe hepatitis in the early stages.The performance of the nomogram was evaluated using the area under the curve and the mean absolute error of the calibration curve.Results Significant difference was observed in the serum total bile acid(TBA)level between the severe group[240.00(183.30,268.70)umol/L]and the non-severe group[93.40(20.10,271.70)μmol/L,U=269.00,P=0.002].Additionally,the levels of apolipoprotein A1(APOA1)[0.32(0.18,0.48)g/L]and uric acid(UA)[156.15(117.00,202.00)μmol/L]were significantly lower in the severe group compared to the non-severe group(APOA1:[0.77(0.63,1.06)g/L,U=71.00,P<0.001];UA:[334.05(243.70,401.00)μmol/L,U=83.00,P<0.001]).The researchers developed a nomogram,which incorporated two independent factors(APOA1 and UA)and an additional variable(TBA),exhibiting a strong predictive ability,with an area under the curve(AUC)of 0.963(95%confidence interval:0.927-0.998)and a well-fitted calibration curve.Positive and negative predictive values of 94.0%and 88.2%were calculated,and a nomogram score of 129 or greater was considered indicative of a higher likelihood of developing severe illness.Conclusions This nomogram offers a rapid and accurate means of evaluating the probability of severe illness in patients with chronic liver disease after overlapping infection with HEV,which c

关 键 词：戊型肝炎病毒属 肝炎 慢性 重叠感染 列线图 

分 类 号：R512.6[医药卫生—内科学] R575[医药卫生—临床医学]