丙型肝炎病毒IgG抗体阳性者确诊丙型肝炎的高危因素分析及列线图预测模型构建  

Analysis of High Risk Factors and Construction of A Nomogram Prediction Modelfor Hepatitis C in Hepatitis C Virus-IgG Antibody-Positive Patients

作　　者：周文娟[1] 郑玲玲[2] 念欲霞[2] 张晓琍[1] ZHOU Wenjuan;ZHENG Lingling;NIAN Yuxia;ZHANG Xiaoli(Department of Laboratory Medicine,Fujian Medical University Union Hospital,Fuzhou 350001,China;Department of Prevention and Healthcare,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院检验科,福州350001 [2]福建医科大学附属协和医院预防保健科,福州350001

出　　处：《福建医科大学学报》2024年第2期116-121,142,共7页Journal of Fujian Medical University

基　　金：福建省卫生健康科技计划项目(2021RKA003)。

摘　　要：目的分析丙型肝炎(丙肝)病毒(HCV)免疫球蛋白G(IgG)抗体阳性者中确诊HCV的高危因素,同时建立列线图(nomogram)预测模型,为基层医疗机构丙肝的临床诊断和转诊决策提供依据。方法回顾性收集2022年1月—2023年10月住院筛查患者中同时进行HCV\|RNA、HCV-IgG抗体、肝功能和血常规检测HCV-IgG抗体阳性者的人口学特征及丙肝相关各项指标。采用logistic回归分析HCV-IgG抗体阳性者确诊丙肝的高危因素,并构建nomogram模型,分别采用一致性系数和校准曲线评估模型的预测性能和符合度。结果394例HCV-IgG抗体阳性者中,HCV-RNA阳性率为30.2%。多因素logistic分析显示,在HCV-IgG抗体阳性的人群中,HCV-IgG≥5.0 S/CO、天冬氨酸氨基转移酶(AST)>35 U/L和有肝炎相关临床症状为HCV-RNA阳性的独立危险因素,其OR值分别为233.926(95%CI:31.814~1720.046)、4.079(95%CI:2.105~7.904)和5.295(95%CI:1.505~18.634)。用于预测HCV-RNA阳性的nomogram模型准确度为0.923,灵敏度为99.2%,特异度为74.5%。结论基于HCV-IgG抗体、AST和肝炎相关临床症状的nomogram模型具有高准确度,可用于指导临床医生判断HCV-IgG抗体阳性者确诊HCV感染的风险。Objective To analyze the high-risk factors for hepatitis C virus(HCV)diagnosis in patients with hepatitis C virus antibody-immunoglobulin G(HCV-IgG)antibody positive,and to establish a nomogram prediction model to provide a basis for the clinical diagnosis and treatment decision-making of hepatitis C in primary medical institutions.Methods The demographic characteristics and indicators related to hepatitis C of HCV-IgG antibody positive patients who underwent HCV\|RNA,HCV-IgG antibody,liver function,and routine blood detection from January 2022 to October 2023 were retrospectively collected.Logistic regression was used to analyze the high-risk factors for the diagnosis of hepatitis C in HCV-IgG antibody-positive patients,and a nomogram model was constructed to assess the predictive performance and compliance of the model using the consistency coefficient and calibration curve,respectively.Results 394 patients with HCV-IgG antibody positive for HCV-RNA positive rate was 30.2%,multivariate logistic analysis showed that HCV-IgG≥5.0 S/CO,aspartate aminotransferase(AST)>35 U/L and clinical symptoms related to hepatitis were independent risk factors for HCV-RNA positive in the HCV-IgG antibody positive population,and the OR values were 233.926(95%CI:31.814-1720.046),4.079(95%CI:2.105-7.904),5.295(95%CI:1.505-18.634).The nomogram used to predict HCV-RNA positivity had a precision of 0.923.The value of sensitivity was 99.2%and specificity was 74.5%.Conclusion The nomogram model based on HCV-IgG antibody,AST and hepatitis-related clinical symptoms has high accuracy and can be used to guide clinicians in determining the risk of confirmed HCV diagnosis in HCV-IgG antibody-positive individuals.

关 键 词：丙型肝炎 丙型肝炎病毒核糖核酸 丙型肝炎病毒抗体免疫球蛋白G 天冬氨酸氨基转移酶 列线图 

分 类 号：R512.63[医药卫生—内科学]