重症巴德-吉亚利综合征患者短期预后的危险因素分析  

Analysis of risk factors of short-term prognosis in patients with severe Budd-Chiari syndrome

作　　者：王则栋 凌帅波 李素新[1] 李路豪 刘兆臣 李丁洋 李林[1] 杨洋[1] 刘胜炎 党晓卫[1] Wang Zedong;Ling Shuaibo;Li Suxin;Li Luhao;Liu Zhaochen;Li Dingyang;Li Lin;Yang Yang;Liu Shengyan;Dang Xiaowei(Department of Hepatopancreatobiliary Surgery,the First Affiliated Hospital of Zhengzhou University,Key Laboratory of Precision Diagnosis and Treatment in General Surgical(Hepatobiliary and Pancreatic)Diseases of Health Commission of Henan Province,Henan Province Engineering Research Center of Minimally Invasive Diagnosis and Treatment of Hepatobiliary and Pancreatic Diseases,Budd-Chiari Syndrome Diagnosis and Treatment Center of Henan Province,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肝胆胰外科、河南省卫生健康委员会普通外科(肝胆胰)疾病精准诊疗重点实验室、河南省肝胆胰疾病微创诊治工程研究中心、河南省布-加综合征诊疗中心,郑州450052

出　　处：《中华外科杂志》2024年第6期606-612,共7页Chinese Journal of Surgery

基　　金：河南省重点研发专项(231111313500);河南省自然科学基金(232300420232)。

摘　　要：目的探讨重症巴德-吉亚利综合征患者的短期预后因素,建立重症巴德-吉亚利综合征患者短期预后的列线图预测模型并评价其临床应用价值。方法本研究为回顾性队列研究。回顾性分析2018年1月至2023年12月郑州大学第一附属医院肝胆胰外科收治的171例重症巴德-吉亚利综合征患者的临床资料。其中男性105例,女性66例,年龄(52.1±12.8)岁(范围:18~79岁)。根据患者确诊后28 d内是否死亡,分为死亡组(38例)和生存组(133例)。分析患者短期死亡的危险因素,通过单因素及多因素Logistic回归分析筛选出重症巴德-吉亚利综合征患者短期死亡的独立危险因素,将这些因素纳入并建立列线图预测模型。通过受试者工作特征曲线的曲线下面积(AUC)验证模型区分度,并采用自举重采样法对其进行内部验证;通过Hosmer-Lemeshow检验验证模型的校准度;通过临床决策曲线(DCA)验证模型临床有效性。结果单因素及多因素Logistic回归分析结果显示,肝性脑病史、白细胞计数、肾小球滤过率和凝血酶原时间是患者死亡的独立相关因素(P值均<0.05)。建立患者短期死亡的预测模型AUC为0.908(内部验证AUC为0.895),具有良好的区分度和校准度(P=0.663)。DCA中阈概率值设定为17%,人群临床净获益为18%,表明预测模型具有临床有效性。结论肝性脑病史、白细胞计数、肾小球滤过率和凝血酶原时间是重症巴德-吉亚利综合征患者死亡的独立相关因素。重症巴德-吉亚利综合征短期预后列线图预测模型可以在临床早期筛选并识别重症巴德-吉亚利综合征短期死亡的高危患者。Objective To explore the risk factors of short-term prognosis of severe Budd-Chiari syndrome(BCS)patients,established and verified the nomogram prediction model for these BCS patients and evaluated its clinical application value.Methods This study is a retrospective cohort study.The clinical data of 171 patients with severe BCS diagnosed were retrospectively analyzed in the Department of Hepatopancreatobiliary Surgery First Affiliated Hospital of Zhengzhou University from January 2018 to December 2023.There were 105 males and 66 females,aged(52.1±12.8)years(range:18 to 79 years).The patients were divided into two groups based on whether they died within 28 days:the death group(n=38)and the survival group(n=133).The risk factors for short-term death of patients were analyzed,and independent risk factors were screened by univariate and multivariate analysis.Furthermore,these factors were used to establish the nomogram prediction model.The area under the curve(AUC),the Bootstrap Resampling,the Hosmer-Lemeshow test and the Decision Curve Analysis(DCA)were used to verify the model′s differentiation,internal verification,calibration degree and clinical effectiveness,respectively.Results Univariate and multivariate Logistics regression analysis showed that the history of hepatic encephalopathy,white blood cell,glomerular filtration rate and prothrombin time were independent risk factors(P<0.05).The above factors were used to successfully establish the prediction model with 0.908 of AUC and 0.895 of the internal verification of AUC,indicating that the predictive model was valuable.The 0.663 P-values in the Hosmer-Lemeshow test indicated the high calibration degree of the model.The clinical effectiveness of the model was proved by the 18%clinical benefit population using the DCA curve with the 17%probability threshold.Conclusions The independent risk factors are the history of hepatic encephalopathy,white blood cell,glomerular filtration rate and prothrombin time.An adequate basis was acquired by establishing a nomogra

关 键 词：BUDD-CHIARI综合征 诊断 危险因素 短期预后 

分 类 号：R575[医药卫生—消化系统]