肝癌介入术后急性肝功能恶化的风险列线图模型的构建与验证  

Development and validation of a risk nomogram model for acute liver function deterioration after hepatocellular carcinoma intervention

作　　者：王会哲 卢双动 王谦[1] 刘龙艳 沈丹平[1] 张咏华[1] 汪明泉 WANG Hui-zhe;LU Shuang-dong;WANG Qian;LIU Long-yan;SHEN Dan-ping;ZHANG Yong-hua;WANG Ming-quan(Baoding Second Central Hospital,Hebei,072750,China)

机构地区：[1]保定市第二中心医院,河北072750

出　　处：《肝脏》2024年第6期681-686,共6页Chinese Hepatology

基　　金：保定市科技计划自筹经费项目(2341ZF037)。

摘　　要：目的 构建与验证肝癌介入术后急性肝功能恶化(ALFD)的风险列线图模型。方法 从2020年5月—2022年5月保定市第二中心医院收治的肝癌患者中选取90例行介入治疗者作为研究对象,根据术后是否发生ALFD分为恶化组(n=29例)和良好组(n=61例),收集两组患者临床资料,使用单因素、多因素logistic回归分析肝癌介入术后发生ALFD的危险因素,据此建立列线图风险预测模型,并进行验证。结果 经单因素、logistic多因素回归分析结果显示,Child-Pugh分级(B级)、高FIB和APRI水平是影响肝癌患者介入术后发生ALFD的危险因素(P<0.05);构建的列线图模型显示,Child-Pugh分级(B级)是肝癌患者介入术后发生ALFD的最强预测因子,然后是血清FIB、APRI高表达。模型验证结果显示,列线图ROC曲线下面积为0.751(95%CI:0.665~0.840),C-index为0.811,H-L拟合优度检验结果显示,预测值与实际观测值之间差异无统计学意义(χ^(2)=4.001,P=0.463),表明该模型预测精准度和区分度良好。结论 Child-Pugh分级(B级)、血清FIB和APRI高表达均是影响肝癌患者介入术后发生ALFD的危险因素,据此构建的列线图模型能有效预测肝癌介入术后ALFD的发生风险。Objective To develop and validate a risk nomogram model for predicting acute liver function deterioration(ALFD)after interventional surgery for hepatocellular carcinoma(HCC).Methods Ninety patients with HCC who underwent interventional surgery at the hospital from May 2020 to May 2022 were selected Patients were divided into a deterioration group(n=29 cases)and a non-deterioration group(n=61 cases)based on the occurrence of ALFD post-surgery.Clinical data from both groups were collected.Univariate and multivariate logistic regression analyses were used to identify risk factors for ALFD after intervention,and the risk prediction model was established and verified.Results Univariate and multivariate logistic regression analyses showed that Child-Pugh grade B and high levels of fibrosis-4 index(FIB-4)and aspartate aminotransferase to platelet ratio(APRI)were risk factors for ALFD in patients with HCC after intervention(P<0.05).The nomogram model showed that Child-Pugh grade B was the strongest predictor,followed by high levels of FIB and APRI.Model validation showed that the area under the ROC curve of the column graph was 0.751(95%CI:0.665~0.840),and the C-index was 0.811.The Hosmer-Lemeshow goodness of fit test showed no significant difference between predicted and observed value(χ^(2)=4.001,P=0.463),indicating that the model had accurate predictive capability and good discriminatory power.Conclusion Child-Pugh grade B,high levels of FIB and APRI are risk factors for ALFD in patients with HCC post-intervention.The nomogram model effectively predicts the risk of ALFD after interventional surgery for HCC.

关 键 词：肝癌介入术 急性肝功能恶化 危险因素 风险列线图模型 

分 类 号：R735.7[医药卫生—肿瘤]