基于中医因素的肝硬化合并轻微型肝性脑病风险预测模型的构建及验证  

Construction and validation of a risk prediction model for liver cirrhosis complicated with minimal hepatic encephalopathy based on the involvement of traditional Chinese medicine factors

作　　者：温井奎[1] 赵亚男 王守云[1] 周晓丹 焦秀娟[1] 曹立华[1] 赵培利[1] 刘加群[1] 齐丽韫[1] 刘坤[1] 赵志军[1] 赵晶 Wen Jingkui;Zhao Yanan;Wang Shouyun;Zhou Xiaodan;Jiao Xiujuan;Cao Lihua;Zhao Peili;Liu Jiaqun;Qi Liyun;Liu Kun;Zhao Zhijun;Zhao Jing(Department of Liver Diseases of Traditional Chinese and Western Medicine,the Third Hospital of Qinhuangdao,Hebei Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第三医院中西医肝病科,河北秦皇岛066000

出　　处：《中国肝脏病杂志(电子版)》2024年第4期48-56,共9页Chinese Journal of Liver Diseases:Electronic Version

基　　金：2019年秦皇岛市市级科技计划自筹经费项目(201902A164)。

摘　　要：目的构建基于中医因素的肝硬化合并轻微型肝性脑病(minimalhepatic encephalopathy,MHE)风险预测模型。方法选取秦皇岛市第三医院2019年1月至2022年1月收治的408例肝硬化患者为训练集,并按照相同标准选取2022年2月至2023年1月收治的125例肝硬化患者为验证集。分析患者的临床资料[包括病程、病因、终末期肝病模型(model for end-stage liver disease,MELD)评分、国际标准化比值(international normalized ratio,INR)、总胆红素(total bilirubin,TBil)等]和中医证候特点,采用Lasso回归和多因素Logistic回归分析肝硬化患者发生MHE的危险因素,采用R(R3.6.3)软件包和rms程序包构建列线图模型,采用图形校准法和Hosmer-Lemeshow(H-L)进行拟合优度检验。采用校正曲线、受试者工作特征(receiver operating characteristic curve,ROC)曲线及决策曲线评价列线图模型的预测效能。结果训练集的408例肝硬化患者中44例发生MHE,其发生率为10.78%。训练集MHE组和非MHE组患者中医证型分布、病程、肝性脑病病史、感染、碱中毒、肾功能不全、脾脏肿大、TBil水平异常和ALB水平异常的比例差异均有统计学意义(P均<0.05)。Logistic回归分析表明肝肾阴虚(OR=1.354,95%CI:1.053~1.740,P=0.018)、失代偿期肝硬化(OR=2.776,95%CI:1.323~5.824,P=0.007)、肝性脑病病史(OR=2.767,95%CI:1.339~5.720,P=0.006)、感染(OR=2.596,95%CI:1.237~5.450,P=0.012)、碱中毒(OR=3.023,95%CI:1.447~6.317,P=0.003)、脾脏肿大(OR=2.786,95%CI:1.345~5.770,P=0.006)、TBil>24μmol/L(OR=2.593,95%CI:1.261~5.333,P=0.010)、ALB≤35 g/L(OR=0.426,95%CI:0.204~0.890,P=0.023)是肝硬化患者并发MHE的独立危险因素。训练集和验证集的一致性指数分别为0.822和0.807,校正曲线与理想曲线走势大致相符,H-L拟合优度检验表明训练集(χ^(2)=13.542,P=0.082)和验证集(χ^(2)=10.747,P=0.073)模型拟合效果较好,训练集和验证集的模型ROC曲线下面积分别为0.803(95%CI:0.775~0.831)和0.796(95Objective To construct a risk prediction model for liver cirrhosis complicated with minimal hepatic encephalopathy(MHE)based on the involvement of traditional Chinese medicine factors.Methods A total of 408 patients with liver cirrhosis admitted to the Third Hospital of Qinhuangdao from January 2019 to January 2022 were selected as the training set,and 125 patients with liver cirrhosis from February 2022 to January 2023 were selected as the validation set according to the same standard.The clinical data[including course of disease,cause of disease,model for end-stage liver disease(MELD)score,international normalized ratio(INR),total bilirubin(TBil),etc.]and traditional Chinese medicine syndrome characteristics of the patients were analyzed.Lasso regression and multivariate Logistic regression were used to analyze the risk factors for MHE in patients with liver cirrhosis.The nomogram model was constructed by R(R3.6.3)software package and rms program package,and the goodness of fit was tested by graphical calibration method and Hosmer Lemeshow(H-L)method.The predictive performance of the nomogram model was evaluated by calibration curve,receiver operating characteristic(ROC)curve and decision curve.Results Among the 408 patients with liver cirrhosis in the training set,44 cases were confirmed with MHE,and the incidence rate was 10.78%.There were statistically significant differences in the distribution of traditional Chinese medicine syndrome types,disease duration,history of hepatic encephalopathy,infection,alkalosis,renal dysfunction,splenomegaly,abnormal TBil and ALB levels between patients in MHE group and non MHE group in the training set(all P<0.05).Logistic regression analysis showed that liver and kidney yin deficiency(OR=1.354,95%CI:1.053~1.740,P=0.018),decompensated cirrhosis(OR=2.776,95%CI:1.323~5.824,P=0.007),history of hepatic encephalopathy(OR=2.767,95%CI:1.339~5.720,P=0.006),infection(OR=2.596,95%CI:1.237~5.450,P=0.012),alkalosis(OR=3.023,95%CI:1.447~6.317,P=0.003),splenomegaly(OR=2.786,95%CI:1.345~5

关 键 词：肝硬化 轻微型肝性脑病 中医因素 危险因素 预测 列线图 

分 类 号：R57[医药卫生—消化系统]