基于免疫指标的肝癌癌前病变患者肝癌发生风险预测模型的构建与评价  

Construction and evaluation of nomogram prediction model for hepatocellular carcinoma occurrence in patients with precancerous lesions based on immune indexes

作　　者：梁羽玲 解宇晴 石宛鑫 刘晓利 闫慧文 商子梦 霍光远 杨志云 LIANG Yu-ling;XIE Yu-qing;SHI Wan-xin;YANG Zhi-yun(Department of Combined TCM and West Medicine,Beijing Ditan Hospital,Capital Medical University(Beijing,100015),China)

机构地区：[1]首都医科大学附属北京地坛医院中西医科,北京100015 [2]中医药防治传染性重症肝病研究与转化联合实验室 [3]北京中医药大学第一临床医学院

出　　处：《中西医结合肝病杂志》2025年第2期133-137,共5页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：国家自然科学基金面上项目(No.82274479);国家自然科学基金青年项目(No.82104781);中医药防治传染性重症肝病研究与转化联合实验室,北京市医院管理中心北京市卫健委卓越计划:病毒性乙型肝炎全程诊疗优化模式研究(No.BRWEP2024W10217010);国家重点研发计划(No.2024YFC3044700);重点医学专业发展计划(No.ZYLX202127);高层次公共卫生技术人才建设项目(学科带头人-02-16);首都卫生发展科研专项(No.2020-2-2173);北京市青苗项目(No.QML0231801);养阴扶正解毒方治疗肝癌医疗机构制剂研发(No.DTTP-202301)。

摘　　要：目的:明确甲胎蛋白(AFP)异常的肝硬化患者免疫指标与肝癌发病率的关系,构建一种新的肝癌预测模型。方法:回顾性收集2017年1月至2018年1月就诊的AFP异常的肝硬化患者241例,分析患者临床资料,对患者5年肝癌发病率进行分析。将241例患者按3∶1随机分为训练集和验证集,通过单因素和多因素分析筛选自变量,采用多因素Logistic回归构建预测模型,并绘制受试者工作特征(ROC)曲线评估模型对AFP异常的肝硬化患者肝癌发病率的预测价值。结果:AFP异常的肝硬化患者5年肝癌发病率为41.9%,年龄、单核细胞计数、碱性磷酸酶、凝血酶原时间、CD4^(+)T淋巴细胞计数、CD8^(+)T淋巴细胞计数被筛选为差异有统计学意义的临床预测因子,并基于这6个临床特征构建多因素Logistic回归预测模型,预测模型的5年肝癌发病率ROC曲线下面积为0.89(95%CI=0.94~0.84),预测价值明显优于1年和3年肝癌发病率预测价值。结论:AFP异常的肝硬化患者5年肝癌发病率较高,其中年龄增长、单核细胞计数增加、碱性磷酸酶升高、凝血酶原时间延长是其危险因素,CD4^(+)T淋巴细胞计数和CD8^(+)T细胞计数增加是其保护因素。纳入CD4^(+)T淋巴细胞计数和CD8^(+)T淋巴细胞计数等免疫指标的肝癌发生预测模型对肝癌的发生具有良好的预测价值,且其长期预测效能优于短期预测效能。临床实践中可动态监测预测模型中这6种指标的变化,为临床治疗方案提供依据。Objective:To investigate the relationship between immune indexes and the incidence of hepatocellular carcinoma in cirrhotic patients with abnormal a-fetoprotein,and to establish a new prediction model for hepatocellular carcinoma occurrence.Methods:241 patients with cirrhosis with abnormal a-fetoprotein were retrospectively collected from Beijing Ditan Hospital Affiliated to Capital Medical University from January 2017 to January 2018.The clinical data of the patients were analyzed,and the 5-year hepatocellular carcinoma incidence rate of cirrhosis patients with abnormal a-fetoprotein was analyzed.A total of 241 patients were randomly divided into a training set and a validation set according to 3∶1.Independent variables were screened through univariate and multivariate analysis.Multivariate logistic regression was used to construct a prediction model,and ROC curve was drawn to evaluate the predictive value of the model for hepatocellular carcinoma incidence in patients with cirrhosis with abnormal a-fetoprotein.Results:The 5-year incidence of hepatocellular carcinoma in cirrhotic patients with abnormal a-fetoprotein was 41.9%.Age,monocyte count,alkaline phosphatase,prothrombin time,CD4^(+)T cell count and CD8^(+)T cell count were screened as clinical predictors with significant differences,and a multivariate logistic regression prediction model was constructed based on these 6 clinical characteristics.The ROC curve area under the 5-year prediction model was 0.89(95%CI:0.94-0.84),and the prediction value was significantly better than that of the 1-year and 3-year prediction value.Conclusion:The 5-year incidence of hepatocellular carcinoma in cirrhotic patients with abnormal A-fetoprotein is higher,among which age increased monocyte count,increased alkaline phosphatase and prothrombin time are risk factors,and increased CD4^(+)T cell count and CD8^(+)T cell count are protective factors.The prediction model of hepatocellular carcinoma including CD4^(+)T cell count and CD8^(+)T cell count has good predictive value

关 键 词：肝癌癌前病变 肝癌发生率 甲胎蛋白 免疫指标 列线图预测模型 

分 类 号：R735.7[医药卫生—肿瘤]