丙型肝炎肝硬化失代偿患者再代偿的影响因素分析  

Influencing factors for recompensation in patients with decompensated hepatitis C cirrhosis

作　　者：许丹青 木唤 张映媛 常丽仙 王远珍 李卫昆 董智坚 张丽华 程怡菁 刘立 XU Danqing;MU Huan;ZHANG Yingyuan;CHANG Lixian;WANG Yuanzhen;LI Weikun;DONG Zhijian;ZHANG Lihua;CHENG Yijing;LIU Li(Yunnan Provincial Clinical Medical Center for Infectious Diseases,The Third People’s Hospital of Kunming,Kunming 650041,China;School of Public Health,Dali University,Dali,Yunnan 371000,China)

机构地区：[1]昆明市第三人民医院云南省传染性疾病临床医学中心,昆明650041 [2]大理大学公共卫生学院,云南大理371000

出　　处：《临床肝胆病杂志》2025年第2期269-276,共8页Journal of Clinical Hepatology

基　　金：佑安专科联盟科研专项基金(LM202014)。

摘　　要：目的研究丙型肝炎肝硬化失代偿期患者再代偿发生的影响因素,建立预测模型。方法选取2019年1月—2022年12月在昆明市第三人民医院住院诊断为丙型肝炎肝硬化失代偿的患者217例,至少1年之内再住院无门静脉高压相关并发症即再代偿组(n=63),未再代偿者为对照组(n=154)。收集相关临床资料,对可能影响再代偿发生的因素进行单因素及多因素分析。计量资料符合正态分布的两组间比较采用成组t检验,不符合正态分布的两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ^(2)检验或Fisher’s确切概率法。运用二元Logistic回归模型分析丙型肝炎肝硬化失代偿患者再代偿发生的影响因素,采用受试者操作特征曲线(ROC曲线)评价模型的预测效能。结果217例丙型肝炎肝硬化失代偿期患者中63例发生再代偿(29.03%)。再代偿组与对照组相比,HIV史(χ^(2)=4.566,P=0.034)、部分脾栓塞史(χ^(2)=6.687,P=0.014)、Child-Pugh评分(χ^(2)=11.978,P=0.003)、腹水分级(χ^(2)=14.229,P<0.001)、Alb(t=4.063,P<0.001)、前白蛋白(Z=−3.077,P=0.002)、HDL(t=2.854,P=0.011)、超敏C反应蛋白(Z=−2.447,P=0.014)、凝血酶原时间(Z=−2.441,P=0.015)、CEA(Z=−2.113,P=0.035)、AFP(Z=−2.063,P=0.039)、CA125(Z=−2.270,P=0.023)、三碘甲状腺素原氨酸(Z=−3.304,P<0.001)、甲状腺素(Z=−2.221,P=0.026)、CD45+(Z=−2.278,P=0.023)、IL-5(Z=−2.845,P=0.004)、TNF-α(Z=−2.176,P=0.030)、门静脉宽度(Z=−5.283,P=0.005)差异均有统计学意义。多因素分析结果显示,部分脾栓塞史(OR=3.064,P=0.049)、HIV史(OR=0.195,P=0.027)、少量腹水(OR=3.390,P=0.017)、AFP(OR=1.003,P=0.004)及门静脉宽度(OR=0.600,P<0.001)为丙型肝炎肝硬化失代偿期发生再代偿的独立影响因素。ROC曲线结果显示HIV史、腹水分级、部分脾脏栓塞史、AFP、门静脉宽度、联合预测模型的曲线下面积依次为0.556、0.641、0.560、0.589、0.745、0.817。结论部分脾Objective To investigate the influencing factors for recompensation in patients with decompensated hepatitis C cirrhosis,and to establish a predictive model.Methods A total of 217 patients who were diagnosed with decompensated hepatitis C cirrhosis and were admitted to The Third People’s Hospital of Kunming l from January,2019 to December,2022 were enrolled,among whom 63 patients who were readmitted within at least 1 year and had no portal hypertension-related complications were enrolled as recompensation group,and 154 patients without recompensation were enrolled as control group.Related clinical data were collected,and univariate and multivariate analyses were performed for the factors that may affect the occurrence of recompensation.The independent-samples t test was used for comparison of normally distributed measurement data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed measurement data between two groups;the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.A binary Logistic regression analysis was used to investigate the influencing factors for recompensation in patients with decompensated hepatitis C cirrhosis,and the receiver operating characteristic(ROC)curve was used to assess the predictive performance of the model.Results Among the 217 patients with decompensated hepatitis C cirrhosis,63(29.03%)had recompensation.There were significant differences between the recompensation group and the control group in HIV history(χ^(2)=4.566,P=0.034),history of partial splenic embolism(χ^(2)=6.687,P=0.014),Child-Pugh classification(χ^(2)=11.978,P=0.003),grade of ascites(χ^(2)=14.229,P<0.001),albumin(t=4.063,P<0.001),prealbumin(Z=−3.077,P=0.002),high-density lipoprotein(t=2.854,P=0.011),high-sensitivity C-reactive protein(Z=−2.447,P=0.014),prothrombin time(Z=−2.441,P=0.015),carcinoembryonic antigen(Z=−2.113,P=0.035),alpha-fetoprotein(AFP)(Z=−2.063,P=0.039),CA125(Z=−2.270,P=0.023),TT3(Z=�

关 键 词：丙型肝炎 肝硬化 再代偿 危险因素 

分 类 号：R512.63[医药卫生—内科学] R575.2[医药卫生—临床医学]