基于凝血指标构建预测布-加综合征病人短期复发风险列线图模型  

Establishment of a nomogram model for the prediction of the risk of short-term recurrence in patients with Budd-Chiari syndrome based on coagulation parameters

作　　者：刘祥婷 卢宁 李胜利 陆召军 LIU Xiangting;LU Ning;LI Shengli;LU Zhaojun(Department of General Practice,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221006,China;Clinical Research Institute,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221006,China;School of Public Health,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China)

机构地区：[1]徐州医科大学附属医院全科医学科,江苏徐州221006 [2]徐州医科大学附属医院临床研究院,江苏徐州221006 [3]徐州医科大学公共卫生学院,江苏徐州221004

出　　处：《安徽医药》2025年第4期763-767,共5页Anhui Medical and Pharmaceutical Journal

基　　金：江苏省科研与实践创新计划项目(SJCX22_1276)。

摘　　要：目的分析凝血指标对布-加综合征(BCS)病人短期复发的影响,并建立相关列线图预测模型。方法回顾性分析2008年1月至2022年3月徐州医科大学附属医院收治的1243例BCS病人的临床资料,根据是否在1年内复发分为复发组(192例)和非复发组(1051例),利用倾向性得分匹配(PSM),按1∶1进行配对后平衡病人组间差异。将logistic回归中差异有统计学意义的凝血相关危险因素纳入列线图,通过受试者操作特征曲线(ROC曲线)及其曲线下面积(AUC)、校准曲线及其临床决策曲线(DCA)验证该模型的效能。结果经PSM后,2组各纳入190例病人。多因素logistic回归分析结果显示,性别、BCS分型、活化部分凝血活酶时间和纤维蛋白原是BCS 1年内复发的独立危险因素(P<0.05)。基于上述4个危险因素构建列线图,Bootstrap内部验证后,列线图AUC为0.73[95%CI:(0.68,0.78)],提示模型预测效能较好。校准曲线的预测概率与实际概率接近,有良好的一致性。临床决策曲线显示该模型在阈值概率为35%~86%时具有明显的正向净收益。结论中国BCS复发病人存在凝血功能异常。基于性别、BCS分型、FIB、APTT构建的列线图预测模型可以较好地定量评估复发风险,为改善临床预后提供参考。Objective To analyze the impact of coagulation indicators on short-term recurrence in patients with Budd-Chiari syndrome(BCS)and to establish a nomogram prediction model.Methods The clinical data of 1243 patients with BCS admitted to the Affiliated Hospital of Xuzhou Medical University from January 2008 to March 2022 were retrospectively analyzed.They were assigned into recurrence group(n=192)and non-recurrence group(n=1051)according to whether they relapsed within 1 year or not.Using propensity score matching(PSM)as 1∶1,the difference was balanced between patient groups.The statistically significant coagulation related risk factors affecting the recurrence of BCS were identified by logistic regression to construct the prognostic nomogram,whose performance was evaluated using receiver-operating characteristic curve(ROC curve),area under the ROC curve(AUC),calibration curve and decision curve analysis(DCA).Results After propensity score matching,190 patients were included in each group.Logistic regression analysis showed that sex,classification of BCS,activated partial thromboplastin time and fibrinogen were the independent prognostic factors for one-year recurrence of BCS after treatment(P<0.05).The above 4 risk factors were used to construct a nomogran model.After internal validation,the AUC of nomogram was 0.73[95%CI:(0.68,0.78)],suggesting that the predictive efficiency of the model was good.The predicted probability of the calibration curve was close to the actual probability and has a good agreement.The clinical decision curve demonstrated that the model had a significant positive net benefit when the threshold probability ranged from 35%to 82%.Conclusion Coagulation abnormalities are found in Chinese patients with recurrent BCS.This nomogram based on gender,BCS classification,APTT,and FIB can quantitatively assess the recurrence risk,and provide a reference for improving clinical prognosis.

关 键 词：布-加综合征 凝血指标 列线图 危险因素 复发 

分 类 号：R575[医药卫生—消化系统]