急性戊型肝炎所致重度黄疸的特点及预警模型构建  

The characteristics of severe jaundice caused by acute hepatitis E and the construction of a warning model

作　　者：袁敏 许姗 马娇娇 YUAN Min;XU Shan;MA Jiao-jiao(Department of Infectious Diseases,Second Affiliated Hospital of Air Force Medical University,Xi’an 710000,China)

机构地区：[1]空军军医大学第二附属医院传染科,陕西西安710000

出　　处：《肝脏》2025年第2期165-169,共5页Chinese Hepatology

基　　金：陕西省重点研发计划项目(2021SF-223)。

摘　　要：目的探讨急性戊型肝炎所致重度黄疸的特点并构建预警模型。方法回顾性分析2021年1月至2023年1月在空军军医大学第二附属医院接受治疗的122例急性戊型肝炎患者的病历资料,依据80/20定律随机分为训练集96例和验证集26例。根据住院期间是否发生严重黄疸分为重度组和轻中度组,分析急性戊型肝炎发生严重黄疸的风险因素,构建并验证急性戊型肝炎发生严重黄疸的预警模型。结果训练集96例急性戊型肝炎中发生严重黄疸42例(43.75%),表现出明显的发热、纳差、肌肉酸痛、腹胀、呕吐等症状者18例;54例(56.25%)患者为轻中度黄疸。重度组发生肝衰竭占比为14.29%(6/42)高于轻中度组的0(P<0.05)。重度组抗-HEV-IgM基线、总胆红素(TBil)峰值、肌酐峰值、中性粒细胞峰值、甲胎蛋白(AFP)、肝脏弹性值高于轻中度组(P<0.05)。抗-HEV-IgM基线(OR=3.564,95%CI:1.751~7.255)、TBil峰值(OR=3.778,95%CI:1.856~7.687)、肌酐峰值(OR=3.688,95%CI:1.812~7.506)、中性粒细胞峰值(OR=4.216,95%CI:2.072~8.582)、AFP(OR=4.559,95%CI:2.239~9.278)是急性戊型肝炎发生严重黄疸的危险因素(P<0.05)。风险模型预测训练集急性戊型肝炎发生严重黄疸的灵敏度为0.827(95%CI:0.735~0.941),特异度为0.834(95%CI:0.715~0.941),曲线下面积为0.843(95%CI:0.731~0.928)。风险模型预测验证集急性戊型肝炎发生严重黄疸的灵敏度为0.731(95%CI:0.625~0.901),特异度为0.828(95%CI:0.713~0.947),曲线下面积为0.831(95%CI:0.728~0.951)。结论抗-HEV-IgM基线、TBil峰值、肌酐峰值、中性粒细胞峰值、AFP与急性戊型肝炎发生严重黄疸有关,构建预警模型有助于早期甄别急性戊型肝炎发生严重黄疸的风险。Objective To explore the characteristics of severe jaundice caused by acute hepatitis E and to construct an early warning model.Methods This is a retrospective analysis of the medical records of 122 patients with acute hepatitis E who received treatment at the Second Affiliated Hospital of Air Force Medical University from January 2021 to January 2023.According to the 80/20 law,they were randomly divided into a training set(N=96 cases)and a validation set(N=26 cases).The patients were divided into a severe group and a mild to moderate group based on whether they occurred severe jaundice during hospitalization.The risk factors for severe jaundice in acute hepatitis E were analyzed,and a warning model for severe jaundice in acute hepatitis E patients were constructed and verified.Results Among the 96 cases of acute hepatitis E,42 cases developed severe jaundice,with an incidence rate of 43.75%(42 cases/96 cases).18 cases exhibited obvious symptoms such as fever,poor appetite,muscle soreness,abdominal distension,and vomiting;54 cases(56.25%)of patients had mild to moderate jaundice.The proportion of liver failure in the severe group was higher than that in the mild to moderate group(P<0.05).The baseline,total bilirubin(TBil)peak,creatinine peak,neutrophil peak,alpha fetoprotein(AFP),and liver elasticity,the value of anti-hepatitis E virus immunoglobulin M antibody(HEV IgM)in the severe group were higher than those in the mild to moderate group(P<0.05).Anti-HEV IgM baseline(OR=3.564,95%CI=1.751~7.255),peak TBil(OR=3.778,95%CI=1.856~7.687),peak creatinine(OR=3.688,95%CI=1.812~7.506),peak neutrophil count(OR=4.216,95%CI=2.072~8.582),and AFP(OR=4.559,95%CI=2.239~9.278)are risk factors for severe jaundice in acute hepatitis E(P<0.05).The sensitivity of the risk model for predicting severe jaundice in acute hepatitis E in the training set was 0.827(95%CI=0.735~0.941),the specificity was 0.834(95%CI=0.715~0.941),and the area under the curve was 0.843(95%CI=0.731~0.928).The sensitivity of the risk model prediction validatio

关 键 词：急性戊型肝炎 重度黄疸 影响因素 预警模型 

分 类 号：R512.6[医药卫生—内科学]