基于血清人β防御素-1、白细胞介素-6和血小板-白蛋白-胆红素评分构建乙型肝炎病毒相关慢加急性肝衰竭患者短期预后的预测模型  

A short-term prognostic nomogram for HBV-related acute-on-chronic liver failure incorporating serum hBD-1,IL-6 and PALBI score

作　　者：陈庆 陈雪英 段兴元 CHEN Qing;CHEN Xueying;DUAN Xingyuan(Intensive Care Department of Chuantou Xichang Hospital,Liangshan 615600,China)

机构地区：[1]川投西昌医院重症科,凉山州615600 [2]冕宁县人民医院消化内科,凉山州615601 [3]攀钢集团总医院重症科,攀枝花617000

出　　处：《传染病信息》2025年第2期116-122,共7页Infectious Disease Information

摘　　要：目的基于血清人β防御素-1(human beta-defensin-1,HBD-1)、白细胞介素-6(interleukin-6,IL-6)和血小板一白蛋白-胆红素(platelet-albumin-bilirubin,PALBI)评分构建乙型肝炎病毒(hepatitisBvirus,HBV)相关慢加急性肝衰竭(acute-on-chronicliverfailure,ACLF)患者短期预后的预测模型。方法选取2021年5月至2024年1月川投西昌医院收治的HBV-ACLF患者395例,根据28d情况分为死亡组(175例)和存活组(220例)。收集HBV-ACLF患者临床资料,并计算PALBI评分。单因素分析、最小绝对收缩和选择算子回归(least absolute shrinkage and selection operator,LASSO)筛选影响HBV-ACLF患者短期预后的因素,将非零特征变量进行多因素非条件Logistic回归确定独立危险因素;R语言构建基于血清HBD-1、IL-6、PALBI评分的HBV-ACLF患者短期预后预测模型,使用一致性指数、校准曲线、决策曲线和Hosmer-Lemeshow检验进行内部验证;受试者工作特征(receiver operating characteristic,ROC)曲线确定基于血清HBD-1、IL-6和PALBI评分的HBV-ACLF患者短期预后预测模型的预测能效。结果395例HBV-ACLF患者28d病死率为44.30%(175/395)。单因素分析显示,ACLF分期、肝腹水、肝性脑病、上消化道出血、中性粒细胞/淋巴细胞计数比值、总胆红素、乳酸脱氢酶、白蛋白、纤维蛋白原、国际标准化比值(international normalized ratio,INR)、凝血酶原活动度、HBD-1、IL-6、CTP(Child-Turcotte-Pugh)评分、PALBI评分与HBV-ACLF患者短期预后有关(P<0.05)。LASSO回归筛选出9个具有非零特征的变量,多因素非条件Logistic回归显示,ACLF分期、肝性脑病、上消化道出血、INR、HBD-1、IL-6、CTP评分、PALBI评分为HBV-ACLF患者死亡的独立危险因素(P<0.05)。基于血清HBD-1、IL-6和PALBI评分构建HBV-ACLF患者短期预后预测模型[Logit(P)=-12.971+1.284×ACLF分期+1.291×肝性脑病+1.461×上消化道出血+1.337×INR+0.019×HBD-1+0.064×IL-6+0.434XCTP+0.240×PALBI评分]。经内部验证,�Objective A short-term prognostic prediction model is constructed for patients with hepatitis B virus(HBV)-acute-on-chronic liver failure(ACLF)based on serum human beta-defensin-1(HBD-1),interleukin-6(IL-6),and platelet-albumin-bilirubin(PALBI)score.Methods A total of 395 patients with HBV-ACLF admitted to our hospital between May 2021 and January 2024 were selected and divided into a death group(175 cases)and a survival group(220 cases)based on their 28-day outcomes.Clinical data were collected,and serum HBD-1 and IL-6 levels were measured by enzyme-linked immunosorbent assay on the second day of admission.The PALBI score was calculated.Univariate analysis and least absolute shrinkage and selection operator(LASSO)regression were used to identify factors influencing the short-term prognosis of HBV-ACLF patients.Multivariable logistic regression was conducted to determine independent risk factors among non-zero feature variables.A short-term prognostic prediction model was constructed using R software based on serum HBD-1,IL-6,and PALBI scores,and internal validation was performed using the concordance index,calibration curve,decision curve,and Hosmer-Lemeshow test.The predictive efficiency of the model was evaluated using the receiver operating characteristic(ROC)curve.Results The 28-day mortality rate of 395 HBV-ACLF patients was 44.30%(175/395).Univariate analysis revealed that ACLF staging,ascites,hepatic encephalopathy,upper gastrointestinal bleeding,neutrophil-to-lymphocyte ratio,total bilirubin,lactate dehydrogenase,albumin,fibrinogen international normalized ratio(INR),prothrombin activity,HBD-1,IL-6,Child-Turcotte-Pugh(CTP)score,and PALBI score were associated with the short-term prognosis of HBV-ACLF patients(P<0.05).LASSO regression identified 9 variables with non-zero characteristics.Multivariate unconditional logistic regression showed that ACLF staging,hepatic encephalopathy,upper gastrointestinal bleeding,INR HBD-1,IL-6,CTP score,and PALBI score were independent risk factors for mortality in HBV-ACL

关 键 词：乙型肝炎病毒相关慢加急性肝衰竭 人β防御素-1 白细胞介素-6 血小板-白蛋白-胆红素评分 短期预后 预测模型 

分 类 号：R575.3[医药卫生—消化系统]