摘要
目的分析乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者90 d生存的影响因素,并构建预测模型。方法HBV-ACLF患者370例,根据患者90 d生存情况分为生存者284例和死亡者86例。收集患者的临床及实验室检查资料,包括年龄、性别、白细胞计数(WBC)、中性粒细胞计数、淋巴细胞计数、凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、α-L-岩藻糖苷酶(AFU)、白蛋白(ALB)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆固醇(TC)、直接胆红素(DBIL)、肌酐(Cr)、血钠(Na)、甘油三酯(TG)、胱抑素C(CysC)、并发肝性脑病、并发腹水等,采用单因素和多因素Logistic回归分析法分析HBV-ACLF患者90 d生存的独立影响因素,并构建HBV-ACLF患者90 d生存的预测模型。采用受试者工作特征(ROC)曲线下面积(AUC)比较新预测模型与终末期肝病模型(MELD)评分、MELD-Na评分及MELD 3.0评分等经典预测模型的预测效能;采用Hosmer-Lemeshow检验评估各预测模型的拟合优度;采用Brier分数综合评价各预测模型的准确性。结果年龄、DBIL、PTA是HBV-ACLF患者90 d生存的独立影响因素(P均<0.05)。构建的HBV-ACLF患者90 d生存的预测模型为PI=0.062×年龄(岁)+0.004×DBIL(μmol/L)-0.055×PTA(s)-0.239。与经典预测模型比较,构建的新预测模型的AUC、H-L检测P值均最高,且Brier分数最小。结论HBV-ACLF患者90 d生存的独立影响因素是年龄、DBIL、PTA,成功构建了HBV-ACLF患者90 d生存的预测模型,且新预测模型相较于经典模型预测效能更高。
Objective To analyze the influencing factors for 90-day survival in patients with hepatitis B virus-relat⁃ed acute-on-chronic liver failure(HBV-ACLF)and to construct a prediction model.Methods A total of 370 HBVACLF patients were divided into two groups based on their 90-day survival status:284 survivors and 86 non-survivors.Clinical and laboratory data of the patients were collected,including age,gender,white blood cell count(WBC),neutro⁃phil count,lymphocyte count,prothrombin activity(PTA),activated partial thromboplastin time(APTT),α-L-fucosi⁃dase(AFU),albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total cholesterol(TC),direct bilirubin(DBIL),creatinine(Cr),serum sodium(Na),triglycerides(TG),cystatin C(CysC),concur⁃rent hepatic encephalopathy,and concurrent ascites.Univariate and multivariate Logistic regression analyses were used to identify the independent influencing factors for 90-day survival in HBV-ACLF patients.SPSS 27.0 statistical software was used to construct the prediction model for 90-day survival in HBV-ACLF patients.The area under the receiver operating characteristic(ROC)curve(AUC)was used to compare the predictive performance of the new model with that of classical prediction models,including the Model for End-Stage Liver Disease(MELD)score,MELD-Na score,and MELD 3.0 score.The Hosmer-Lemeshow test was applied to evaluate the goodness of fit of each prediction model,and the Brier score was used to comprehensively assess the accuracy of each model.Results Age,DBIL,and PTA were identified as inde⁃pendent influencing factors for 90-day survival in HBV-ACLF patients(all P<0.05).The constructed prediction model for 90-day survival in HBV-ACLF patients was defined as:PI=0.062×age(years)+0.004×DBIL(μmol/L)-0.055×PTA(s)-0.239.Compared with the classical prediction models,the new model exhibited the highest AUC and Hosmer-Lemeshow test P-value,as well as the lowest Brier score.Conclusions Age,DBIL and PTA are independent influenc⁃ing factors for 90-day survival in HBV-ACLF patients.A prediction model for 90-day survival in HBV-ACLF patients is successfully constructed,and this new model shows better predictive performance than the classical models.
作者
伍细蓉
李荣婷
陈亚琼
WU Xirong;LI Rongting;CHEN Yaqiong(Department of Clinical Laboratory,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)
出处
《山东医药》
2026年第1期114-117,共4页
Shandong Medical Journal
关键词
乙型肝炎
慢加急性肝衰竭
预后预测模型
hepatitis B
acute-on-chronic liver failure
prognostic prediction model
