摘要
目的 探索肝硬化门脉性肺动脉高压(POPH)的危险因素,构建无创化预测模型.方法 回顾性分析2013年1月—2022年8月在河北医科大学第三医院住院的310例肝硬化门静脉高压患者的临床资料,依据超声估测的肺动脉收缩压是否≥40 mmHg分为POPH组(n=31)和非POPH组(n=279).符合正态分布的计量资料2组间比较采用成组t检验,不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验或Fisher确切概率法.应用二元Logistic回归分析筛选独立危险因素,并构建列线图预测模型,采用Bootstrap重抽样法进行内部验证,用C指数和校准曲线评价模型区分度和一致性.用rms包绘制列线图.结果 与非POPH组相比,POPH组平均年龄偏小,女性、肝性脑病、Child-Pugh C级占比较高,DBil、MELD评分、ALBI评分、国际标准化比值、凝血酶原时间、FIB-4指数、LOK评分、Forns指数较高,但Alb、ALT、GGT、血红蛋白、总胆固醇、甘油三酯水平较低,差异均具有统计学意义(P值均<0.05).多因素分析结果显示,性别(OR=0.172,95%CI:0.064～0.462,P<0.001)、年龄(OR=0.944,95%CI:0.901～0.989,P=0.016)、ALBI评分(OR=3.091,95%CI:1.100～8.687,P=0.032)和肝性脑病(OR=3.466,95%CI:1.331～9.031,P=0.011)是POPH的独立影响因素.基于以上危险因素建立的肝硬化POPH预测模型的C指数为0.796(95%CI:0.701～0.890),提示模型区分度良好,校准曲线显示模型校准能力较好,提示模型具有一定预测效能.结论 年轻女性、ALBI评分升高、合并肝性脑病是肝硬化患者发生POPH的独立危险因素,基于上述因素建立的预测模型具有一定的临床应用价值.
Abstract
Objective To investigate the risk factors for portopulmonary hypertension(POPH)in liver cirrhosis,and to construct a noninvasive predictive model.Methods A retrospective analysis was performed for the clinical data of 310 cirrhotic patients with portal hypertension who were hospitalized in The Third Affiliated Hospital of Hebei Medical University from January 2013 to August 2022,and according to whether pulmonary artery systolic pressure was≥40 mmHg on ultrasound,the patients were divided into POPH group with 31 patients and non-POPH group with 279 patients.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous 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 determine the independent risk factors for POPH,and a nomogram prediction model was constructed.The Bootstrap resampling method was used for internal validation,and C-index and calibration curve were used to assess the discriminatory ability and consistency of the model.The rms package was used to plot the nomogram.Results Compared with the non-POPH group,the POPH group had a significantly younger age,a significantly higher proportion of women or patients with hepatic encephalopathy or Child-Pugh class C disease,and significantly higher levels of direct bilirubin,Model for End-Stage Liver Disease score,albumin-bilirubin(ALBI)score,international normalized ratio,prothrombin time,FIB-4 index,LOK score,and Forns index,as well as significantly lower levels of serum albumin,alanine aminotransferase,gamma-glutamyl transpeptidase,hemoglobin,total cholesterol,and triglycerides(all P<0.05).The multivariate analysis showed that sex(odds ratio[OR]=0.172,95%confidence interval[CI]:0.064-0.462,P<0.001),age(OR=0.944,95%CI:0.901-0.989,P=0.016),ALBI score(OR=3.091,95%CI:1.100-8.687,P=0.032),and hepatic encephalopathy(OR=3.466,95%CI:1.331-9.031,P=0.011)were independent risk factors for POPH.A predictive model for POPH in liver cirrhosis was established based on the above independent risk factors,with a C-index of 0.796(95%CI:0.701-0.890),suggesting that the model had good discriminatory ability,and the calibration curve showed that the model had good calibration ability,suggesting that the model had certain predictive efficacy.Conclusion Young female individuals,elevated ALBI score,and comorbidity with hepatic encephalopathy are independent risk factors for POPH in patients with liver cirrhosis,and the predictive model established based on these factors has a certain clinical application value.
维普
万方数据