目的 探讨影响妊娠期急性脂肪肝(acute fatty liver of pregnancy，AFLP)患者住院时间相关因素并建立预测模型。方法 回顾性分析本院 2008 年 1 月—2023 月 1 月共 49 例AFLP 病例资料，根据患者住院时间中位数分组:A组(n=21 例)，B组(n=28 例)。分析 2 组术前一般实验室资料、临床特征和产后不良后果。采用多因素二元Logistic回归分析影响AFLP住院时间的独立影响因素，建立住院时间预测模型。结果 B组与A组比较，住院天数(d)(15。5 vs 8)、术前黄疸[n(%)][16(57。1%)vs 3(14。3%)]、TT(s)(24。2 vs 21。3)、PT(s)(16。8 vs 15。3)、APTT(s)(52。3 vs 40。7)、TBIL(μmol/L)(77。2 vs 45。2)、IBIL(μmol/L)(21。2 vs 10)、Cre(μmol/L)(171。97±53。34 vs 131。81±45。06)、TT延长[n(%)][24(85。7%)vs 11(52。4%)]、APTT延长[n(%)][27(96。4%)vs 7(33。3%)]、IBIL升高[n(%)][19(67。9%)vs 4(19%)]、Cre 浓度升高[n(%)][21(75%)vs 8(38%)]，产后血浆置换次数[n(%)][23(82。1%)vs 5(23。8%)]和妊娠后合并感染现象[n(%)][21(75%)vs 4(19%)]，显著高于A组。B组与A组比较，术前Plt(×109/L)(128 vs 221)与Fib含量(g/L)(0。9 vs 1。6)，明显低于A组。单因素Logistic回归分析发现术前黄疸、妊娠后合并感染、产后需血浆置换次数、术前TT延长、术前APTT延长、Cre浓度升高是AFLP住院时间的影响因素。根据AIC(赤池信息量准则)指标最小值结果，逐步法多因素Logistic二元回归显示:产后血浆置换需≥4 次、黄疸、术前APTT延长三者是AFLP患者住院时间的独立危险因素并将三者纳入建立逻辑回归预测模型。逻辑回归预测模型经正则化技术评估解决过拟合问题，并通过自助法技术为每个模型获取了估计效应大小的置信区间。结论 术前黄疸、术前APTT延长(APTT>43 s)和产后血浆置换次数是AFLP 患者住院时间延长的独立危险因素，并成功建立预测效能高的AFLP住院时间逻辑回归预测模型。
Factors influencing the length of hospital stays of the AFLP patients and the establishment of prediction model
Objective To investigate the factors influencing the length of hospital stays of the acute fatty liver of preg-nancy(AFLP)patients,so as to establish the prediction model.Methods A total of 49 patients diagnosed as AFLP)in ShenZhen People's Hospital between January 2008 and January 2023 were retrospectively analyzed.According to the medi-an length of hospital stays,the patients were divided into two groups:Group A(n=21)and Group B(n=28).Preoperative general laboratory data,clinical features and postpartum adverse outcomes in both groups were analyzed.Multivariate binary logistic regression was used to analyze the independent factors affecting the length of hospital stays for AFLP,and a predic-tion model for hospitalization time was established.Results Comparison between Group B and Group A were as follows:hospital stays(d)(15.5 vs 8),preoperative icterus(%)[16(57.1%)vs 3(14.3%)],thrombin time(TT)(s)(24.2 vs 21.3),prothrombin time(PT)(s)(16.8 vs 15.3),activated partial thromboplastin time(APTT)(s)(52.3 vs 40.7),total bilirubin(TBIL)(μmol/L)(77.2 vs 45.2),indirect bilirubin(IBIL)(μmol/L)(21.2 vs 10),creatinine(Cre)(μmol/L)[(171.97±53.34)vs(131.81±45.06]),TT extension(%)[24(85.7%)vs 11(52.4%)],APTT extension(%)[27(96.4%)vs 7(33.3%)],IBIL elevation(%)[19(67.9%)vs 4(19%)],Cre concentration rise(%)[21(75%)vs 8(38%)],number of postpartum plasma exchange sessions(%)[23(82.1%)vs 5(23.8%)],postpregnancy co-infection phenomenon(%)[21(75%)vs 4(19%)],with Group B significantly higher than Group A.The preoperative platelet count(×109/L)(128 vs 221)and the concentration of fibrinogen(g/L)[0.9 vs 1.6]in Group B were significantly lower than those in Group A.Univariate logistic regression analysis showed that preoperative icterus,postpregnancy co-infection phe-nomenon,number of postpartum plasma exchange sessions,preoperative TT extension,preoperative APTT extension,Cre concentration rise were influencing factors for the hospital stays of AFLP patients.According to the minimum result of Akaike information criterion,the multivariate binary logistic regression analysis(step-wise selection)showed that the number of postpartum plasma exchange sessions,icterus,preoperative APTT extension were the independent risk factor influencing the hospital stays of AFLP patients,and the logistic regression prediction model was established by incorporating the above three factors.Regularization techniques were further employed in linear regression to address and assess overfitting issues.Addi-tionally,the confidence interval for the estimated effect sizes in each model have been acquired by bootstrapping techniques.Conclusion Preoperative icterus,preoperative APTT extension(APTT>43s)and the number of postpartum plasma ex-change sessions were the independent risk factor influencing the hospital stays of AFLP patients and the logistic regression prediction model with high predictive effectiveness was established successfully.
acute fatty liver of pregnancy(AFLP)hospital staysinfluencing factorpredictive model
国家科技期刊平台
NSTL
万方数据
