首页|肝硬化食管胃静脉曲张发生的影响因素分析及列线图预测模型构建

肝硬化食管胃静脉曲张发生的影响因素分析及列线图预测模型构建

Analysis of influencing factors on the occurrence of esophageal and gastric varices in liver cirrhosis and construction of a column chart prediction model

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目的 探讨肝硬化患者发生食管胃静脉曲张(EGV)的影响因素,构建EGV发生的列线图预测模型.方法 采用横断面研究,选取2022年1月至2023年4月因肝硬化至复旦大学附属闵行医院就诊且接受胃镜检查的患者(n=127),按是否存在EGV分为EGV组(n=74)和非EGV组(n=53),比较两组患者的临床及辅助检查资料,通过单因素和多因素logistic回归分析,探讨EGV发生的独立影响因素,进一步构建列线图预测模型,并评价其预测效能.结果 多因素logistic回归分析显示脾大(OR=28.38,95%CI:6.30~127.89,P<0.001)、血吸虫感染(OR=0.05,95%CI:0.01~0.28,P=0.001)和脂肪肝(OR=0.09,95%CI:0.02~0.33,P<0.001)是肝硬化患者发生EGV的独立影响因素,基于该模型构建用于预测肝硬化患者发生EGV概率的列线图.列线图模型表现出良好的一致性和区分度(曲线下面积为0.927,95%CI:0.883~0.972),并通过Bootstrap方法进行内部验证,显示平均绝对误差为0.029.结论 脾大、血吸虫感染和脂肪肝是肝硬化患者发生EGV的独立影响因素,肝硬化患者发生EGV的Nomogram列线图预测模型具有良好的预测性能,能为肝硬化EGV的无创风险筛查与防治策略提供科学依据.
Objective To explore the influencing factors of esophageal and gastric varices(EGV)in patients with liver cirrhosis,and to construct a column chart prediction model for EGV occurrence.Methods A cross-sectional study was conducted to select patients(n=127)who underwent gastroscopy at Minhang Hospital,Fudan University from January 2022 to April 2023 due to liver cirrhosis.Patients were divided into EGV group(n=74)and non EGV group(n=53)based on the presence of EGV.Clinical and auxiliary examination data of the two groups were compared.Univariate and multivariate logistic regression analysis were used to explore the independent influencing factors of EGV occurrence,and a column chart prediction model was further constructed to evaluate its predictive efficacy.Results Multivariate logistic regression analysis showed that splenomegaly(OR=28.38,95%CI:6.30-127.89,P<0.001),schistosomiasis infection(OR=0.05,95%CI:0.01-0.28,P=0.001),and fatty liver(OR=0.09,95%CI:0.02-0.33,P<0.001)were independent influencing factors for the occurrence of EGV in patients with liver cirrhosis.Based on this model,a column chart was constructed to predict the probability of EGV occurrence in patients with liver cirrhosis.The column chart model showed good consistency and discrimination(area under the curve was 0.927,95%CI:0.883-0.972),and was internally validated using the Bootstrap method,showing an average absolute error of 0.029.Conclusions Spleen enlargement,schistosomiasis infection,and fatty liver are independent influencing factors for the occurrence of EGV in patients with liver cirrhosis.The Nomogram column chart prediction model for the occurrence of EGV in patients with liver cirrhosis has good predictive performance and can provide scientific basis for non-invasive risk screening and prevention strategies for EGV in liver cirrhosis.

Liver cirrhosisEsophageal and gastric varicesRisk factors

李晓娟、徐鑫鑫、方青青、陈炜、陈颖

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复旦大学附属闵行医院消化内科,上海 201199

肝硬化 食管和胃静脉曲张 危险因素

闵行区自然科学基金闵行区公共卫生重点学科建设项目

2022MHZ028MGWXK2023-05

2024

中国医师杂志
中华医学会 湖南省医学会

中国医师杂志

CSTPCD
影响因子:0.876
ISSN:1008-1372
年,卷(期):2024.26(4)
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