| 史诗,王一帆,杨艳芬,等.非生物型人工肝治疗肝衰竭病人列线图预后模型的构建[J].安徽医药,2025,29(4):798-804. |
| 非生物型人工肝治疗肝衰竭病人列线图预后模型的构建 |
| A nomogram prognostic model for liver failure patients treated with non-bioartificial liver support system |
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| DOI：10.3969/j.issn.1009-6469.2025.04.034 |
| 中文关键词: 非生物型人工肝 肝衰竭 多因素 Cox回归 列线图模型 预后 |
| 英文关键词: Non-bioartificial liver support system Liver failure Multifactorial Cox regression Nomogram model Prognosis |
| 基金项目:北京肝胆相照基金会 “2022年度人工肝专项基金”项目( iGandanF-1082022-RGG005) |
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| 中文摘要: |
| 目的基于多因素 Cox回归分析探讨行非生物型人工肝治疗肝衰竭病人的预后影响因素并构建列线图预后模型，以指导临床决策。方法回顾性收集 2014年 1月至 2022年 12月于山西医科大学第一医院感染科收治的 275例行非生物型人工肝治疗肝衰竭病人的临床资料，依据病人 3个月的病情随访结局分为生存组( 177例)和不良结局组(98例)对观察指标进行单因素与多因素 Cox回归分析，基于特征变量绘制列线图预测模型并评价模型。利用 X-tile 3.6.1软件将列线图，风险得分进行分组进一步探讨其临床价值。结果生存组的年龄、血清总胆红素［(364.98±151.22)μmol/L比( 434.69±144.45)μmol/L］、凝血酶原时间［25.00(20.80，31.45)s比 29.58(23.95，44.33)s］、国际标准化比值［2.17(1.91，2.82)比 2.85(2.17，3.91)］低于不良结局组( P<0.05)；凝血酶原活动度［33.12(24.10，39.20)%比 25.73(19.40，33.78)%］、动态 MELD评分(终末期肝病预后模型)高于不良结局组( P<0.05)；生存组的病因［肝炎病毒 58(32.8)%，药物性 48(27.1)%，酒精性 33(18.6)%及其他 38(21.5)%］与不良结局组［40(40.8)%，12(12.2)%，11(11.2)%及 35(35.7)%］相比差异有统计学意义(P<0.05)。多因素 Cox回归分析显示，病因 -药物性及酒精性、年龄、血清总胆红素、凝血酶原时间、凝血酶原时间活动度、国际标准化比值及动态 MELD评分为非生物型人工肝治疗肝衰竭病人预后的独立影响因素，基于上述指标构建列线图模型；该模型的一致性指数及 AUC分别为 0.75、0.78，校正曲线及决策分析曲线提示该模型预测性能良好，低风险病人的生存率明显优于中、高风险组( P<0.001)。结论基于病因 -药物性及酒精性、年龄、血清总胆红素、凝血酶原时间、凝血酶原时间活动度、国际标准化比值及动态 MELD评分构建的列线图预后模型对于行非生物型人工肝治疗肝衰竭病人的临床决策有较高指导意义。 |
| 英文摘要: |
| Objective To investigate the prognostic factors and construct a nomogram prognostic model based on multifactorial Coxregression analysis in liver failure patients treated with non-bioartificial liver support system to guide clinical decision-making.Meth. ods Clinical data of 275 liver failure patients treated with non-bioartificial liver support system in the Department of Infection, FirstHospital of Shanxi Medical University from January 2014 to December 2022 were retrospectively collected, and patients were assignedinto survival group (177 cases) and poor prognosis group (98 cases) based on their 3-month follow-up outcomes. The observed indicatorswere analyzed sequentially by univariate and multifactor Cox regression analysis, and the nomogram model was constructed based onthe characteristic variables, and then the model was evaluated. Next, the nomogram risk scores were grouped using X-tile 3.6.1 software to further explore their clinical value.Results Age, serum total bilirubin [(364.98±151.22) mmol/L vs. (434.69±144.45) mmol/L], plas. minogen time [25.00 (20.80, 31.45) s vs. 29.58 (23.95, 44.33) s], and international normalized ratio [2.17 (1.91, 2.82) vs. 2.85 (2.17, 3.91)] in survival group were lower than those in the poor prognosis group (P<0.05); and plasminogen activity [33.12 (24.10, 39.20)% vs. 25.73 (19.40, 33.78)%], and ambulatory MELD score in survival group were higher than those in the poor outcome group (P<0.05);the etiology of the disease in the survivor group [hepatitis viruses 58(32.8)%, pharmacologic 48 (27.1)%, alcoholic 33 (18.6)%, and oth.er 38 (21.5)%] was higher than those in the poor prognosis group [40 (40.8)%, 12 (12.2)% , 11 (11.2)% and 35 (35.7)%], and the differ. ence was statistically significant (P<0.05). Multi-factor Cox regression analysis showed that etiology-drug and alcohol, age, total serumbilirubin, prothrombin time, prothrombin time activity, international normalized ratio and dynamic MELD score were independent fac.tors affecting the prognosis of patients with liver failure treated with abiotic artificial liver, and a nomogram model was constructedbased on these indicators. The consistency index and AUC of the model were 0.75 and 0.78, respectively, and the calibration curve anddecision analysis curve suggested that the model had good predictive performance, and in addition, the survival rate of low-risk patients was significantly better than that of the medium-and high-risk groups (P<0.001).Conclusion The nomogram prognostic model based on etiology-drug and alcohol, age, total serum bilirubin, prothrombin time, prothrombin time activity, international normalized ratio anddynamic MELD score has high clinical guideline significance in liver failure patients treated with non-bioartificial liver support system. |
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