摘要
目的探讨原发性干燥综合征(pSS)合并肝损伤患者血液检查指标变化情况,分析其独立影响因素,构建预测模型。方法选取2017年3月至2022年12月期间上海市同济医院风湿免疫科住院的pSS患者为研究对象。依据pSS患者是否出现肝损伤分组。对比两组患者的一般情况以及血液检查实验室指标,完成pSS患者合并出现肝损伤的单因素分析。以单因素分析结果中具有统计学意义的变量作为自变量,以pSS患者是否合并出现肝损伤作为因变量,实施logistic回归多因素分析,筛选pSS患者合并出现肝损伤的独立影响因素。利用logistics回归模型筛选出的独立影响因素以及logistics回归模型的P值预测概率,采用受试者工作特征(ROC)曲线的方法,对各指标及pSS合并肝损伤的风险预测效能进行计算。结果共241例pSS患者纳入研究,男性13例,女性228例,平均年龄(57.35±13.22)岁,平均病程(7.84±2.36)年。pSS肝损伤85人,pSS无肝损伤156人。两组患者的ANA阳性率、AMA-M2抗体阳性率、抗SSB抗体阳性率、IgM升高率、C4降低率、ESSDAI评分、DBIL、TBA、ALT、AST、γ-GT、ALP的数据差异有统计学意义(均P<0.05)。多因素分析结果显示,ANA阳性、AMA-M2抗体阳性、抗SSB抗体阴性、IgM升高、C4减低、高ESSDAI评分、肝功能指标DBIL、TBA、γ-GT升高是pSS患者出现肝损伤的独立危险因素(P<0.05)。利用logistics回归模型的独立影响因素以及P值预测概率对pSS合并肝损伤的风险进行预测,约登指数分别为13.33%、16.58%、13.97%、18.51%、16.37%、44.74%、48.27%、40.68%、57.89%、82.04%。结论肝损伤在pSS患者中发生率较高,部分血液检查指标可构成该类患者肝损伤的独立影响因素,并且对于肝损伤的出现具有良好的预测效果。
Objective To research the changes in blood test indicators in patients with primary Sjogren's syndrome(pSS)combined with liver injury,analyzing their independent influencing factors,and constructing a predictive model.Methods Patients with pSS admitted to the Rheumatology and Immunology Department of Tongji Hospital in Shanghai from March 2017 to December 2022 were selected as the study subjects.Grouping based on whether pSS patients have liver injury.Compare the general situation and blood test laboratory indicators of two groups of patients,and complete a univariate analysis of pSS patients with liver injury.Using statistically significant variables in the univariate analysis results as independent variables and whether pSS patients have liver injury as dependent variables,logistic regression multivariate analysis was performed to screen for independent influencing factors of liver injury in pSS patients.Using the independent influencing factors screened out by the logistic regression model and the P-value prediction probability of the logistic regression model,the risk prediction efficacy of each indicator for pSS combined with liver injury was calculated using the method of receiver operating characteristic(ROC)curve.Results A total of 241 patients with pSS were included in the study,including 13 males and 228 females,with an average age of(57.35±13.22)years and a mean course of disease of(7.84±2.36)years.85 cases of pSS liver injury and 156 cases of pSS without liver injury.The ANA positive rate,AMA-M2 antibody positive rate,anti SSB antibody positive rate,IgM increase rate,C4 decrease rate,ESSDAI score,DBIL,TBA,ALT,ASTγ-GT and ALP were statistically significant(both P<0.05).The results of multivariate analysis showed that ANA was positive,AMA-M2 antibody was positive,anti SSB antibody was negative,IgM was increased,C4 was reduced,ESSDAI score was high,elevated liver function indicators DBIL,TBA,γ-GT were an independent risk factor for liver injury in pSS patients(P<0.05).The independent influencing factors and P-value prediction probability of logistic regression model were used to predict the risk of pSS combined with liver injury.The Jordan index was 13.33%,16.58%,13.97%,18.51%,16.37%,44.74%,48.27%,40.68%,57.89%,and 82.04%,respectively.Conclusion The incidence of liver injury is relatively high in patients with pSS,and some blood test indicators can constitute independent influencing factors for liver injury in such patients,and have a good predictive effect on the occurrence of liver injury.
作者
梁媛媛
王艳青
吴珍珍
潘胜男
王璇
汤建平
LIANG Yuanyuan;WANG Yanqing;WU Zhenzhen;PAN Shengnan;WANG Xuan;TANG Jianping(Department of Rheumatology and Immunology,Shanghai Tongji Hospital,Shanghai 200065,China)
出处
《中国实验诊断学》
2023年第12期1387-1392,共6页
Chinese Journal of Laboratory Diagnosis
基金
国家自然科学基金(81671598)
中华国际医学交流基金会(Z-2014-06-2-1620)
上海吴孟超医学科技基金会(JJHXM-2019011)
同济大学附属同济医院临床研究培育重点项目(ITJZD1909)
作者简介
通信作者:汤建平
