摘要
目的调查HIV/AIDS患者出现肝损伤发生情况,建立其预测模型并进行验证。方法选择2021年1~12月四川绵阳四○四医院接诊的290例新确诊HIV/AIDS患者,以7∶3分为模型组203例与验证组87例。收集可能影响HIV/AIDS患者肝损伤的因素,根据有无出现肝损伤将患者分为2组,比较2组患者性别、年龄、BMI等各因素,采用LASSO回归筛选变量后行多因素Logistic回归筛选出独立性影响因素,根据Logistic回归结果构建列线图模型。结果肝损伤组与无肝损伤组患者饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、使用其他类型抗反转录病毒药物、磺胺类药物使用情况、糖尿病、心血管病、营养状况差异均具有统计学意义(P<0.05)。LASSO回归模型筛选出7个潜在影响因素:饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况。多因素Logistic回归分析显示:饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况是HIV/AIDS患者肝损伤的独立影响因素(P<0.05)。基于上述影响因素构建HIV/AIDS患者肝损伤风险预测的列线图模型,模型组列线图模型预测HIV/AIDS患者肝损伤的受试者操作曲线下面积(area under the subject curve,AUC)为0.969(95%CI:0.904,0.988);验证组AUC为0.971(95%CI:0.905,0.992)。Bootstrap法重复抽样1000次,并以验证组进行验证,校准曲线结果显示:模型组与验证组预测曲线与标准曲线基本拟合;H-L拟合优度检验结果显示,该列线图模型预测HIV/AIDS患者肝损伤的概率与实际概率比较,差异无统计学意义(χ^(2)=2.088,P=0.148)。模型组决策曲线分析结果显示:当该列线图模型预测HIV/AIDS患者肝损伤的概率阈值为0.15~0.95时,患者的净受益率>0;验证组决策曲线分析结果显示:当该列线图模型预测HIV/AIDS患者肝损伤的概率阈值为0.10~0.95时,患者的净受益率>0。结论饮酒史、CD4^(+)T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况是HIV/AIDS患者肝损伤的独立影响因素,基于上述因素构建的列线图模型用于HIV/AIDS肝损伤风险预测具有较高的准确度。
ObjectiveTo investigate the occurrence of liver injury in HIV/AIDS patients,and establish and verify its prediction model.MethodsA total of 290 newly-diagnosed HIV/AIDS patients admitted to Mianyang 404 Hospital from January to December 2021 were subjected,and then assigned into a test group(n=203)and validation group(n=87)at a ratio of 7∶3.The factors that may affect the liver injury in HIV/AIDS patients were collected.The patients were divided into 2 groups according to the presence or absence of liver injury.Their gender,age,BMI and other factors were compared between the 2 groups.LASSO regression analysis was used to screen variables,then multivariate logistic regression analysis was employed to screen out independent influencing factors,and a nomogram model was constructed according to the logistic regression results.ResultsThere were statistical differences between the patients with and without liver injury in history of alcohol drinking,CD4^(+)T lymphocyte level,use of antifungal drugs,other types of antiretroviral drugs and sulfonamides,complications of tuberculosis,diabetes,cardiovascular disease,and nutritional status(P<0.05).LASSO regression model screened out 7 potential influencing factors,including drinking history,CD4^(+)T lymphocyte level,antifungal drug use,comorbid tuberculosis infection,diabetes,cardiovascular disease,and nutritional status.Multivariate logistic regression analysis showed that drinking history,CD4^(+)T lymphocyte level,use of antifungal drugs,comorbid tuberculosis,diabetes,cardiovascular disease,and nutritional status were independent influencing factors of liver injury in HIV/AIDS patients(P<0.05).Based on the above influencing factors,a nomogram model for predicting the risk of liver injury in HIV/AIDS patients was constructed.The results of ROC curve analysis showed that the area under the subject curve(AUC)of the model group was 0.969(95%CI:0.904~0.988),and the AUC of the validation group was 0.971(95%CI:0.905~0.992)for predicting liver injury in HIV/AIDS patients.After Bootstrapping was conducted for repeated sampling 1000 times,and the verification group was used for verification.The results of the calibration curve indicated that the prediction curve of the model group and the verification group basically fitted the standard curve.The results of the H-L goodness of fit test suggested that the nomogram model predicted the probability of liver injury in HIV/AIDS patients was not significantly different from the actual probability(Chi-square=2.088,P=0.148).The analysis results of decision curve of model group showed that when the probability threshold of predicting liver injury of HIV/AIDS patients by the nomograph model was 0.15~0.95,the net benefit rate of patients was greater than 0.While,the analysis results of the decision curve of the validation group showed that when the probability threshold of predicting the liver injury of HIV/AIDS patients by the nomograph model was 0.10~0.95,the net benefit rate of the patients was greater than 0.ConclusionHistory of drinking,CD4^(+)T lymphocyte level,use of antifungal drugs,comorbid tuberculosis infection,diabetes,cardiovascular disease,and nutritional status are independent influencing factors of liver injury in HIV/AIDS patients.Our nomogram model constructed based on the above factors has high accuracy and discrimination for HIV/AIDS liver injury risk prediction.
作者
文丽娟
雷学忠
司果
龙波
何易佳
WEN Lijuan;LEI Xuezhong;SI Guo;LONG Bo;HE Yijia(Department of Infectious Diseases,Sichuan Mianyang 404 Hospital,Mianyang,Sichuan Province,621000;Center of Infectious Diseases,West China Hospital,Sichuan University,Chengdu,Sichuan Province,610044,China)
出处
《陆军军医大学学报》
CAS
CSCD
北大核心
2023年第8期817-824,共8页
Journal of Army Medical University
基金
国家科技重大专项(2017ZX10202203-008-005)
四川省科技计划重点研发项目(2018SZ0137)。
作者简介
通信作者:雷学忠,E-mail:18980601317@163.com。
