摘要
目的 以肝硬化伴食管胃静脉曲张破裂出血(EGVB)患者为研究对象,综合评估经颈静脉肝内门体分流术(TIPS)后生存相关危险因素,构建TIPS术后生存预测模型。方法 收集2015年1月—2018年12月在南京大学医学院附属鼓楼医院消化内科接受TIPS治疗的352例肝硬化伴EGVB患者的临床资料,并按照7∶3的比例随机分配至训练组(n=248)和验证组(n=104)。采用Cox回归分析筛选出影响TIPS术后生存的独立危险因素,构建预测模型列线图;采用一致性指数(C-index)和受试者操作特征曲线(ROC曲线)评估模型的区分能力,同时通过校准曲线评估模型预测价值。符合正态分布的计量资料两组间比较采用成组t检验;非正态分布的计量资料两组间比较采用Wilcoxon秩和检验。计数资料两组间比较采用χ^(2)检验。通过Kaplan-Meier分析计算累积生存率。结果 训练组患者的1、3、5年累积生存率分别为91.1%、79.5%和77.0%。Cox多因素回归分析结果显示,年龄(HR=1.047,95%CI:1.032~1.092,P<0.001)、MELD评分(HR=1.127,95%CI:1.003~1.268,P=0.045)和血清钠水平(HR=0.928,95%CI:0.878~0.981,P=0.008)是患者生存的独立影响因素,并以此建立预测模型和列线图。训练组和验证组预测模型C-index分别为0.760和0.757。训练组列线图预测1、3、5年生存率的ROC曲线下面积分别为0.807、0.788和0.787。校准曲线显示列线图预测与实际结果一致性较好。结论 基于年龄、MELD评分和血清钠构建了预测肝硬化伴EGVB患者TIPS术后生存的列线图模型,该模型具有良好的区分度与准确度。
Objective To investigate the risk factors for survival after transjugular intrahepatic portosystemic shunt(TIPS)in patients with liver cirrhosis and esophagogastric variceal bleeding(EGVB),and to establish a predictive model for survival after TIPS.Methods Clinical data were collected from 352 patients with liver cirrhosis and EGVB who underwent TIPS in Department of Gastroenterology,Affiliated Drum Tower Hospital of Nanjing University Medical School,from January 2015 to December 2018,and the patients were randomly divided into training group(n=248)and validation group(n=104)at a ratio of 7∶3.The Cox regression analysis was used to identify the independent risk factors for survival after TIPS,and a nomogram predictive model was established.The index of concordance(C-index)and the receiver operating characteristic(ROC)curve were used to assess the discriminatory ability of the model,and the calibration curve was used to assess the predictive value of the model.The independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups.The Kaplan-Meier analysis was used to calculate cumulative survival rate.Results For the patients in the training group,the 1-,3-,and 5-year cumulative survival rates were 91.1%,79.5%,and 77.0%,respectively.The multivariate Cox regression analysis showed that age(hazard ratio[HR]=1.047,95%confidence interval[CI]:1.032—1.092,P<0.001),MELD score(HR=1.127,95%CI:1.003—1.268,P=0.045),and serum sodium(Na)(HR=0.928,95%CI:0.878—0.981,P=0.008)were independent influencing factors for survival,and a predictive model and a nomogram were established based on these factors.The predictive model had a C-index of 0.760 in the training group and 0.757 in the validation group.In the training group,the nomogram had an area under the ROC curve of 0.807,0.788,and 0.787,respectively,in predicting 1-,3-,and 5-year cumulative survival rates.The calibration curve showed relatively high consistency between the results predicted by the nomogram and the actual results.Conclusion A nomogram model is established based on age,MELD score,and Na for predicting survival after TIPS in patients with liver cirrhosis and EGVB,and this model has good discriminatory ability and accuracy.
作者
尹晓春
诸葛宇征
张峰
YIN Xiaochun;ZHUGE Yuzheng;ZHANG Feng(Department of Gastroenterology,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;Department of Gastroenterology,Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《临床肝胆病杂志》
北大核心
2025年第6期1120-1127,共8页
Journal of Clinical Hepatology
基金
国家自然科学基金(82370628)。
关键词
肝硬化
食管和胃静脉曲张
门体分流术
经颈静脉肝内
预后
列线图
Liver Cirrhosis
Esophageal and Gastric Varices
Portasystemic Shunt,Transjugular Intrahepatic
Prognosis
Nomograms
作者简介
通信作者:张峰,fzdndx@126.com(ORCID:0000-0002-3653-5977)。
