摘要
目的建立HBV相关原发性肝癌并发自发性腹膜炎的列线图预测模型并对其进行评价。方法选取2012年1月-2022年12月在昆明市第三人民医院住院治疗的1298例HBV相关原发性肝癌患者进行回顾性研究;收集患者的一般资料和血清学指标,按照是否合并自发性腹膜炎分为感染组(n=262)与对照组(n=1036)。采用单因素和LASSO回归分析筛选变量,然后采用二元logistic回归分析HBV相关原发性肝癌患者发生自发性腹膜炎的影响因素并据此建立列线图预测模型,最后采用Hosmer-lemeshow(H-L)拟合优度检验、受试者操作特征(ROC)曲线、校准曲线、决策曲线分析(DCA)、临床影响曲线(CIC)对列线图预测模型的拟合度、准确性、校准性、临床实用性进行评价。结果单因素分析结果显示,两组在是否有门静脉癌栓(PVTT)、Child-Pugh分级、中国肝癌分期方案(CNLC)分期、饮酒史、吸烟史、白细胞计数(WBC)、中性粒细胞计数(NE)、血红蛋白(Hb)、纤维蛋白原(FIB)、异常凝血酶原(PIVKA-Ⅱ)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、总蛋白(TP)、前白蛋白(PA)、γ-谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)、胆碱酯酶(CHE)、总胆汁酸(TBA)、总胆固醇(TC)、低密度脂蛋白(LDL)、肌酐(Cr)、HBV DNA、CD3+T细胞计数、CD4+T细胞计数、CD8+T细胞计数、CD4+T细胞/CD8+T细胞比值、降钙素原(PCT)、血清淀粉样蛋白A(SAA)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、甲胎蛋白(AFP)、IL-4等方面差异有统计学意义(P<0.05)。LASSO回归分析筛选出Child-Pugh分级、PVTT、WBC、CHE、hs-CRP 5个变量;二元logistic回归分析结果显示,Child-Pugh分级(B级:OR=5.780,95%CI 3.271~10.213,P<0.001;C级:OR=14.818,95%CI 7.697~28.526,P<0.001)、PVTT(OR=2.893,95%CI 2.037~4.108,P<0.001)、WBC(OR=1.088,95%CI1.031~1.148,P=0.002)、hs-CRP(OR=1.005,95%CI 1.001~1.010,P=0.026)为HBV相关原发性肝癌患者发生自发性腹膜炎的独立危险因素。利用这4个变量构建列线图预测模型并对该模型进行评价,H-L拟合优度检验的P值为0.760,ROC曲线下面积为0.866、敏感度为0.870、特异度为0.716,校准曲线平均绝对误差为0.022,DCA和CIC分析显示该列线图预测模型具有一定的临床效用。结论利用Child-Pugh分级、PVTT、WBC、hs-CRP共4个变量构建的HBV相关原发性肝癌患者发生自发性腹膜炎的列线图预测模型具有较高的拟合度和准确度,预测概率与实际发生概率一致性较高,同时具有一定的临床实用性。
Objective To establish and evaluate a nomogram prediction model for spontaneous peritonitis in HBV-related primary liver cancer.Methods A retrospective study was conducted on 1298 patients with HBV-related primary liver cancer hospitalized in the Kunming Third People's Hospital from January 2012 to December 2022.General data and serological indicators were collected,and patients were divided into infection group(n=262)and control group(n=1036)based on the occurrence of spontaneous peritonitis.Univariate and LASSO regression analyses were used to screen variables,followed by binary logistic regression to analyze the influencing factors of spontaneous peritonitis in HBV-related primary liver cancer patients,leading to the establishment of a nomogram prediction model.Finally,the Hosmer-lemeshow(H-L)goodness of fit test,receiver operating characteristic(ROC)curve,calibration curve,decision curve analysis(DCA)and clinical impact curve(CIC)were utilized to evaluate the fit degree,accuracy,calibration,and clinical practicability of the nomogram prediction model.Results Single factor analysis revealed significant differences between infection group and control group in portal vein cancer thrombus(PVTT),Child-Pugh grade,China Liver Cancer Staging(CNLC)stage,alcohol consumption history,smoking history,white blood cell count(WBC),neutrophil count(NE),hemoglobin(Hb),fibrinogen(FIB),abnormal prothrombin(PIVKA-Ⅱ),aspartate aminotransferase(AST),alanine aminotransferase(ALT),total protein(TP),prealbumin(PA),γ-glutamyltransferase(GGT),alkaline phosphatase(ALP),cholinesterase(CHE),total bile acid(TBA),total cholesterol(TC),low density lipoprotein(LDL),creatinine(Cr),HBV DNA,CD3+T cells count,CD4+T cells count,CD8+T cells count,CD4+T cells/CD8+T cells ratio,procalcitonin(PCT),serum amyloid A(SAA),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP),alpha-fetoprotein(AFP),and IL-4(P<0.05).LASSO regression analysis identified 5 variables:Child-Pugh grade,PVTT,WBC,CHE and hs-CRP.Binary logistic regression analysis indicated that Child-Pugh grade(Grade B:OR=5.780,95%CI 3.271-10.213,P<0.001;Grade C:OR=14.818,95%CI 7.697-28.526,P<0.001),PVTT(OR=2.893,95%CI 2.037-4.108,P<0.001),WBC(OR=1.088,95%CI 1.031-1.148,P=0.002),and hs-CRP(OR=1.005,95%CI 1.001-1.010,P=0.026)were the independent risk factors of spontaneous peritonitis in HBV-related primary liver cancer patients.Using these 4 variables,a nomogram prediction model was constructed and evaluated.The P-value of the H-L goodness of fit test was 0.760.Moreover,the area under ROC curve(AUC)was 0.866,with a sensitivity of 0.870 and a specificity of 0.716.The average absolute error of the calibration curve is 0.022.DCA and CIC analyses demonstrated that the nomogram prediction model possessed some clinical utility.Conclusion The nomogram prediction model for spontaneous peritonitis in HBV-related primary liver cancer patients,constructed using Child-Pugh grade,PVTT,WBC and hs-CRP,exhibits a high fitting degree and accuracy,with the prediction probability highly consistent with the actual occurrence probability,and possesses certain clinical practicability.
作者
魏红艳
陈永臻
田仁海
常丽仙
张映媛
许丹青
刘春云
刘立
Wei Hong-Yan;Chen Yong-Zhen;Tian Ren-Hai;Chang Li-Xian;Zhang Ying-Yuan;Xu Dan-Qing;Liu Chun-Yun;Liu Li(Department of Hepatology and Immunology,Kunming Third People's Hospital/Yunnan Clinical Center for Infectious Diseases,Kunming,Yunnan 650041,China;School of Public Health,Dali University,Dali,Yunnan 671000,China)
出处
《解放军医学杂志》
北大核心
2025年第8期949-957,共9页
Medical Journal of Chinese People's Liberation Army
基金
昆明市卫生健康委员会卫生科研课题(2023-03-08-001,2022-03-08-008)。
关键词
慢性乙型肝炎
原发性肝癌
自发性腹膜炎
列线图
chronic hepatitis B
primary liver cancer
spontaneous peritonitis
nomogram
作者简介
魏红艳,硕士研究生,主要从事疾病预防与控制方面的研究;通信作者:刘春云,E-mail:15887004598@163.com;通信作者:刘立,E-mail:liuli197210@163.com。
