乙肝肝硬化门脉高压进展的危险因素分析及列线图预测模型构建

Analysis of Risk Factors for the Progression of Portal Hypertension in Hepatitis B Cirrhosis and Construction of a Nomogram Prediction Model

摘要: 目的：探讨乙肝肝硬化门脉高压进展的危险因素并建立预测模型，并验证其预测价值。方法：选取2022年6月至2023年9月在青岛市第六人民医院住院的行HVPG检查的患者共180例，其中符合乙肝肝硬化门脉高压的患者88例，根据HVPG数据将其分为5 mmHg < HVPG < 10 mmHg组和HVPG ≥ 10 mmHg组，分析患者的一般资料、合并症及实验室指标。采用单因素及二元Logistic回归分析法筛选其危险因素并建立Logistic回归模型，并在此基础上构建列线图预测模型。结果：单因素分析结果显示白细胞计数(WBC)、凝血酶原时间(PT)、血清总胆红素(TBIL)、前白蛋白(PA)、白蛋白(ALB)、肝硬度(LSM)与乙肝肝硬化门脉高压进展具有相关性(P < 0.05)，多因素分析结果显示，前白蛋白(OR 0.982, 95% CI 0.967~0.997, P = 0.019)、肝硬度(OR 1.308, 95% CI 1.101~1.554, P = 0.002)，是门脉高压进展的独立危险因素。基于多因素Logistic回归分析结果，构建乙肝肝硬化门脉高压进展的风险预测列线图模型。Hosmer-Lemeshoe拟合优度检验结果显示，该列线图模型的拟合程度较好(χ2 = 6.88, P = 0.5495)。校准曲线分析结果显示，该列线图模型预测乙肝肝硬化门脉高压进展的发生率与实际发生率基本吻合。ROC曲线分析结果显示，该列线图模型乙肝肝硬化门脉高压进展的AUC为0.900 (P < 0.001, 95% CI: 0.834~0.966)，模型净获益。结论：前白蛋白及肝硬度是乙肝肝硬化门脉高压进展的独立危险因素，据此建立的模型为临床早期预测和判断临床显著门脉高压患者提供参考。

Abstract: Objectives: To investigate the risk factors for the progression of portal hypertension in hepatitis B cirrhosis, establish a prediction model, and verify its predictive value. Methods: A total of 180 pa-tients hospitalized in the Sixth People’s Hospital of Qingdao from June 2022 to September 2023 who underwent HVPG examination were selected. Among them, 88 patients with portal hypertension due to hepatitis B cirrhosis were divided into 5 mmHg< HVPG < 10 mmHg group and HVPG ≥ 10 mmHg group according to HVPG data. The general information, complications and laboratory indi-cators of the patients were analyzed. Single factor and binary logistic regression analysis were used to screen the risk factors and establish a logistic regression model. Based on this, a column chart prediction model was constructed. Results: Univariate analysis showed that white blood cell count (WBC), prothrombin time (PT), serum total bilirubin (TBIL), prealbumin (PA), albumin (ALB), liver stiffness (LSM) were correlated with the progression of portal hypertension in hepatitis B cirrhosis (P < 0.05), multivariate analysis showed that prealbumin (OR 0.982, 95% CI 0.967~0.997, P = 0.019) and liver stiffness (OR 1.308, 95% CI 1.101~1.554, P = 0.002) were independent risk factors for the progression of portal hypertension. Based on the results of multivariate logistic regression analysis, a risk prediction nomogram model for the progression of portal hypertension in hepatitis B cirrho-sis was constructed. The results of Hosmer-Lemeshoe’s goodness-of-fit test showed that the nomo-gram model had a good fit (χ2 = 6.88, P = 0.5495). The results of calibration curve analysis showed that the nomogram model predicted the incidence of portal hypertension progression in hepatitis B cirrhosis and the actual incidence rate was basically consistent. The results of ROC curve analysis showed that the AUC of portal hypertension progression in hepatitis B cirrhosis was 0.900 (P < 0.001, 95% CI: 0.834~0.966). Conclusion: Low prealbumin and LSM are independent risk factors for the progression of portal hypertension in patients with chronic hepatitis B cirrhosis, and the pre-diction model established by this method provides a reference for early clinical prediction and judgment of clinically significant portal hypertension patients.