乙肝后肝硬化患者死亡概率预测模型建立与评价

发布时间：2018-06-16 06:56

本文选题：乙肝后肝硬化 + 死亡概率　；参考：《中国公共卫生》2015年02期

【摘要】：目的建立和验证预测乙肝后肝硬化患者死亡概率的数学模型,为肝硬化患者选择适宜的治疗方案及合理分配肝移植的肝源提供参考依据。方法收集中南大学湘雅附属第一、二、三医院2000年11月—2012年11月收治的1 386例住院乙肝后肝硬化患者的临床记录和随访资料,应用logistic回归分析方法筛选变量建立患者入院后死亡预测数学模型,并运用受试工作者曲线(ROC)及儿童-特科特-pugh分级(CTP)评分、终末期肝病模型(MELD)评分比较其预测效率。结果经多因素logistic回归分析,凝血酶原时间国际标准化比值(INR)、血清钠(Na)、总胆红素(TBIL)、血清肌酐(CRE)、脾厚度、上消化道出血和肝性脑病等7个指标进入回归方程,对乙肝后肝硬化患者死亡预测的敏感度为91.5%,特异度为92.4%,正确指数为0.839,阳性预测值为84.6%,阴性预测值为96.0%,阳性似然比为12.04,阴性似然比为0.09;患者入院3个月时CTP评分、MELD评分、logistic回归模型ROC的曲线下面积(AUG)及其95%CI分别为0.786(0.762~0.789)、0.825(0.794~0.864)、0.912(0.875~0.931),3种评分方法的AUG差异有统计学意义(Z=2.16,P=0.015)。结论 logistic回归模型能较好判断乙肝后肝硬化患者的短期存活或死亡概率,具有较强的诊断准确度和预后评估价值。
[Abstract]:Objective to establish and verify a mathematical model for predicting the probability of death in patients with posthepatitic cirrhosis of hepatitis B, and to provide a reference basis for the selection of appropriate treatment schemes and the rational allocation of liver sources for liver transplantation. Methods the clinical records and follow-up data of 1 386 patients with posthepatitic cirrhosis admitted to Xiangya affiliated Hospital of Central South University from November 2000 to November 2012 were collected. Logistic regression analysis was used to establish the mathematical model of postadmission mortality prediction, and the predictive efficiency was compared by using the test worker curve (ROC) and the child-Tecot-pugh grade (CTP) score as well as the end-stage liver disease model (MELDD) score. Results by multivariate logistic regression analysis, seven indexes, I. e., International standardized ratio of prothrombin time (INRN), sodium, total bilirubin (TBILL), creatinine (creatinine) in serum, splenic thickness, upper digestive tract hemorrhage and hepatic encephalopathy, entered the regression equation. The sensitivity, specificity, correct index, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and negative likelihood ratio of the patients with posthepatitic cirrhosis were 91.5 and 91.5, 92.4, 0.839, 84.6, 96.0, 12.04 and 0.09 respectively. In logistic regression model, the area under the curve of ROC and its 95 CI were 0.786 / 0.762and 0.789 / 0 / 0.825 / 0.794 / 0. 864 / 0. There were statistically significant differences among the AUG scores of three scoring methods: ZJ2. 16, P0.015, and 0. 912, 0. 875, 0. 931, P = 0. 05, P, 0. 015, P = 0. 01515, P = 0. 015, P = 0. 015, respectively. Conclusion logistic regression model can judge the short term survival or death probability of patients with posthepatitic cirrhosis of hepatitis B, and has strong diagnostic accuracy and prognostic value.
【作者单位】：中南大学公共卫生学院流行病学与卫生统计学系;
【基金】：湖南省科学技术厅科技计划项目(2012FJ4133)
【分类号】：R575.2

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