颈静脉肝内门体分流术治疗肝硬化顽固性腹水疗效的影响因素及疗效预测模型构建OA
Factors influencing the efficacy of TIPS in the treatment of refractory ascites in liver cirrhosis and construction of a predictive model for efficacy
目的:分析影响颈静脉肝内门体分流术(TIPS)治疗肝硬化顽固性腹水疗效的影响因素并构建疗效预测模型.方法:选取360例行TIPS治疗的肝硬化顽固性腹水患者,依据简单随机化的方式分为建模组(252例)和验证组(108例).收集患者临床资料,随访1年,观察建模组患者生存及死亡情况,采用多因素Cox回归分析影响TIPS治疗肝硬化顽固性腹水疗效的因素.采用受试者工作特征(ROC)曲线及校正曲线分析验证列线图模型的预测价值.结果:对建模组患者随访1年,生存156例(61.90％),死亡96例(38.10％).多因素Cox回归分析显示,年龄增长、Child-Pugh 评分升高、MELD评分升高及大量腹水为影响TIPS治疗肝硬化顽固性腹水疗效的独立危险因素(P＜0.05).使用R软件构建预测模型,绘制Hosmer-Lemeshow拟合度曲线评估模型的有效性,结果显示建模组x2=7.569,P=0.457;验证组x2=6.754,P=0.356.绘制ROC曲线评估模型的区分度,结果建模组ROC曲线下面积为0.904(95％CI=0.861～0.937),灵敏度、特异度分别为 80.21％、87.18％;验证组 ROC 曲线下面积为 0.854(95％CI=0.804～0.895),灵敏度、特异度分别为81.25％、72.44％.结论:年龄增长、Child-Pugh评分升高、MELD评分升高及大量腹水是影响TIPS治疗肝硬化顽固性腹水疗效的独立危险因素,以此构建的列线图可作为临床预测TIPS治疗肝硬化顽固性腹水疗效的有效工具.
Objective:To analyze the influencing factors of the curative effect of transjugular intrahepatic portosystemic stent shunt(TIPS)in the treatment of refractory ascites in cirrhosis,and to construct a predictive curative model.Methods:360 patients with refractory ascites due to liver cirrhosis treated with TIPS(admitted to our hospital)were selected and randomly divided into a modeling group(252 cases)and a validation group(108 cases)based on a simple randomization method.The data of the patients were collected,and the patients were followed up for 1 year.They were grouped into the survival group and the death group according to the survival situation,and the factors affecting the efficacy of the patients were analyzed(univariate and multivariate Cox analysis).Using receiver operating characteristic(ROC)curve and calibration curve analysis to validate the predictive value of the column chart model.Results:After treatment,the patients were followed up for 1 year,156 cases(61.9％)survived,and 96 cases(38.1％)died.Univariate analysis showed that age,Child-Pugh score,MELD score and ascites volume were the factors affecting the efficacy of TIPS in the treatment of refractory ascites in cirrhosis(P＜0.05);four different variables including age,Child-Pugh score,model for end-stage liver disease(MELD)score and ascites volume were included in the multivariate analysis,and it was shown that older age,higher Child-Pugh score,higher MELD score and more ascites volume were independent risk factors affecting the efficacy of TIPS in the treatment of refractory ascites in liver cirrhosis(P＜0.05).R software was used to build a prediction model,and the H-L fit curve was drawn to evaluate the validity of the model,and the results showed that the modeling group x2=7.569,P=0.457;the validation group x2=6.754,P=0.356.The ROC curve was drawn to evaluate the discrimination of the model,the results showed that the area under the ROC curve of the modeling group was 0.904(95％CI:0.861-0.937),and the sensitivity and specificity were 80.21％and 87.18％,respectively.The area under the ROC curve of the validation group was 0.854(95％CI:0.804-0.895),and the sensitivity and specificity were 81.25％and 72.44％,respectively.Conclusion:Older age,higher Child-Pugh score,higher MELD score and more ascites are independent risk factors that affect the efficacy of TIPS for refractory ascites.The nomogram constructed in this way can be used as an effective tool to clinically predict the efficacy of TIPS in the treatment of refractory ascites in cirrhosis.
向波;王勤;李洪焱
重庆市南川区人民医院消化内科(重庆,408400)重庆市南川区人民医院消化内科(重庆,408400)重庆市南川区人民医院消化内科(重庆,408400)
医药卫生
肝硬化顽固性腹水颈静脉肝内门体分流术疗效预测预测模型
refractory ascites in cirrhosistransjugular intrahepatic portosystemic stent shuntefficacy predictionpredictive model
《中西医结合肝病杂志》 2026 (2)
154-158,5
2019年四川医学青年创新科研课题(No.Q19033)
评论