乙型肝炎肝硬化伴腹水患者衰弱现状及影响因素分析OA
Current status survey and influencing factors of frailty in patients with hepatitis B cirrhosis complicated by ascites
目的 探析乙型肝炎肝硬化伴腹水患者发生衰弱的现状及影响因素,同时构建列线图模型并进行验证,以期为临床治疗提供参考.方法 选择2022年3月—2025年3月空军军医大学唐都医院收治的500例乙型肝炎肝硬化伴腹水患者为研究对象.根据患者是否发生衰弱分为未衰弱组(n=362)与衰弱组(n=138).收集全部患者的临床资料.采用logistic回归分析探讨乙型肝炎肝硬化伴腹水患者衰弱的影响因素.采用R软件的"ms"包构建列线图模型,通过绘制校准曲线、进行Hosmer-Lemeshow拟合优度检验、绘制受试者工作特征(ROC)曲线以及决策曲线等方式对模型开展内外部验证.结果 单因素分析结果显示:2组患者在年龄、身体质量指数(BMI)、Child-Pugh评分、肝硬化病程、凝血酶原时间(PT)、白细胞计数(WBC)水平、胆碱酯酶(CHE)水平、Barthel指数评分方面比较,差异均有统计学意义(P<0.05).多因素logistic回归分析结果显示:年龄、BMI、肝硬化病程、Child-Pugh评分、PT、WBC、CHE、Barthel指数是乙型肝炎肝硬化伴腹水患者发生衰弱的影响因素(P<0.05).ROC曲线显示,模型曲线下面积(AUC)为0.95(95%CI:0.93～0.97),提示该模型评估效能良好.对模型进行Hosmer-Lemeshow拟合优度检验,χ2=3.937,P=0.863,认为拟合的概率值和实际的概率值基本一致.决策曲线显示患者净获益均比另外2条极端曲线高,且阈值概率在0.02～1.00时,模型均能产生更好的临床效益.结论 年龄、BMI、肝硬化病程、Child-Pugh评分、PT、日常生活能力、CHE、WBC是乙型肝炎肝硬化伴腹水患者发生衰弱的影响因素,以此构建的列线图模型预测患者是否发生衰弱具有良好效能.
Objective To investigate the current status and influencing factors of frailty in patients with hepatitis B cirrhosis complicated by ascites,and to construct and validate a nomogram model,providing references for clinical treatment.Methods A total of 500 pa-tients with hepatitis B cirrhosis complicated by ascites admitted to Tangdu Hospital,Air Force Medical University from March 2022 to March 2025 were enrolled.Based on the occurrence of frailty,patients were assigned to non-frailty(n=362)and frailty groups(n=138).Clinical data were collected for all patients.Logistic regression analysis was used to identify factors influencing frailty.The"ms"package in R software was employed to construct a nomogram model.Internal and external validation of the model was performed by plotting calibration curves,conducting Hosmer-Lemeshow goodness-of-fit tests,plotting receiver operating characteristic(ROC)curves,and performing decision curve analysis(DCA).Results Univariate analysis showed statistically significant differences between the two groups in age,body mass index(BMI),Child-Pugh score,duration of cirrhosis,prothrombin time(PT),white blood cell count(WBC)level,cholinesterase(CHE)level,and Barthel Index score(P<0.05).Multivariate logistic regression analysis identified age,BMI,duration of cirrhosis,Child-Pugh score,PT,WBC,CHE,and Barthel Index were influencing factors for frailty in patients with hepatitis B cirrhosis complicated by ascites(P<0.05).The ROC curve showed an area under the curve(AUC)of 0.95(95%CI:0.93-0.97),indicating good predictive performance of the model.The Hosmer-Lemeshow goodness-of-fit test suggested that the fit-ted probability values were essentially consistent with the actual probability values(χ2=3.937,P=0.863).DCA demonstrated that the net benefit for patients was higher than that of the two extreme curves,and the model could yield better clinical benefit when the threshold probability ranged from 0.02 to 1.00.Conclusion Age,BMI,duration of cirrhosis,Child-Pugh score,PT,activities of daily living,CHE,and WBC are influencing factors for frailty in patients with hepatitis B cirrhosis complicated by ascites.The nomogram model constructed based on these factors demonstrates good efficacy in predicting the occurrence of frailty in these patients.
刘庆珍;党肖;汪春付;马颖颖;王李晶子;张岚;胡进佩
空军军医大学唐都医院传染病科,西安 710038空军军医大学唐都医院传染病科,西安 710038空军军医大学唐都医院传染病科,西安 710038空军军医大学唐都医院传染病科,西安 710038空军军医大学唐都医院传染病科,西安 710038空军军医大学唐都医院传染病科,西安 710038空军军医大学唐都医院传染病科,西安 710038
医药卫生
慢性乙型肝炎肝硬化腹水衰弱影响因素
Chronic hepatitis BCirrhosisAscitesFrailtyInfluencing factors
《保健医学研究与实践》 2026 (1)
23-29,7
陕西省重点研发计划项目(2022SF-186)空军军医大学第二附属医院科研课题项目(HLKYKT-202505).
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