乙型肝炎病毒感染患者抗病毒治疗后肾损伤风险预测模型的构建与验证OA

Objective To investigate the risk factors for renal injury in patients with hepatitis B virus(HBV)infection receiving regular nucleotide analogue(NAs)therapy,construct a renal injury prediction model,and validate its efficacy.Methods A total of 484 patients with chronic HBV in-fection admitted to Qingdao Sixth People's Hospital were selected as modeling group,and 208 patients with chronic HBV infection admitted to Qingdao Municipal Hospital were selected as validation group.Univariate and multivariate logistic regression analyses were used to screen the independent influen-cing factors for renal injury in patients in the modeling group,and a prediction model was constructed.The receiver operating characteristic(ROC)curve was drawn,and decision curve analysis(DCA)was performed to evaluate the efficacy of the prediction model.Results Univariate analysis in the modeling group showed that compared with non-renal injury patients,renal injury patients were ol-der,had more severe disease stages,and had a higher proportion of comorbid hypertension and dia-betes.They also had longer activated partial thromboplastin time(APTT)and prothrombin time(PT),higher levels of total bilirubin,aspartate aminotransferase(AST),phosphorus,blood glu-cose,and uric acid,and lower levels of red blood cell count,hemoglobin,platelet count,albumin,and hepatitis B virus surface antigen(HBsAg).All these differences were statistically significant(P＜0.05).Multivariate logistic regression analysis showed that age(OR=1.104,P＜0.001),hypertension(OR=2.556,P=0.005),hemoglobin(OR=0.976,P＜0.001),APTT(OR=1.131,P＜0.001),phosphorus(OR=13.142,P=0.001),and uric acid(OR=1.008,P＜0.001)were independent influencing factors for renal injury in HBV-infected patients regularly tak-ing NAs orally.Based on these factors,a renal injury prediction model was constructed.The ROC curve showed that the area under the curve(AUC)for predicting renal injury by this prediction model was 0.876 in the modeling group and 0.826 in the validation group.The DCA results showed that using this prediction model was beneficial for clinical decision-making at all probability thresh-olds.Conclusion Age,hypertension,hemoglobin,APTT,blood phosphorus,and uric acid are independent predictive factors for renal injury in HBV-infected patients regularly taking NAs orally.The prediction model constructed based on these factors has been validated to show high clinical practical value.