慢性药物性肝损伤后肝功能恢复的风险预测模型构建

摘要/Abstract

摘要： 目的探讨影响慢性药物性肝损伤(DILI)3年后肝功能恢复的相关因素,并构建风险列线图模型。方法回顾性分析2017年1月至2019年12月在蒙城县第一人民医院127例确诊为慢性DILI患者的临床资料。比较3年后患者肝功能未恢复组和恢复组患者的临床资料。多因素分析影响慢性DILI患者3年后肝功能恢复的相关因素。构建慢性DILI患者3年后肝功能未恢复的风险预测模型并进行验证及效能评估。结果肝功能未恢复组与恢复组性别、年龄、BMI、吸烟史、饮酒史、合并基础疾病、用药史、临床分型、DILI严重程度分级、炎症分级、Hb、前白蛋白、WBC、TBil、IgA、IgG及IgM水平对比,差异均无统计学意义(P>0.05)。未恢复组纤维化程度分级为S3/S4级占比、ALT、AST、ALP及GGT水平高于恢复组(P<0.05),PLT水平低于恢复组(P<0.05)。多因素分析结果显示,纤维化程度分级为S3/S4级(OR=2.757,95%CI:1.054~6.963)、PLT(OR=0.347,95%CI:0.143~0.844)、ALT(OR=3.228,95%CI:1.328~7.846)及AST(OR=3.031,95%CI:1.247~7.367)均为影响慢性DILI患者3年后肝功能未恢复的独立相关因素(P<0.05)。以上述危险因素作为预测变量,建立列线图预测模型,列线图模型验证结果显示C-index指数为0.916(95%CI:0.872~0.935),校正曲线趋近于理想曲线(P>0.05)。ROC结果显示:列线图模型预测慢性DILI患者3年后肝功能未恢复的灵敏度为80.65%(95%CI:61.94%~91.88%),特异度为92.71%(95%CI:85.06%~96.77%),AUC为0.882(95%CI:0.812~0.932)。结论 PLT、ALT及AST均与慢性DILI患者3年后肝功能未恢复有关,基于上述危险因素建立的列线图模型对慢性DILI患者3年后肝功能未恢复的预测效能良好。

关键词: 慢性, 药物性肝损伤, 肝功能恢复, 风险因素, 列线图, 预测模型

Abstract: Objective To investigate the factors associated with the failure of liver function recovery following 3 years of chronic drug-induced liver injury (DILI) and to develop a predictive risk nomogram model.Methods Clinical data from 127 patients diagnosed with chronic DILI at the First People's Hospital of Mengcheng County between January 2017 and December 2019 were retrospectively analyzed. Patients were categorized into recovery and non-recovery groups based on their liver function status after 3 years. A comparative analysis was conducted between these groups. The study focused on multivariate analysis of factors influencing non-recovery in liver function among chronic DILI patients after 3 years. The primary Objective was to develop and validate an effective risk prediction model for chronic DILI patients whose liver function did not recover after 3 years.Results In the analysis of chronic DILI patients, no significant differences were observed between the non-recovery and recovery groups in terms of sex distribution, age, BMI, smoking and drinking history, comorbidities, medication history, clinical classification, DILI severity, inflammation grade, hemoglobin(Hb), prealbumin(PAB), white blood cell count(WBC), total bilirubin(TBIL), IgA, IgG and IgM levels(P>0.05). However, higher levels of fibrosis grade S3/S4, ALT, AST, ALP, and GGT were noted in the non-recovery group compared to the recovery group (P<0.05), along with lower platelet counts(PLT)(P<0.05). Multivariate analysis identified fibrosis grade S3/S4 (OR=2.757, 95% CI: 1.054~6.963), PLT (OR=0.347, 95% CI: 0.143~0.844), ALT (OR=3.228, 95% CI: 1.328~7.846) and AST (OR=3.031, 95% CI: 1.247~7.367) as independent factors influencing non-recovery of liver function in chronic DILI patients after 3 years (P<0.05). A nomoram prediction model was established using these risk factors.. The model`s validation indicated a C-index of 0.916 (95% CI: 0.872~0.935), with the correction curve closely aligning with the ideal curve (P>0.05). ROC analysis of the nomograph model revealed its efficacy in predicting the non-recovery of liver function in chronic DILI patients over a three-year period, with a sensitivity of 80.65% (95% CI: 61.94%~91.88%), specificity of 92.71% (95% CI: 85.06%~96.77%), and an AUC of 0.882 (95% CI: 0.812~0.932).Conclusion PLT, ALT and AST are all significantly asoociated with the failure of liver function recovery in patients with chronic DILI after 3 years. The nomogram model, developed based on these risk factors, demonstrates a strong predictive capability for assessing liver function recovery failure in chronic DILI patients over the same period .

Key words: Chronic, Drug induced liver injury, Liver function recovery, Risk factors, Nomogram, Prediction model

杨红, 谢鹏飞, 姜曼. 慢性药物性肝损伤后肝功能恢复的风险预测模型构建[J]. 肝脏, 2023, 28(12): 1480-1483.

YANG Hong, XIE Peng-fei, JIANG Man. Development of a risk prediction model for non-recovery of liver function following 3 years of chronic drug-induced liver injury[J]. Chinese Hepatolgy, 2023, 28(12): 1480-1483.

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