个体化预测老年患者消化道术后肠外营养相关性肝损伤列线图模型的建立及验证

摘要/Abstract

摘要： 目的构建老年患者消化道术后肠外营养(PN)相关性肝损伤列线图预测模型并验证。方法收集2018年3月至2022年3月本院的368例老年消化道术后PN患者的完整资料,依据是否发生PN相关肝损伤分为损伤组与对照组,基于患者资料建立列线图模型,再收集2022年3月至2024年3月的158例患者的资料,对建立的模型进行外部验证。多因素logistic回归模型分析影响因素;R3.6.3软件及rms程序包构建老年消化道术后PN相关肝损伤的列线图预测模型;列线图模型的区分度和一致性用受试者工作特征(ROC)曲线、校准曲线评估。结果损伤组白蛋白(Alb)[(31.75±7.92)g/L]、前白蛋白(PAB)[(128.73±32.56)mg/L]均低于对照组[(37.82±8.71)g/L、(175.96±38.71)mg/L],尿素氮(BUN)、血肌酐(Scr)、C-反应蛋白(CRP)、禁食时间、PN时间均高于对照组(P<0.05)。多因素logistic结果显示,Alb(OR=0.910,95%CI=0.842~0.983)、PAB(OR=0.951,95%CI=0.931~0.972)、PN时间(OR=2.225,95%CI=1.535~3.226)、禁食时间(OR=1.725,95%CI=1.379~2.157)均是PN相关肝损伤的影响因素(P<0.05)。列线图模型显示,Alb每降低1 g/L增加3.42分的权重;PAB每降低10 mg/L增加7.14分的权重;禁食时间每增加1 d增加7.81分的权重;PN时间每增加1 d增加5.73分的权重。H-L拟合度检验显示模型一致性较好(χ²=8.129、P=0.421)。ROC曲线下面积(AUC)为0.881(95%CI:0.832~0.929),表明该模型区分度较好。外部验证结果亦显示模型一致性(χ²=5.586、P=0.694)、区分度均较好,AUC为0.931(95%CI:0.893~0.969)。结论 Alb、PAB、禁食时间及PN时间均是老年消化道术后PN患者PN相关肝损伤的影响因素,本研究建立的列线图风险预测模型实用性较高。

关键词: 消化道手术, 肠外营养, 肠外营养相关性肝损伤, 列线图

Abstract: Objective To construct and validate a column chart prediction model for postoperative parenteral nutrition (PN) associated liver disease(PNALD) in elderly gastrointestinal surgery patients. Methods The complete data were collected from 368 elderly postoperative PN patients in our hospital from March 2018 to March 2022. Patients were divided into two groups based on whether PN related liver injury occurred: the injury group and the control group. A column chart model was established based on data of 368 patients. Data from 158 patients from March 2022 to March 2024 were collected for external validation of the established model. The multi factor logistic regression model was used to analyze the influencing factors. The R3.6.3 software and RMS package were used to construct a column chart prediction model for PN related liver injury in elderly patients after gastrointestinal surgery. The discrimination and consistency of the column chart model ere evaluated using receiver operating characteristic (ROC) curves and calibration curves. Results The albumin (ALB)[(31.75±7.92)g/L] and prealbumin (PAB)[(128.73±32.56)mg/L] in the injury group were lower than those in the control group[(37.82±8.71)g/L、(175.96±38.71)mg/L], while urea nitrogen (BUN), serum creatinine (Scr), C-reactive protein (CRP), fasting time[(15.68±4.28)d], and PN time[(12.85±2.57)d] were higher than those in the control group[(11.04±2.63)d、(9.11±1.84)d] (P<0.05). Multivariate logistic regression showed that ALB(OR=0.910,95CI%=0.842~0.983), PAB(OR=0.951,95CI%=0.931~0.972), PN time(OR=2.225,95CI%=1.535~3.226), and fasting time(OR=1.725,95CI%=1.379~2.157) were all influencing factors of PN related liver injury (P<0.05). The column chart model showed that for every 1g/L decrease in ALB, the weight increased by 3.42 points; for every 10 mg/L decrease in PAB, the weight increased by 7.14 points; the weight increased by 7.81 points for every additional day of fasting time; the weight increased by 5.73 points for every 1-day increase in PN time. The H-L fit test showed a χ² of 8.129 and a P-value of 0.421, indicating good consistency. The area under the ROC curve was 0.881 (95% CI: 0.832~0.929), indicating good discrimination of the model. The external validation results showed good model consistency (χ²=5.586, P=0.694) and discriminability, with an AUC of 0.931 (95% CI: 0.893~0.969). Conclusion Alb, PAB, fasting time, and PN time are all influencing factors of PN-associated liver disease in elderly PN patients undergoing gastrointestinal surgery. The column chart risk prediction model established in this study has high practicality.

Key words: Gastrointestinal surgery, Parenteral nutrition, Parenteral nutrition-associated liver disease, Column chart

张早春, 雷萍, 孙组建. 个体化预测老年患者消化道术后肠外营养相关性肝损伤列线图模型的建立及验证[J]. 肝脏, 2025, 30(8): 1133-1137.

ZHANG Zao-chun,LEI Ping, SUN Zu-jian. Establishment and validation of a column chart model for individualized prediction of parenteral nutrition associated liver disease in elderly patients after gastrointestinal surgery[J]. Chinese Hepatolgy, 2025, 30(8): 1133-1137.

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