肝性脑病危险因素分析及诊断模型的临床研究

肝脏 ›› 2024, Vol. 29 ›› Issue (9): 1085-1090.

肝性脑病危险因素分析及诊断模型的临床研究

邓文佳, 王磊, 王浩然, 赵鸽

150001 黑龙江哈尔滨医科大学附属第一医院重症医学科(邓文佳, 王磊), 神经外科六病房(王浩然);710061 陕西西安交通大学第一附属医院重症医学科(赵鸽)

收稿日期:2023-07-25 出版日期:2024-09-30 发布日期:2024-11-13
基金资助:
国家自然科学基金面上项目(81670572)

A clinical research on the risk factors and the development of diagnostic model for hepatic encephalopathy

DENG Wen-jia¹, WANG Lei¹, WANG Hao-ran², ZHAO Ge³

1. Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Heilongjiang 150001, China;
2. Sixth Ward of Neurosurgery, Harbin , the First Affiliated Hospital of Harbin Medical University, Heilongjiang 150001, China;
3. Department of Intensive Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi 710061, China

Received:2023-07-25 Online:2024-09-30 Published:2024-11-13

摘要/Abstract

摘要： 目的确定肝性脑病(hepatic encephalopathy,HE)的实验室诊断指标,建立HE诊断模型,探讨血清同型半胱氨酸、乳酸、降钙素原和胆汁酸水平在HE中的诊断价值。方法研究对象为哈尔滨医科大学附属第一医院于2020年8月—2022年8月收治的肝硬变患者371例,运用Spearman分析相关系数,采用单因素和多因素分析方法对住院患者进行分析,识别影响HE发生的因素,并建立诊断模型。结果 HE患者降钙素原(378.2±71.5)pg/mL、胆汁酸(41.6±9.5)μmol/L均高于非HE患者的(47.3±8.1)pg/mL、(9.7±0.8)μmol/L(P<0.05),HE患者乳酸(0.29±0.11)mmol/L、血清同型半胱氨酸(2.8±1.1)μmol/L均低于非HE患者的(0.94±0.17)pg/mL、(10.2±2.3)μmol/L(P<0.05)。Spearman相关分析表明,乳酸、降钙素原、胆汁酸、血清同型半胱氨酸和HE之间的相关系数分别为-0.15、0.41、0.29和-0.19。单因素logistic回归分析显示,随着胆汁酸水平的升高(P=0.004)和血清同型半胱氨酸水平的升高(P=0.058),发生HE的风险增加。胆汁酸水平和血清同型半胱氨酸的多因素logistic回归诊断模型显示,ROC曲线下面积的AUC值为0.720,表明该诊断模型取得了满意的评价效果。模型公式为logistic回归方程P=-2.4544+0.0117胆汁酸水平+0.0198血清同型半胱氨酸。结论本研究采用logistic回归分析方法建立HE诊断模型,有利于患者的早期鉴别诊断。特别是联合检测血清同型半胱氨酸和胆汁酸水平被认为更有意义。

关键词: 肝性脑病, 血清同型半胱氨酸, 乳酸, 降钙素原和胆汁酸

Abstract: Objective To identify laboratory diagnostic markers of hepatic encephalopathy (HE), we developed a diagnostic model of HE and investigated the diagnostic value of serum homocysteine, lactate, procalcitonin, and bile acid levels in HE. Methods A total of 371 patients with liver cirrhosis admitted to the First Affiliated Hospital of Harbin Medical University from August 2020 to August 2022 were analyzed using Spearman’s correlation coefficient, univariate and multivariate analysis to identify factors affecting the occurrence of HE, and to establish a diagnostic model. Results Procalcitonin (378.2 ± 71.5 pg/mL), bile acid ( 41.6 ± 9.5 μmol/L) in patients with HE was higher than those (Procalcitonin 47.3 ± 8.1 pg/mL, bile acid 9.7 ± 0.8 μmol/L) in non HE (P<0.05), lactic acid (0.29 ± 0.11 mmol/L), serum homocysteine (2.8 ± 1.1 μmol/L) in patients with HE was lower than those (lactic acid 0.94 ± 0.17 pg/mL, serum homocysteine 10.2 ± 2.3 μmol/L) in patients with non HE (P<0.05). Spearman correlation analysis showed that the correlation coefficients between lactate, procalcitonin, bile acids, serum homocysteine and HE were -0.15, 0.41, 0.29 and -0.19, respectively. Univariate logistic regression analysis showed that the risk of developing HE increased with higher bile acid levels (P=0.004) and higher serum homocysteine levels (P=0.058). The multivariate logistic regression diagnostic model of bile acid levels and serum homocysteine showed that the area under the ROC curve (AUC) was 0.720, indicating that the diagnostic model achieved satisfactory evaluation effect. The model formula was the logistic regression equation P=-2.4544 + 0.0117 * (bile acid level) + 0.0198 * (serum homocysteine). Conclusion In this study, logistic regression analysis was used to establish a diagnostic model of HE, which is beneficial for the early differential diagnosis of patients. Especially the combined detection of serum homocysteine and bile acid levels was considered more meaningful.

Key words: Hepatic encephalopathy, Serum homocysteine, Lactate, Procalcitonin and bile acids

邓文佳, 王磊, 王浩然, 赵鸽. 肝性脑病危险因素分析及诊断模型的临床研究[J]. 肝脏, 2024, 29(9): 1085-1090.

DENG Wen-jia, WANG Lei, WANG Hao-ran, ZHAO Ge. A clinical research on the risk factors and the development of diagnostic model for hepatic encephalopathy[J]. Chinese Hepatolgy, 2024, 29(9): 1085-1090.

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