急性戊型肝炎所致重度黄疸的特点及预警模型构建

摘要/Abstract

摘要： 目的探讨急性戊型肝炎所致重度黄疸的特点并构建预警模型。方法回顾性分析2021年1月至2023年1月在空军军医大学第二附属医院接受治疗的122例急性戊型肝炎患者的病历资料,依据80/20定律随机分为训练集96例和验证集26例。根据住院期间是否发生严重黄疸分为重度组和轻中度组,分析急性戊型肝炎发生严重黄疸的风险因素,构建并验证急性戊型肝炎发生严重黄疸的预警模型。结果训练集96例急性戊型肝炎中发生严重黄疸42例(43.75%),表现出明显的发热、纳差、肌肉酸痛、腹胀、呕吐等症状者18例;54例(56.25%)患者为轻中度黄疸。重度组发生肝衰竭占比为14.29%(6/42)高于轻中度组的0(P<0.05)。重度组抗-HEV-IgM基线、总胆红素(TBil)峰值、肌酐峰值、中性粒细胞峰值、甲胎蛋白(AFP)、肝脏弹性值高于轻中度组(P<0.05)。抗-HEV-IgM基线(OR=3.564,95%CI:1.751～7.255)、TBil峰值(OR=3.778,95%CI:1.856～7.687)、肌酐峰值(OR=3.688,95%CI:1.812～7.506)、中性粒细胞峰值(OR=4.216,95%CI:2.072～8.582)、AFP(OR=4.559,95%CI:2.239～9.278)是急性戊型肝炎发生严重黄疸的危险因素(P<0.05)。风险模型预测训练集急性戊型肝炎发生严重黄疸的灵敏度为0.827(95%CI:0.735～0.941),特异度为0.834(95%CI:0.715～0.941),曲线下面积为0.843(95%CI:0.731～0.928)。风险模型预测验证集急性戊型肝炎发生严重黄疸的灵敏度为0.731(95%CI:0.625～0.901),特异度为0.828(95%CI:0.713～0.947),曲线下面积为0.831(95%CI:0.728～0.951)。结论抗-HEV-IgM基线、TBil峰值、肌酐峰值、中性粒细胞峰值、AFP与急性戊型肝炎发生严重黄疸有关,构建预警模型有助于早期甄别急性戊型肝炎发生严重黄疸的风险。

关键词: 急性戊型肝炎, 重度黄疸, 影响因素, 预警模型

Abstract: Objective To explore the characteristics of severe jaundice caused by acute hepatitis E and to construct an early warning model. Methods This is a retrospective analysis of the medical records of 122 patients with acute hepatitis E who received treatment at the Second Affiliated Hospital of Air Force Medical University from January 2021 to January 2023. According to the 80/20 law, they were randomly divided into a training set (N=96 cases) and a validation set (N=26 cases). The patients were divided into a severe group and a mild to moderate group based on whether they occurred severe jaundice during hospitalization. The risk factors for severe jaundice in acute hepatitis E were analyzed, and a warning model for severe jaundice in acute hepatitis E patients were constructed and verified. Results Among the 96 cases of acute hepatitis E, 42 cases developed severe jaundice, with an incidence rate of 43.75% (42 cases/96 cases). 18 cases exhibited obvious symptoms such as fever, poor appetite, muscle soreness, abdominal distension, and vomiting; 54 cases (56.25%) of patients had mild to moderate jaundice. The proportion of liver failure in the severe group was higher than that in the mild to moderate group (P<0.05). The baseline, total bilirubin (TBil) peak, creatinine peak, neutrophil peak, alpha fetoprotein (AFP), and liver elasticity, the value of anti-hepatitis E virus immunoglobulin M antibody (HEV IgM) in the severe group were higher than those in the mild to moderate group (P<0.05). Anti-HEV IgM baseline (OR=3.564, 95% CI=1.751~7.255), peak TBil (OR=3.778, 95% CI=1.856~7.687), peak creatinine (OR=3.688, 95% CI=1.812~7.506), peak neutrophil count (OR=4.216, 95% CI=2.072~8.582), and AFP (OR=4.559, 95% CI=2.239~9.278) are risk factors for severe jaundice in acute hepatitis E (P<0.05). The sensitivity of the risk model for predicting severe jaundice in acute hepatitis E in the training set was 0.827 (95% CI=0.735~0.941), the specificity was 0.834 (95% CI= 0.715~0.941), and the area under the curve was 0.843 (95% CI=0.731~0.928). The sensitivity of the risk model prediction validation set for severe jaundice in acute hepatitis E was 0.731 (95% CI=0.625~0.901), the specificity was 0.828 (95% CI= 0.713~0.947), and the area under the curve was 0.831 (95% CI=0.728~0.951). Conclusion Anti HEV-IgM baseline, TBil peak, creatinine peak, neutrophil peak, and AFP level are associated with severe jaundice in acute hepatitis E. The Construction of an early warning model may help to identify the risk of severe jaundice in acute hepatitis E patients.

Key words: Acute hepatitis E, Severe jaundice, Influencing factors, Early warning model

袁敏, 许姗, 马娇娇. 急性戊型肝炎所致重度黄疸的特点及预警模型构建[J]. 肝脏, 2025, 30(2): 165-169.

YUAN Min, XU Shan, MA Jiao-jiao. The characteristics of severe jaundice caused by acute hepatitis E and the construction of a warning model[J]. Chinese Hepatolgy, 2025, 30(2): 165-169.

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