基因3型丙型肝炎肝硬化失代偿患者再代偿的影响因素

摘要/Abstract

摘要： 目的探讨基因3型丙型肝炎失代偿期肝硬化患者再代偿发生的影响因素,并建立预测模型。方法纳入2019年1月1日至2022年12月31日昆明市第三人民医院诊断为丙型肝炎失代偿期肝硬化且HCV基因分型为3a或3b型患者184例,分为再代偿组51例,未再代偿组133例。卡钳值为0.1,以1∶1匹配得到组间均衡性良好 PSM的再代偿组和未再代偿组,对可能影响再代偿发生的因素进行单因素及多因素Cox比例风险回归模型分析。结果 102例匹配成功,再代偿组和未再代偿组各51例。再代偿组内镜治疗史11例(21.6%)、Child-Pugh分级A级12例(23.5%)、B级29例(56.9%)、C级10例(19.6%)、无腹水11例(21.6%)、少量腹水22例(43.1%)、中大量腹水18例(35.3%) 、Alb(31.83±5.73)g/L、PTA(66.24±16.51)%、CD4⁺淋巴细胞计数[541.36(331.80,722.98)个/μL,未再代偿组分别为13例(9.8%)、9例(6.8%)、79例(56.4%)、45例(33.8%)、13例(9.8%)、33例(24.8%)、87例(65.4%) 、(28.55±5.77)g/L、PTA(54.78±16.00)%、345.93(235.38,676.71)个/μL。多因素分析结果显示,内镜治疗史(HR=2.718,95%CI:1.307~5.653,P=0.007)、中大量腹水(HR=0.325,95%CI:0.117~0.903,P=0.031)、PTA(HR=1.027,95%CI:1.004~1.051,P=0.023)、CD4⁺淋巴细胞计数(HR=1.002,95%CI:1.000~1.003,P=0.005)是基因3型丙型肝炎失代偿期肝硬化患者再代偿发生的影响因素。结论有内镜治疗史的基因3型丙型肝炎失代偿期肝硬化患者更容易出现再代偿,合并中大量腹腔积液的患者不易出现再代偿,PTA、CD4⁺淋巴细胞计数与再代偿发生密切相关,列线图预测模型可有效评估基因3型丙型肝炎失代偿期肝硬化患者再代偿的发生。

关键词: 丙型肝炎, 基因3型, 失代偿期肝硬化, 再代偿, 影响因素, 预测模型

Abstract: Objective Propensity score matching (PSM) analysis was used to investigate the factors affecting the occurrence of recompensation in decompensated cirrhotic patients with genotype (GT)-3 hepatitis C viral (HCV) infection, and to establish a prediction model. Methods A total of 184 patients admitted to Kunming Third People's Hospital from January 1, 2019 to December 31, 2022 who were diagnosed as decompensated cirrhosis related to GT-3a or 3b HCV infection were retrospectively collected. The relevant clinical data were collected. The re-hospitalized patients without portal hypertension-related complications within at least 1 year were grouped as the recompensated group (n=51), while the control group was not compensated (n=133). With a caliper value of 0.1, the recompensation group and control group with well-balanced PSM were obtained by 1∶1 matching. The factors that may affect the occurrence of recompensation were analyzed by univariate and Multivariant COX proportional risk regression model. Results One hundred and two cases were successfully matched, with 51 cases in the re-compensation group and 51 cases in the control group. Single factor Cox regression analysis showed that in the re-compensation group, there were 11 cases (21.6%) with a history of endoscopic treatment, 12 cases (23.5%) with Child-Pugh score A, 29 cases (56.9%) with Child-Pugh score B, 10 cases (19.6%) with Child-Pugh score C, 11 cases (21.6%) without ascites grading, 22 cases (43.1%) with small ascites, 18 cases (35.3%) with moderate to large ascites, Alb level of (31.83±5.73) g/L, PTA of (66.24±16.51)%, CD4⁺lymphocyte count of 541.36 (331.80, 722.98)/μL], which were significantly different when compared to those of 13 cases (9.8%), 9 cases (6.8%), 79 cases (56.4%), 45 cases (33.8%), 13 cases (9.8%), 33 cases (24.8%), 87 cases (65.4%), (28.55±5.77 g/L), PTA (54.78±16.00)%, and CD4⁺lymphocyte count [345.93 (235.38, 676.71)/μL] in the control group (HR=2.111, HR=2.485, HR=0.293, HR=1.060, HR=1.028, HR=1.002). The results of multivariate analysis showed that the history of endoscopic treatment (HR=2.718, 95%CI: 1.307~5.653, P=0.007), moderate to large ascites (HR=0.325, 95%CI: 0.117~0.903, P=0.031), PTA (HR=1.027, 95%CI: 1.004~1.051, P=0.023), and CD4⁺lymphocyte count (HR=1.002, 95%CI: 1.000~1.003, P=0.005) were the influencing factors of decompensation in cirrhotic patients with GT-3 HCV infection. Conclusion Recompensation is more likely to occur in decompensated cirrhotic patients with GT-3 HCV infection, with a history of endoscopic therapy, and less likely to occur in patients with a large amount of abdominal ascites. PTA and CD4⁺ lymphocyte count are closely related to the occurrence of recompensation. The established nomogram prediction model can effectively evaluate the probability of the occurrence of recompensation in GT-3 HCV infection related cirrhotic patients at decompensated stage.

Key words: Hepatitis C, Genotype 3, Decompensated liver cirrhosis, Recompensation, Influence factor, Prediction model

许丹青, 查兴坤, 撒采芬, 木唤, 张映媛, 牟春燕, 李卫昆, 刘立. 基因3型丙型肝炎肝硬化失代偿患者再代偿的影响因素[J]. 肝脏, 2025, 30(9): 1204-1209.

XU Dan-qing, ZHA Xing-kun, SA Cai-fen, MU Huan, ZHANG Ying-yuan, MOU Chun-yan, LI Wei-kun, LIU Li. A study on the recompensation of decompensated cirrhotic patients with genotype 3 hepatitis C viral infection based on propensity score matching analysis[J]. Chinese Hepatolgy, 2025, 30(9): 1204-1209.

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