慢性乙型肝炎患者肝细胞脂肪变性影响因素的分类树模型分析

Classification tree model analysis of influencing factors for hepatocyte steatosis in patients with chronic hepatitis B

目的基于分类树模型对慢性乙型肝炎(CHB)患者发生肝细胞脂肪变性的高危人群和影响因素进行研究,建立一种评估CHB患者发生肝细胞脂肪变性风险的简单方法。方法收集2006年1月-2014年12月在佛山市顺德区第一人民医院感染性疾病科住院,行肝穿刺活组织检查的CHB患者的临床资料和病理结果,利用分类树模型分析肝细胞脂肪变性的影响因素,采用索引值曲线、错分矩阵和估计误差对分类树模型分类效果进行整体评价。结果 CHB患者合并肝细胞脂肪变性的影响因素有BMI、总胆固醇、低密度脂蛋白,其中最重要的影响因素是BMI。该分类树模型的敏感性为84.3%,特异性为81.5%,准确率为82.9%,模型估计误差为0.171,模型拟合效果较好。结论通过分类树模型发现CHB患者发生肝细胞脂肪变性和BMI、总胆固醇、低密度脂蛋白等3个影响因素关系密切,根据这3个指标可以建立一种简单的分类方法来评估CHB患者发生肝细胞脂肪变性的风险,有必要开展进一步临床研究以明确其临床应用价值。

Objective To investigate the influencing factors for hepatocyte steatosis in patients with chronic hepatitis B（ CHB） and the high- risk population by classification tree model analysis,and to establish a simple method to assess the risk of hepatocyte steatosis in CHB patients. Methods The clinical data and pathological results of the CHB patients who underwent liver biopsy in Department of Infectious Diseases,The First People’s Hospital of Shunde,from January 2006 and December 2014 were collected. The classification tree model was applied to analyze the influencing factors for hepatocyte steatosis,and index value curve,misclassification matrix,and error of estimation were applied for overall evaluation of classification results of the classification tree model. Results The influencing factors for hepatocyte steatosis in CHB patients were body mass index（ BMI）,total cholesterol,and low- density lipoprotein,and the most important factor was BMI. This classification tree model had a sensitivity of 84. 3%,a specificity of 81. 5%,an accuracy of 82. 9%,and an error of estimation of 0. 171,suggesting that this model was well fitted. Conclusion Classification tree model analysis shows that the pathogenesis of hepatocyte steatosis in CHB patients is closely related to the influencing factors BMI,total cholesterol,and low- density lipoprotein. A simple classification method is established based on these factors to evaluate the risk of hepatocyte steatosis in CHB patients. It is necessary to conduct further clinical studies to investigate the clinical value of this method.