术前全新无创诊断肝硬化模型的建立及评估

Establishment and evaluation of a novel and non-invasive diagnostic model on cirrhotic patients

目的采用常规实验室血清学指标建立术前无创诊断肝硬化模型并评估其临床价值。方法回顾性分析广西医科大学附属肿瘤医院2013年9月至2016年12月行肝切除术的1044例肝细胞肝癌(HCC)患者,按3∶1随机分为建模组(783例)和验证组(261例)。采用logistic回归分析建模组中与肝硬化发生相关的独立危险因素,随后建立PPH评分。通过测算受试者工作特征曲线下面积(AUC)和拟合优度,分别在建模组、验证组中评估该模型诊断肝硬化的准确度与符合度,并与终末期肝病预后模型(MELD)评分,FIB-4指数,Forns指数及天冬氨酸转氨酶-血小板比值(APRI)评分比较。结果建模组中单因素和多因素logistic回归分析显示,凝血酶原时间、血小板计数和乙肝表面抗原阳性与肝硬化发生密切相关。建模组PPH评分(AUC=0.705)诊断肝硬化的准确度显著优于MELD(AUC=0.557),APRI(AUC=0.598),FIB-4(AUC=0.597)及Forns评分(AUC=0.665),验证组也得到相似结果(AUC:0.702比0.554比0.624比0.634比0.580)。两组的拟合优度均显示肝硬化发生实际值和预测值差异无统计学意义,该模型符合度良好。结论该模型诊断肝硬化的准确度优于MELD、APRI、FIB-4及Forns评分,对于肝硬化患者的临床治疗决策具有一定的指导意义。

Objective To establish and evaluate a novel and non-invasive diagnostic model using routine laboratory serological indexes in cirrhotic patients.Methods A retrospective study was conducted on 1044 consecutive patients with hepatocellular carcinoma(HCC)treated by hepatectomy in the Affiliated Tumor Hospital of Guangxi Medical University from September 2013 to December 2016.These patients were divided into a training cohort(n=783)and a validation cohort(n=261)using the 3∶1 matching principle.Logistic regression analysis was used to identify independent risk factors related to occurrence of cirrhosis in the training cohort,and then a PPH score was established.The accuracy of the model in predicting cirrhosis in two groups was evaluated respectively by the area under the receiver operating characteristic curve(AUC)and goodness of fit,and compared with the following commonly used predictive systems:the model for end-stage liver disease(MELD)score,fibrosis index based on 4 factor score(FIB-4),Forns score and aspartate aminotransferase to platelet ratio index score(APRI).Results Univariate and multivariate Logistic regression analysis in the training cohort showed prothrombin time,platelet count and hepatitis B surface antigen positivity were closely related to occurrence of cirrhosis.The accuracy of the PPH score(AUC=0.705)in diagnosing cirrhosis in the training cohort was significantly better than the MELD score(AUC=0.557),APRI score(AUC=0.598),FIB-4 score(AUC=0.597)and Forns score(AUC=0.665).Similar results were obtained in the validation cohort(AUC:0.702 vs 0.554 vs 0.624 vs 0.634 vs 0.580).The goodness of fit indicated that there was no significant difference between the actual and predicted values of cirrhosis in the two cohorts,and the model was in good agreement.Conclusions A novel and non-invasive model for the diagnosis of cirrhosis was successfully established.The accuracy of this model in diagnosing cirrhosis was better than the MELD,APRI,Fib-4 and Forns scores.This model has significance in guiding clinical treatment decision in HCC patients with cirrhosis.