基于血小板参数的酒精性肝硬化预测模型构建与评估

Establishment and assessment of a prediction model for alcoholic cirrhosis based on platelet parameters

目的构建血小板参数用于酒精性肝炎(alcoholic hepatitis,AH)转变为酒精性肝硬化(alcoholic cirrhosis,AC)的预测模型,并评估其预测价值。方法回顾性分析2018年1月至2020年12月台州医院肝胆外科收治的首诊AH、AC患者共计60例,其中AH组与AC组各为30例,并收集同期健康体检者30例作为健康对照组,采用二元Logistic回归分析AH转变为AC的相关危险因素并建立预测模型,以受试者工作特征曲线(ROC)的曲线下面积评估其价值,并选取21例AH男性患者对模型进行验证。结果经单因素及多因素Logistic回归分析发现,血小板平均体积(MPV)增高,血小板计数(PLT)、大血小板计数(P-LCC)降低是AH转变为AC的独立危险因素。预测模型为P=e^(x)/(l+e^(x)),X=-3.580+1.731×PLT赋值+2.402×MPV赋值+2.571×P-LCC赋值,其中PLT赋值≥125×10^(9)/L为0,<125×10^(9)/L为1;MPV赋值≤10.5 fL为0,>10.5 fL为1;P-LCC赋值≥37×10^(9)/L为0,<37×10^(9)/L为1。ROC曲线下面积为0.957(95%CI 0.912~0.989),灵敏度为87.0%,特异度为96.0%。模型验证结果:灵敏度为90.9%,特异度为60.0%,正确率为76.2%,提示其预测效果较好。结论血小板参数PLT、P-LCC、MPV在预测AH转变为AC中有一定的价值,其模型具有较好的灵敏度和特异度,可为医护人员及时采取预防性管理措施提供参考。

objective To establish a predictive model for conversion from alcoholic hepatitis(AH)to alcoholic cirrhosis(AC)based on platelet parameters.Methods This study retrospectively analyzed 30 cases with AH and 30 cases with AC from Jan.2018 to Dec.2020 in Taizhou Hospital of Zhejiang Province.A binary Logistic regression analysis was performed to predict the disease conversion from AH to AC.Cutoff points were identified following Youden’s index of receiver operator characteristic(ROC)curve.Twenty-one patients with AH were collected for independent validation.Results The MPV level,platelet count(PLT)and macroplatelet count(P-LCC)were independent risk factors for disease conversion.The prediction model was P=E^(X)/(1+E^(X)),X=-3.580+1.731×PLT+2.402×MPV+2.571×P-LCC,the value for PLT≥125×10^(9)/L is 0,<125×10^(9)/L is 1;the value for MPV≤10.5 fL is 0,>10.5 fL is 1;the value for P-LCC≥37×10^(9)/L is 0,<37×10^(9)/L is 1.The area under the ROC curve(AUC)was 0.957(95%CI 0.912-0.989),the sensitivity was 87.1%and the specificity was 96.0%.The verification results showed that the sensitivity,specificity and accuracy were 90.9%,60.0%and 76.2%,indicating a good prediction effect.Conclusion MPV,PLT and P-LCC have predictive value in the conversion from AH to AC,which might provide reference for physicians to take advanced interfere treatment.