儿童传染性单核细胞增多症并发肝损害的因素分析及列线图的建立

Analysis of risk factors of liver damage of children with infectious mononucleosis and establishment of the nomogram

目的分析传染性单核细胞增多症(IM)患儿并发肝功能损害的危险因素,并基于此构建列线图模型。方法选取2020年1月至2021年4月于我院收治入院的80例IM患儿为研究对象,并根据谷丙转氨酶水平将其分为肝功能正常组和异常组。对两组患儿的临床资料进行回顾性研究,在单因素分析的基础上,建立多因素Logistic回归模型筛选IM并发肝功能损害的危险因素,并基于此构建列线图模型。结果多因素Logistic回归分析显示,肝脏肿大(OR=6.850,95%CI:1.146~40.950)、高水平IL-6(OR=1.059,95%CI:1.012~1.110)、高水平INF-γ(OR=1.017,95%CI:1.002~1.032)的IM患儿并发肝功能损害的风险增高;较高CD4^(+)/CD8^(+)比值的IM患儿并发肝功能损害的风险降低(OR=0.005,95%CI:0.001~0.997)。在此基础上,构建了预测IM并发肝损害的列线图模型,经评估模型C指数为0.905(95%CI:0.831~0.979),显示预测能力良好;Calibration校准曲线显示列线图预测IM并发肝损伤的风险与实际发生风险之间具有良好的一致性,平均绝对误差为0.041。结论肝脏肿大、高IL-6水平、高INF-γ水平、低CD4^(+)/CD8^(+)比值是IM患儿并发肝功能损害的危险因素,基于上述变量构建的列线图模型可有效预测IM并发肝功能损害的概率,为其临床早期识别和预防提供依据。

Objective To analyze risk factors of liver damage of children with infectious mononucleosis(IM),and to establish a nomogram model.Methods A total of 80 children with IM who were diagnosed and treated in our hospital from January 2020 to April 2021 were selected as study subjects,and they were divided into normal liver function group and abnormal liver function group according to serum level of alanine aminotransferase(ALT).The clinical data of the children in the two groups were retrospectively analyzed.On basis of univariate analysis,a multivariate Logistic regression model was established to screen the risk factors of IM complicated with liver damage,and then a nomogram model was constructed.Results Multivariate Logistic regression analysis showed that the children with hepatomegaly(OR=6.850,95%CI:1.146-40.950),high serum levels of IL-6(OR=1.059,95%CI:1.012-1.110)and INF-γ(OR=1.017,95%CI:1.002-1.032)had a higher risk of IM complicated with liver damage,while those children with high CD4+/CD8^(+)ratio had lower risk of IM complicated with liver damage(OR=0.005,95%CI:0.001-0.997).On this basis,a nomogram model for predicting IM complicated with liver damage was constructed.After evaluation,C index of the model was 0.905(95%CI:0.831-0.979),indicating that the model had a good predictive ability.Calibration curve showed good consistency between the nomogram predicting the risk of IM complicated with liver damage and the actual risk,with a mean absolute error of 0.041.Conclusion Hepatomegaly,high serum levels of IL-6 and INF-γ,low serum CD4^(+)/CD8^(+)ratio are risk factors for IM complicated with liver damage of the children.The nomogram model constructed based on the above variables could effectively predict the probability of IM complicated with liver damage,and provide a basis for early clinical identification and prevention of the disease.