老年自身免疫性肝炎患者治疗后应答不佳的危险因素及风险模型构建

Risk factors and risk model construction of poor response to treatment in elderly patients with autoimmune hepatitis

目的 探讨老年自身免疫性肝炎(AIH)患者治疗后应答不佳的危险因素并构建风险模型。方法 纳入2019年1月—2022年1月我院明确诊断的169例老年AIH患者为研究对象,分为应答组(n=131)和应答不佳组(n=38)。收集并比较2组患者临床特征、肝功能以及肝穿刺病理指标。利用单因素和多因素分析明确影响老年AHI治疗后应答不佳的危险因素并构建模型。通过受试者工作特征曲线明确所构建的风险模型的预测效能。结果 同应答组相比,应答不佳组患者免疫球蛋白IgG>20 g/L、总胆红素(TBil)>34.2μmol/L、汇管区炎症程度为轻-中度以及肝硬化的比例均显著升高(均P<0.05)。IgG>20 g/L(OR=4.19)、TBil>34.2μmol/L(OR=3.14)、轻-中度汇管区炎症(OR=4.16)和肝硬化(OR=2.83)是影响老年AIH治疗后应答不佳的危险因素,在风险模型中的分值均为1分。当患者评分为2分或以上时,该模型预测老年AIH患者治疗后应答不佳的曲线下面积为0.79,敏感性和特异性分别为81.6%和59.5%。结论 患者总胆红素、IgG水平以及汇管区炎症、肝硬化对老年AIH患者治疗后应答影响显著。本研究所构建的风险模型具有潜在的临床应用前景。

Objective To explore the risk factors of poor response to treatment in elderly patients with autoimmune hepatitis(AIH) and construct a risk model.Methods 169 elderly AIH patients who were definitely diagnosed in Beijing You’an Hospital Affiliated to Capital Medical University from January 2019 to January 2022 were included in the study,They were divided into response group(n=131) and poor response group(n=38).The clinical characteristics,liver function and pathological indexes of liver biopsy were collected and compared between the two groups.Univariate and multivariate analysis were used to identify the risk factors of poor response to treatment in elderly AHI patients,and a model was constructed.The predictive power of the constructed risk model was determined by receiver operating characteristic curve.Results Compared with the response group,the proportion of immunoglobulin IgG>20 g/L,total bilirubin(TBIL)>34.2 μmol/l,mild to moderate inflammation in the portal area and cirrhosis of the poor response group were significantly higher(all P<0.05).IgG>20 g/L(OR=4.19),TBIL>34.2 μmol/l(OR=3.14),mild to moderate inflammation in the portal area(OR=4.16) and cirrhosis(OR=2.83) were the risk factors of poor response to treatment in elderly patients with AIH.Their scores in the risk model were all 1.When the patient’s score was 2 or above,the area under the curve of the model predicting poor response to treatment in elderly patients with AIH was 0.79,and the sensitivity and specificity were 81.6% and 59.5%,respectively.Conclusion The levels of total bilirubin and IgG,as well as portal inflammation and liver cirrhosis have significant effects on the response to treatment in elderly AIH patients.The risk model constructed in this study has potential clinical application prospects.