肝硬化患者发生癌变的影响因素及诊断模型

Influencing factors and the diagnostic model of patients with liver cirrhosis suffering from canceration

目的探讨肝硬化患者发生癌变的影响因素,并建立诊断模型。方法选取68例肝硬化癌变患者作为癌变组,120例肝硬化无癌变患者作为对照组。比较两组患者的一般资料、入院时生化指标检查结果,采用多因素Logistic回归模型分析肝硬化患者发生癌变的影响因素,并建立诊断模型。应用受试者工作特征(ROC)曲线评估诊断模型的区分度,应用拟合优度检验评价诊断模型的校准度,并在80例验证样本中进行临床验证。结果饮酒、中性粒细胞与淋巴细胞比值(NLR)≥2.69、白细胞介素6(IL-6)水平≥71.30 pg/mL均是肝硬化患者发生癌变的独立危险因素(均P<0.05)。构建的诊断模型为:Logit P=2.309×饮酒史+1.666×NLR+1.202×IL-6-6.438。该模型的ROC曲线下面积为0.934,灵敏度为86.8%,特异度为85.0%;拟合优度检验显示χ^(2)=11.435,P=0.178;临床验证结果提示,该模型的灵敏度为84.85%,特异度为80.85%,准确度为82.50%。结论饮酒、NLR≥2.690、IL-6≥71.30 pg/mL的肝硬化患者发生癌变的风险增加,基于上述危险因素构建的诊断模型的区分能力良好,具有较高的临床应用价值。

Objective To explore the influencing factors for patients with liver cirrhosis suffering from canceration,and to establish the diagnostic model.Methods A total of 68 liver cirrhosis patients with canceration were selected as the canceration group,and 120 liver cirrhosis patients without canceration as the control group.The general data,results of biochemical indice examinations at admission were compared between the two groups.The multivariate Logistic regression model was performed to analyze the influencing factors for patients with liver cirrhosis suffering from canceration,and then the diagnostic model was established.The discrimination of diagnostic model was evaluated by the receiver operating characteristic(ROC)curve.The calibration of diagnostic model was evaluated by good-of-fit test,and the clinical verification was performed in 80 verified samples.Results Alcohol drinking,neutrophil-to-lymphocyte ratio(NLR)≥2.69,and interleukin 6(IL-6)≥71.30 pg/mL were independent risk factors for patients with liver cirrhosis suffering from canceration(all P<0.05).The diagnostic model was established as follows:Logit P=2.309×alcohol drinking history+1.666×NLR+1.202×IL-6-6.438.The area under the ROC curve of the model was 0.934,the sensitivity was 86.8%,and the specificity was 85.0%;in addition,the good-of-fit test revealed thatχ^(2)=11.435,P=0.178.The results of clinical verification depicted that the sensitivity of the model was 84.85%,the specificity was 80.85%,and the accuracy was 82.50%.Conclusion The risk of suffering from canceration is increased in liver cirrhosis patients with alcohol drinking,NLR≥2.690,and IL-6≥71.30 pg/mL.The diagnostic model established based on the aforementioned risk factors has a good discrimination function,exerting a relatively high clinical application value.