慢性乙型肝炎抗病毒治疗过程中临床终点事件精准预测体系的建立

Establishment of an accurate prediction system for clinical endpoint events during antiviral therapy for chronic hepatitis B

目的探究影响慢性乙型肝炎(CHB)抗病毒治疗过程中临床终点事件的相关因素,并创建精准预测体系。方法选择2017年2月-2020年1月期间安阳市第五人民医院进行抗病毒治疗的200例CHB患者为研究对象,收集所有患者临床资料,以患者开始抗病毒治疗为起始时间、研究结束或者发生终点事件为截止时间。分析影响抗病毒治疗过程中临床终点事件相关危险因素,并创建预后模型,与终末期肝病模型(MELD)、MELD-Na评分、Fontana-Index评分、Child-Turcotte-Pugh(CTP)评分、CTP-Cr评分进行对比。结果未有终点事件组的CTP-Cr评分(7.51±1.61)、MELD-Na评分(15.07±6.63)、超声评分(12.21±3.25)、Index评分(3.14±1.47)、MELD评分(10.67±3.36)、CTP评分(6.58±2.14)、Na(127.56±10.15)、INR(1.34±0.35)、PT(14.58±2.14)、DBil(19.69±28.66)、TBil(50.88±57.45)与有终点事件组的CTP-Cr评分(8.96±1.35)、MELD-Na评分(22.76±4.91)、超声评分(18.74±4.29)、Index评分(4.69±1.69)、MELD评分(16.74±3.07)、CTP评分(9.14±2.07)、Na(117.96±7.45)、INR(1.72±0.28)、PT(18.57±2.31)、DBil(35.47±30.14)、TBil(78.96±80.14)相比,差异有统计学意义(P<0.05);未有终点事件组的SBP(0.63%)、肝肾综合征(0.00%)、肝性脑病发生率(1.25%)显著低于有终点事件组的10.00%、7.50%、10.00%(P<0.05);多因素分析显示,对比差异明显的预后危险因素主要有INR、WBC、TBil、超声评分(P<0.05);对多种有预测体系评分标准绘制ROC曲线,AUC:Index为0.807、MELD-Na为0.827、MELD为0.804,CTP-Cr为0.800,CTP为0.791,新建体系A的AUC为0.854,新建体系B的AUC为0.834;各模型ROC曲线的AUC进行Z检验,Index、MELD-Na、MELD、CTP-Cr、CTP、预后体系B与预后体系A对比无明显差异(P>0.05)。结论INR、WBC、TBil、肝肾综合征、超声评分是影响CHB抗病毒治疗过程中临床终点事件的独立危险因素,以INR、TBil、肝肾综合征、超声评分为基础新建体系A具有较高的临床终点事件预测评估价值。

Objective To investigate factors affecting clinical endpoint events during antiviral therapy for chronic hepatitis B(CHB)and establishing an accurate prediction system.Methods A total of 200 CHB patients who received antiviral treatment in our hospital from February 2017 to January 2020 our hospital were selected as the subjects.The clinical data were collected.The time of onset,end or end point of the antiviral treatment was the cut-off time.The risk factors of clinical end point events affecting antiviral treatment were analyzed to establish a prognostic model.The clinical value of different systems including with the end stage liver disease model(MELD),MELD-Na score,Fontana-Index score,hild-Turcotte-Pugh(CTP)score and CTP-Cr score was compared.Results CTP-Cr score(7.51±1.61),MELD-Na score(15.07±6.63),ultrasound score(12.21±3.25),Index score(3.14±1.47),MELD score(10.67±3.36),CTP score(6.58±2.14),Na(127.56±10.15),international normalized ratio(INR)(1.34±0.35),prothrombin time(PT)(14.58±2.14),direct bilirubin(DBil)(19.69±28.66),total bilirubin(TBil)(50.88±57.45)were significantly different from those of CTP-Cr in the group with end-point events score(8.96±1.35),MELD-Na score(22.76±4.91),ultrasound score(18.74±4.29),Index score(4.69±1.69),MELD score(16.74±3.07),CTP score(9.14±2.07),Na(117.96±7.45),INR(1.72±0.28),PT(18.57±2.31),DBil(35.47±30.14),TBil(78.96±80.14),the difference was statistically significant(P<0.05);no end-point event group The incidence of SBP(0.63%),hepatorenal syndrome(0.00%),and hepatic encephalopathy(1.25%)were lower than those of the end-point event group(10.00%,7.50%,10.00%)(P<0.05);Multivariate analysis showed that the prognostic risk factors with significant differences were mainly INR,WBC,TBil,and ultrasound score(P<0.05).The receiver operator characteristic(ROC)curves of different systems were conducted,and the area under the curve(AUC)was calculated(Index:0.807,MELD-Na:0.827,MELD:0.804,CTP-Cr:0.800,CTP:0.791).The AUC of?the new system A and B were 0.854 and 0.834 respectively.There was no significant difference between CTP-Cr,CTP,prognosis system B and prognosis system A(P>0.05).Conclusion INR,WBC,TBil,hepatorenal syndrome,and ultrasound score are independent risk factors that affect the clinical endpoints of antiviral treatment.New system A based on the basis of INR,TBil,hepatorenal syndrome,and ultrasound has a high value for predicting and evaluating clinical endpoint events.