肝脏疾病成分输血与相关检验指标主成分分析和预测研究

Analysis and prediction model of key testing indicators in component transfusion for liver disease

目的研究相关检验指标在肝脏疾病成分输血的主成分分析和预测模型。方法采用回顾性方法,收集2017年1月至2022年12月期间住院接受成分输血的肝脏疾病患者与非肝脏疾病患者作为研究对象,根据接受成分输血的类型分为输注悬浮红细胞组、输注病毒灭活冰冻血浆组和输注单采血小板组。收集患者的一般资料和输血前相关实验室指标,包括血红蛋白(Hb)、红细胞压积(HCT)、血小板计数(PLT)、凝血功能指标、肝功能指标以及输血情况,通过t检验与方差检验比较肝脏疾病与非肝脏疾病不同成分输血组上述指标的差异。采用KMO检验、Bartlett球形检验和碎石检验(Scree Test)验证多因子分析的适宜性,利用主成分分析(PCA)对各指标的方差贡献进行观察,评估各指标间的相关性。通过受试者工作曲线(ROC)分析评估各检验指标对于不同成分输血的预测价值。结果共纳入96例肝脏疾病患者与216例非肝脏疾病患者,肝脏疾病中57.3%患者输注血浆(55/96例),非肝脏疾病中54.2%患者接受红细胞输血(117/216例)。输注红细胞组肝病与非肝病患者Hb平均值分别为70.61 g/L和82.82 g/L;HCT平均值分别为20.80%和24.47%;丙氨酸氨基转移酶(ALT)平均值分别为45.94 U/L和25.43 U/L;总胆红素平均值为44.38μmol/L和19.31μmol/L,这四项指标两组患者中存在显著差异(P<0.05)。在输注血浆组肝病与非肝病患者Hb平均值分别为73.45 g/L和111.43 g/L;HCT平均值分别为21.70%和31.06%;ALT平均值分别为59.33 U/L和28.33 U/L;天冬氨酸氨基转移酶(AST)分别为44.35 U/L和22.52 U/L;INR平均值分别为1.43和1.07;以上指标存在显著差异(P<0.05)。输血血小板组肝病与非肝病患者PLT平均值分别为36.70×10^(9)/L和50.76×10^(9)/L;AST平均值分别为54.20 U/L和31.19 U/L;PT平均值分别为15.95 s和12.98 s;APTT平均值分别为54.42 s和29.90 s;INR平均值分别为1.36和1.11;以上五项指标存在显著差异(P<0.05)。PCA分析肝病患者不同成分输血前检验指标显示,血液指标和肝功能指标分布为第一和第二主要成分,非肝病患者输血前检验指标中肝功能和凝血指标为第一和第二主要成分。通过ROC曲线分析肝病患者接受红细胞输血组,HCT曲线下面积为0.912;血浆输血组中,INR和PT曲线下面积为0.964和0.953;在输注单采血小板组中,INR曲线下面积分别为0.938。结论本研究对于不同成分输血前各项指标相关性分析和模型预测,尤其对于肝病患者选择不同成分输血可以提供研究依据。

Objective To study the principal component analysis and prediction model of key test indicators in component transfusion for liver disease.Methods A retrospective study was conducted,collecting data from patients with liver disease and those without,who underwent component transfusion from January 2017 to December 2022.Patients were categorized based on the types of transfusion received:suspended red blood cell transfusion,virus-inactivated frozen plasma transfusion,and single-donor platelet transfusion.Genera patient information and pre-transfusion laboratory indicators were gathered,including hemoglobin(Hb),hematocrit(HCT),platelet count,coagulation function indicators,liver function indicators,and transfusion conditions.Differences in these indicators between liver disease and non-liver disease groups were analyzed using T-tests and variance analysis.The suitability of factor analysis was confirmed by the KMO test,Bartlett's sphericity test,and Scree Test.Principal component analysis(PCA)was utilized to observe the variance contribution of each indicator and evaluate their correlations.Receiver operating characteristic(ROC)curve analysis was performed to assess the predictive value of each test indicator for different component transfusions.Results A total of 96 liver disease patients and 216 non-liver disease patients were included in the study.Among the liver disease patients,57.30%received plasma transfusion(55/96 cases),while 54.20%of the non-liver disease patients received red blood cell transfusion(117/216 cases).The average Hb levels were 70.61 g/L for liver disease patients and 82.82 g/L for non-liver disease patients HCT levels averaged 20.80%and 24.47%,alanine aminotransferase(ALT)were 45.94 U/L and 25.43 U/L,and total bilirubin(TBil)levels were 44.38μmol/L and 19.31μmol/L,respectively,for liver disease and non-liver disease groups.These four indicators showed significant differences between the groups(P<0.05).In the plasma transfusion group,the average Hb levels were 73.45 g/L for liver disease patients and 111.43 g/L for non-liver disease patients.HCT levels averaged 21.70%and 31.06%,ALT levels were 59.33 U/L and 28.33 U/L,aspartate aminotransferase(AAT)levels were 44.35 U/L and 22.52 U/L,and INR values were 1.43 and 1.07,respectively,for liver disease and non-liver disease patients.These indicators also showed significant differences(P<0.05).In the platelet transfusion group,the average platelet counts were 36.70×10^(9)/L for liver disease patients and 50.76×10^(9)/L for non-liver disease patients,ALT levels were 54.20 U/L and 31.19 U/L,PT was 15.95 s and 12.98 s,APTT was 54.42 s and 29.90 s,and INR values were 1.36 and 1.11,respectively,for liver dosease and non-liver disease patients.These five indicators showed significant differences(P<0.05).PCA revealed that the primary and secondary components of pre-transfusion indicators in liver disease patients were blood and liver function indicators,respectively,whereas in non-liver disease patients,the primary components were liver function and coagulation indicators.ROC curve analysis demonstrated that the area under the curve(AUC)for HCT in the red blood cell transfusion group was 0.912;in the plasma transfusion group,the AUCs for INR and PT were 0.964 and 0.953,respectively.In the platelet transfusion group,the AUC for INR was 0.938.Conclusion This study establishes a foundation for correlation analysis and predictive modeling of various pre-transfusion indicators,particularly aiding in the selection of appropriate component transfusions for liver disease patients.