肝性脑病诱发因素的潜在类别模型与高危人群筛选

Latent class model of inducing factors of hepatic encephalopathy and high-risk population screening

目的基于潜在类别模型对肝性脑病诱发因素进行特征识别,对具有不同诱因的肝硬化患者进行分类,提示肝性脑病的高风险患者,为该类患者干预措施的实施提供依据。方法采用Mplus软件,选择上消化道出血、各种感染、大量使用利尿剂、手术、水电解质代谢异常、便秘、腹水7个肝性脑病诱发因素进行潜在类别分析,识别潜在类别,划分特征人群,提示高危患者。结果模型拟合指标显示3-cluster为最佳模型。cluster1、cluster2与cluster3分别命名为诱因较多组、腹水利尿组与一般人群组。个体分类后,三组患者肝性脑病发病率差异有统计学意义(χ~2=60.830,P<0.001),诱因较多组、腹水利尿组、一般人群组分别为16.4%、8.8%、2.4%。结论潜在类别模型可用于对不同肝性脑病诱发因素潜在类别的识别,对具有不同诱因特征的肝硬化患者的分类,比较不同特征患者肝性脑病的发病风险,提示高风险患者,为该类患者的护理干预提供依据。

Objective Based on the latent class model, the inducing factors of hepatic encephalopathy were clustered, and cirrhotic patients with different inducement were classified, which indicated highrisk population of hepatic encephalopathy and provided the basis for the implementation of interventional measures. Methods Using Mplus software, the latent class analysis for seven predisposing factors of hepatic encephalopathy conducted: upper gastrointestinal bleeding, various infections, extensive use of diuretics, surgery, water and electrolyte disorders, constipation and ascites. The latent class was identified; the population with different distribution characteristics of inducing factors of hepatic encephalopathy was classified; high-risk patients of the target disease were indicated. Results The model fitting indicators showed 3-cluster model as the best one. Cluster1, cluster2 and cluster3 were named "moreincentives group","ascites-diuresis group"and"general-population group"respectively. After individual classification, the incidence rate of hepatic encephalopathy in the more-incentives group was 16.4%,8.8% in the ascites-diuretic group, 2.4% in the general-population group, and the difference was statistically significant(χ~2=60.830, P<0.001). Conclusion Latent class models can be used to identify latent class of different hepatic encephalopathy-induced factors, to classify cirrhotic patients with different distribution characteristics of inducing factors, to compare the risk of hepatic encephalopathy among three different groups, to indicate high-risk patients with cirrhosis, and to provide the basis on the nursing intervention.