Objective Clinical medical record data associated with hepatitis B-related acute-on-chronic liver failure(HBV-ACLF)generally have small sample sizes and a class imbalance.However,most machine learning models are desig...Objective Clinical medical record data associated with hepatitis B-related acute-on-chronic liver failure(HBV-ACLF)generally have small sample sizes and a class imbalance.However,most machine learning models are designed based on balanced data and lack interpretability.This study aimed to propose a traditional Chinese medicine(TCM)diagnostic model for HBV-ACLF based on the TCM syndrome differentiation and treatment theory,which is clinically interpretable and highly accurate.Methods We collected medical records from 261 patients diagnosed with HBV-ACLF,including three syndromes:Yang jaundice(214 cases),Yang-Yin jaundice(41 cases),and Yin jaundice(6 cases).To avoid overfitting of the machine learning model,we excluded the cases of Yin jaundice.After data standardization and cleaning,we obtained 255 relevant medical records of Yang jaundice and Yang-Yin jaundice.To address the class imbalance issue,we employed the oversampling method and five machine learning methods,including logistic regression(LR),support vector machine(SVM),decision tree(DT),random forest(RF),and extreme gradient boosting(XGBoost)to construct the syndrome diagnosis models.This study used precision,F1 score,the area under the receiver operating characteristic(ROC)curve(AUC),and accuracy as model evaluation metrics.The model with the best classification performance was selected to extract the diagnostic rule,and its clinical significance was thoroughly analyzed.Furthermore,we proposed a novel multiple-round stable rule extraction(MRSRE)method to obtain a stable rule set of features that can exhibit the model’s clinical interpretability.Results The precision of the five machine learning models built using oversampled balanced data exceeded 0.90.Among these models,the accuracy of RF classification of syndrome types was 0.92,and the mean F1 scores of the two categories of Yang jaundice and Yang-Yin jaundice were 0.93 and 0.94,respectively.Additionally,the AUC was 0.98.The extraction rules of the RF syndrome differentiation model based on the MRSRE method revealed that the common features of Yang jaundice and Yang-Yin jaundice were wiry pulse,yellowing of the urine,skin,and eyes,normal tongue body,healthy sublingual vessel,nausea,oil loathing,and poor appetite.The main features of Yang jaundice were a red tongue body and thickened sublingual vessels,whereas those of Yang-Yin jaundice were a dark tongue body,pale white tongue body,white tongue coating,lack of strength,slippery pulse,light red tongue body,slimy tongue coating,and abdominal distension.This is aligned with the classifications made by TCM experts based on TCM syndrome differentiation and treatment theory.Conclusion Our model can be utilized for differentiating HBV-ACLF syndromes,which has the potential to be applied to generate other clinically interpretable models with high accuracy on clinical data characterized by small sample sizes and a class imbalance.展开更多
目的:分析国产程序性细胞死亡蛋白-1 (PD-1)抑制药相关心肌炎的临床特点。方法:检索CNKI、WanFang Data、VIP、PubMed和Web of Science等文献数据库,收集国产PD-1抑制药相关心肌炎的病例报道文献,进行描述性统计分析。结果:收集到28篇...目的:分析国产程序性细胞死亡蛋白-1 (PD-1)抑制药相关心肌炎的临床特点。方法:检索CNKI、WanFang Data、VIP、PubMed和Web of Science等文献数据库,收集国产PD-1抑制药相关心肌炎的病例报道文献,进行描述性统计分析。结果:收集到28篇文献共29个病例,男17例,女12例;年龄33~82(63.34±12.37)岁。22例(75.86%)患者的心肌炎发生在PD-1抑制药用药第1~2周期后;主要临床表现为气促、乏力、心悸、胸闷;11例患者心电图检查发现心脏传导阻滞,11例有ST-T改变。所有患者均接受了糖皮质激素治疗,12例使用了免疫球蛋白。24例(82.76%)患者治疗后症状明显好转,3例死亡。结论:男性及60岁以上患者使用PD-1抑制药发生心肌炎占比较高,发生时间多在用药早期,提示应及时发现潜在风险人群,尽早采取干预措施,确保患者用药安全。展开更多
基金Key research project of Hunan Provincial Administration of Traditional Chinese Medicine(A2023048)Key Research Foundation of Education Bureau of Hunan Province,China(23A0273).
文摘Objective Clinical medical record data associated with hepatitis B-related acute-on-chronic liver failure(HBV-ACLF)generally have small sample sizes and a class imbalance.However,most machine learning models are designed based on balanced data and lack interpretability.This study aimed to propose a traditional Chinese medicine(TCM)diagnostic model for HBV-ACLF based on the TCM syndrome differentiation and treatment theory,which is clinically interpretable and highly accurate.Methods We collected medical records from 261 patients diagnosed with HBV-ACLF,including three syndromes:Yang jaundice(214 cases),Yang-Yin jaundice(41 cases),and Yin jaundice(6 cases).To avoid overfitting of the machine learning model,we excluded the cases of Yin jaundice.After data standardization and cleaning,we obtained 255 relevant medical records of Yang jaundice and Yang-Yin jaundice.To address the class imbalance issue,we employed the oversampling method and five machine learning methods,including logistic regression(LR),support vector machine(SVM),decision tree(DT),random forest(RF),and extreme gradient boosting(XGBoost)to construct the syndrome diagnosis models.This study used precision,F1 score,the area under the receiver operating characteristic(ROC)curve(AUC),and accuracy as model evaluation metrics.The model with the best classification performance was selected to extract the diagnostic rule,and its clinical significance was thoroughly analyzed.Furthermore,we proposed a novel multiple-round stable rule extraction(MRSRE)method to obtain a stable rule set of features that can exhibit the model’s clinical interpretability.Results The precision of the five machine learning models built using oversampled balanced data exceeded 0.90.Among these models,the accuracy of RF classification of syndrome types was 0.92,and the mean F1 scores of the two categories of Yang jaundice and Yang-Yin jaundice were 0.93 and 0.94,respectively.Additionally,the AUC was 0.98.The extraction rules of the RF syndrome differentiation model based on the MRSRE method revealed that the common features of Yang jaundice and Yang-Yin jaundice were wiry pulse,yellowing of the urine,skin,and eyes,normal tongue body,healthy sublingual vessel,nausea,oil loathing,and poor appetite.The main features of Yang jaundice were a red tongue body and thickened sublingual vessels,whereas those of Yang-Yin jaundice were a dark tongue body,pale white tongue body,white tongue coating,lack of strength,slippery pulse,light red tongue body,slimy tongue coating,and abdominal distension.This is aligned with the classifications made by TCM experts based on TCM syndrome differentiation and treatment theory.Conclusion Our model can be utilized for differentiating HBV-ACLF syndromes,which has the potential to be applied to generate other clinically interpretable models with high accuracy on clinical data characterized by small sample sizes and a class imbalance.
文摘目的:分析国产程序性细胞死亡蛋白-1 (PD-1)抑制药相关心肌炎的临床特点。方法:检索CNKI、WanFang Data、VIP、PubMed和Web of Science等文献数据库,收集国产PD-1抑制药相关心肌炎的病例报道文献,进行描述性统计分析。结果:收集到28篇文献共29个病例,男17例,女12例;年龄33~82(63.34±12.37)岁。22例(75.86%)患者的心肌炎发生在PD-1抑制药用药第1~2周期后;主要临床表现为气促、乏力、心悸、胸闷;11例患者心电图检查发现心脏传导阻滞,11例有ST-T改变。所有患者均接受了糖皮质激素治疗,12例使用了免疫球蛋白。24例(82.76%)患者治疗后症状明显好转,3例死亡。结论:男性及60岁以上患者使用PD-1抑制药发生心肌炎占比较高,发生时间多在用药早期,提示应及时发现潜在风险人群,尽早采取干预措施,确保患者用药安全。
