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目的:建立影响核苷(酸)类似物治疗代偿性乙肝肝硬化疗效的预测模型。方法:204例代偿性乙肝肝硬化患者给予核苷(酸)类似物治疗,治疗48周后随机选取136例作为建模组,68例作为验证组,根据治疗效果将建模组又分为代偿组87例,失代偿组49例,对影响代偿组与失代偿组预后的相关因素进行单因素及Cox回归分析,建立预测方程。结果:多因素Cox比例风险回归分析得出实际较优模型:h(t、x)=h0(t)exp(0.5502_(X16)+0.3247_(X19)-0.0149_(X8)-0.0130_(X11)-0.0125_(X14)),由模型可知ALT(X8)、胆红素(X11)、PT(X14)、透明质酸(X16)、肝硬度值(X19)对核苷(酸)类似物治疗代偿性乙肝肝硬化的预后影响较大;代偿性乙肝肝硬化发展成为失代偿性乙肝肝硬化的概率模型(P)=1/[1+e-h(t、x)],受试者工作特征(ROC)曲线下面积(AUC)为0.8519,回归模型预测能力良好。验证组中失代偿性乙肝肝硬化组ALT、胆红素、PT阳性,透明质酸>200μg/L,肝硬度值>25k Pa比例均高于代偿性乙肝肝硬化组,差异比较有统计学意义(P<0.05)。结论:核苷(酸)类似物可有效抑制代偿性乙肝肝硬化患者HBV-DNA病毒复制,并促进HBe Ag转阴,但其治疗效果受ALT、胆红素、PT、透明质酸、肝硬度值等的影响。
Objective: To establish a predictive model that affects the efficacy of nucleoside (acid) analogues in the treatment of compensated hepatitis B cirrhosis. Methods: Totally 204 patients with compensated cirrhosis of liver cirrhosis were treated with nucleoside (acid) analogues. After 48 weeks of treatment, 136 cases were randomly selected as model group and 68 cases as verification group. The model group was divided into 87 patients in the compensation group and 49 patients in the decompensation group. One-factor and Cox regression analysis were performed on the related factors that affected the prognosis of the compensatory group and the decompensated group, and the predictive equation was established. Results: The multivariate Cox proportional hazards regression analysis showed that the actual optimal model was: h (t, x) = h0 (t) exp (0.5502 X16 + 0.3247 X19 -0.0149 X8 -0.0130 - X11) -0.0125_ (X14)), ALT (X8), bilirubin (X11), PT (X14), hyaluronic acid (X16) and liver cirrhosis (X19) Treatment of compensated hepatitis B cirrhosis prognosis greater impact; compensatory hepatitis B cirrhosis into decompensated hepatitis B cirrhosis probability model (P) = 1 / [1 + eh (t, x)], by The area under the receiver operating characteristic (ROC) curve (AUC) was 0.8519, and the regression model had good predictive power. In the verification group, ALT, bilirubin and PT were positive in patients with decompensated hepatitis B cirrhosis, hyaluronic acid> 200 μg / L, and liver cirrhosis> 25 kPa in compensatory hepatitis B cirrhosis group were statistically significant Significance (P <0.05). Conclusion: Nucleoside (acid) analogs can effectively inhibit the replication of HBV-DNA virus in patients with compensated cirrhosis of hepatitis B and promote the negative conversion of HBe Ag. However, its therapeutic effect is affected by ALT, bilirubin, PT, hyaluronic acid, Hardness and other effects.