个体化预测急性结石性胆囊炎合并肝功能异常的列线图模型构建

目的探讨急性结石性胆囊炎(ACC)合并肝功能异常的危险因素,并建立预测ACC合并肝功能异常的风险列线图模型。方法选取2018年2月至2020年6月于六安市中医院急诊科治疗的200例ACC患者进行回顾性研究,根据是否合并肝功能异常将患者分为肝功能异常组(n=54)和ACC组(n=146),采用Logistic回归分析筛选ACC合并肝功能异常的危险因素,并建立ACC合并肝功能异常的风险列线图模型。结果200例ACC患者中54例合并肝功能异常,发生率为27.00%。ACC组和肝功能异常组在年龄、营养不良、BMI、抽烟史、饮酒史及并存糖尿病等方面差异有统计学意义(P<0.05)。年龄≥60岁、有抽烟史和饮酒史、存在营养不良、BMI≥24、并存糖尿病等为ACC合并肝功能异常的独立危险因素(P<0.05)。基于上述独立危险因素,建立预测ACC合并肝功能异常的风险列线图模型,预测值与实测值基本一致,一致性指数为0.803(95%CI:0.767~0.840);内部验证该模型的ROC曲线下面积(AUC)为0.762;决策曲线显示,阈值概率在3%~75%时,采用本列线图来预测ACC合并肝功能异常的发生风险具有较高的净获益值。结论年龄≥60岁、抽烟史、饮酒史、营养不良、BMI≥24及糖尿病等为ACC合并肝功能异常的独立危险因素,基于以上6项独立危险因素所建立的列线图有助于预测ACC合并肝功能异常的发生风险。

Construction of Nomgram model for individualized prediction of acute calculous cholecystitis complicated with abnormal liver function

Objective To explore the individualized prediction of acute calculous cholecystitis(ACC)complicated with abnormal liver function and the risk factors by establishing risk nomogram model.Methods A retrospective study was performed on 200 ACC patients treated in Lu'an Hospital of Traditional Chinese Medicine from February 2018 to June 2020.The patients were divided into liver function abnormality group(n=54)and ACC group(n=146)according to whether they were complicated with abnormal liver function.Logistic regression analysis was used to screen the risk factors of ACC complicated with abnormal liver function,and the corresponding risk nomogram model was established.Results Out of 200 ACC patients,54(27.00%)had liver function abnormalities.There were statistical differences in age,malnutrition,BMI,smoking history,drinking history and coexisting diabetes mellitus between two groups(P<0.05).Age over 60 years old,smoking and drinking history,malnutrition,BMI≥24 and coexisting diabetes mellitus were the independent risk factors for liver dysfunction in ACC patients(P<0.05).The established risk nomogram model for predicting ACC combined with abnormal liver function was almost equal to the real situation by measurement(adjusted C-index=0.803,95%CI:0.767-0.840).The area under the ROC curve(AUC)of the model was 0.762,and the decision curve showed that nomogram model had a higher net benefit in predicting the risk of ACC combined with abnormal liver function when the threshold probability was in the range of 3%to 75%.Conclusion Old age,smoking history,drinking history,malnutrition,high BMI and diabetes are the independent risk factors of ACC complicated with abnormal liver function,and the nomogram based on the above risk factors is helpful to predict the risk of ACC complicated with abnormal liver function.