【摘要】 目的:对肝硬化患者中轻微型肝性脑病(MHE)风险较高的患者亚群进行有针对性的筛查，为MHE患者早干预提供临床依据。方法:选取2020年8月至2021年12月在延安大学附属医院感染病科住院部就诊年龄在18～65岁之间的肝硬化患者，根据NCT-A、改良版NCT-B、S-ANT1三项测试结果将研究对象分为MHE组与无MHE组，分析肝硬化患者合并MHE相关危险因素，并对各个独立危险因素行ROC曲线分析，评估每个独立危险因素预测效果，进一步构建肝硬化合并MHE的列线图预测模型，对模型进行内部验证和绘制ROC曲线评估模型的预测效果。结果:单因素分析结果显示年龄、受教育年限、肝硬化病程、合并腹水、行脾切除术史、营养风险、总蛋白、天门冬氨酸氨基转移酶、白蛋白、凝血酶原时间、血浆凝血酶原活动度、透明质酸、谷草/谷丙、Child-Pugh分级、MELD评分差异均有统计学意义；多因素分析结果显示年龄、透明质酸>120 ng/ml、Child-Pugh B、Child-Pugh C级、受教育年限<7年是肝硬化患者合并MHE的独立危险因素；列线图预测模型对肝硬化合并MHE预测能力优于各项独立危险因素。结论:年龄、Child-Pugh B/C级、受教育年限<7年、透明质酸>120 ng/ml是肝硬化患者合并MHE的独立危险因素。列线图预测模型具有较好的校准度与区分度。更多还原

【Abstract】 Objective:To carry out targeted screening for the subgroup of patients with high MHE risk in liver cirrhosis patients and provide a clinical basis for early intervention of MHE patients.Methods:Selected patients with liver cirrhosis who were between 18 and 65 years old in the Inpatient Department of Infectious Diseases, Yan’an University Affiliated Hospital from August 2020 to December 2021. According to the test results(NCT-A, NCT-BC, SANT-1), the research subjects were divided into the MHE group and the non-MHE group, the risk factors related to MHE in patients with liver cirrhosis were analyzed, and ROC curve analysis was performed for each independent risk factor to evaluate the predictive effect of each independent risk factor, and further construct the liver cirrhosis combined with the risk factors. The nomogram of MHE predicts the model, and the model is internally validated and the ROC curve is drawn to evaluate the prediction effect of the model.Results:Univariate analysis showed that age, years of education, course of liver cirrhosis, ascites, history of splenectomy, nutritional risk, total protein, aspartate aminotransferase, albumin, prothrombin time. There were statistically significant differences in plasma prothrombin activity, hyaluronic acid, aspartate/glutathione, Child-Pugh grade, and MELD score. The multivariate analysis showed that age, hyaluronic acid greater than 120 ng/ml, Child-Pugh B, Grade C, and less than seven years of education are independent risk factors for MHE in patients with liver cirrhosis. And the predictive ability of the nomogram prediction model for liver cirrhosis with MHE is better than that of independent risk factors.Conclusion:Age, Child-Pugh grade, less than seven years of education, and hyaluronic acid greater than 120 ng/ml were found to be independent risk factors for MHE in patients with liver cirrhosis.The predictive ability of the nomogram prediction model has better calibration and discrimination.更多还原