肝胆胰外科杂志2023，Vol.35Issue(12)：736-741,746,7.DOI:10.11952/j.issn.1007-1954.2023.12.008
乙肝肝硬化门静脉高压症脾切除术后腹腔积液预测模型
Prediction model for ascites after splenectomy in patients with portal hypertension due to cirrhosis of hepatitis B
摘要
Abstract
Objective To explore the risk factors of ascites after splenectomy in patients with hepatitis B cirrhosis and portal hypertension,and to establish a predictive model that can predict ascites after splenectomy.Methods Clinical data of patients with portal hypertension due to hepatitis B cirrhosis,who underwent splenectomy in Nanfang Hospital of Southern Medical University from Jan.2017 to Feb.2023,were retrospectively collected.According to whether there was ascites after surgery,the patients were divided into the ascites group(32 cases)and the non-ascites group(89 cases).SPSS 25.0 software was used to analyze the risk factors of postoperative abdominal fluid accumulation.Based on the results of multiple factor analysis,a predictive model of nomogram was established and evaluated using R language.Results Univariate analysis showed that there were statistically significant differences in age,body mass index(BMI),preoperative splenic vein diameter,preoperative portal vein diameter,preoperative abdominal fluid accumulation,presence of pericardial devascularization,intraoperative blood loss,and albumin levels on the first and fifth day after surgery between the two groups of patients(P<0.05).The results of multivariate analysis showed that patients with a wide diameter of the anterior portal vein(OR=3.331,95%CI 1.128-9.842),the presence of abdominal fluid accumulation before surgery(OR=229.127,95%CI 9.348-5 615.995),and history of pericardial devascularization(OR=6.745,95%CI 1.334-34.093)were independent risk factors for postoperative abdominal fluid accumulation after splenectomy.All the independent risk factors were included to construct a nomogram model of ascites after splenectomy for portal hypertension in patients with hepatitis B cirrhosis.The Hosmer-Limeshow goodness of fit test result of the model was P=0.779,indicating a good degree of fit.The AUC under the ROC curve was 0.852(95%CI 0.781-0.924).The clinical decision curve showed that the model had significant clinical utility in predicting postoperative ascites.Conclusion The diameter of the portal vein before operation,the presence of ascites before operation,and pericardial devascularization are independent risk factors for ascites after splenectomy in patients with hepatitis B cirrhosis and portal hypertension.The nomogram model established on this basis has a good prediction ability for ascites after splenectomy.关键词
乙肝肝硬化/门静脉高压症/脾切除术/腹腔积液/列线图/预测模型Key words
hepatitis B cirrhosis/portal hypertension/splenectomy/ascites/nomogram/prediction model分类
医药卫生引用本文复制引用
李芷西,黄少坚,贺卓,黄嘉明,张起帆,周杰,王恺..乙肝肝硬化门静脉高压症脾切除术后腹腔积液预测模型[J].肝胆胰外科杂志,2023,35(12):736-741,746,7.基金项目
国家自然科学基金项目(82070642) （82070642）
广东省基础与应用基础研究基金(2021A1515012485). （2021A1515012485）
