肝胆胰外科杂志2025，Vol.37Issue(12)：814-821,8.DOI:10.11952/j.issn.1007-1954.2025.12.005
肝泡型棘球蚴病患者离体肝切除联合自体肝移植术后延迟拔管的危险因素分析及列线图预测模型构建
Risk factors and nomogram prediction model for prolonged mechanical ventilation after ex-vivo liver resection and autologous liver transplantation for hepatic alveolar echinococcosis
摘要
Abstract
Objective To identify the risk factors for prolonged mechanical ventilation(PMV)after ex vivo liver resection combined with autologous liver transplantation(ELRA)in patients with hepatic alveolar echinococcosis(HAE),and to construct a nomogram predictive model.Methods A retrospective analysis was performed on 127 patients with HAE who underwent ELRA at the First Affiliated Hospital of Xinjiang Medical University from April 2013 to April 2024.Univariate and multivariate Logistic regression analyses were used to identify the independent risk factors for PMV in patients who underwent ELRA.Based on the results,a nomogram prediction model for PMV was established.Model performance was evaluated using receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA).Results Logistic regression analysis indicated that age(OR=1.088,95％CI 1.039 to 1.138,P<0.001),intraoperative cryoprecipitate transfusion(OR=32.536,95％CI 2.807 to 377.061,P=0.005),alanine aminotransferase(ALT)on postoperative day 0(POD0)(OR=1.001,95％CI 1.000 to 1.002,P=0.024),and prothrombin time(PT)on POD0(OR=1.090,95％CI 1.021 to 1.163,P=0.010)were independent risk factors for PMV,whereas fibrinogen(FIB)on POD1(OR=0.339,95％CI 0.214 to 0.744,P=0.004)was a protective factor.The nomogram incorporating age,POD0 ALT,POD0 PT,and POD1 FIB showed good predictive performance,with an AUC of 0.805.The calibration curve demonstrated good agreement between predicted and observed outcomes,and the DCA showed higher net benefit across a wide range of threshold probabilities,supporting the clinical utility of the model.Conclusion Age,POD0 ALT and POD0 PT were risk factors for PMV after ELRA in HAE patients,while increased POD1 FIB is a protective factor.The nomogram based on these four variables demonstrate good predictive ability and clinical applicability.关键词
肝泡型棘球蚴病/离体肝切除/自体肝移植/延迟拔管/危险因素/列线图/预测模型Key words
hepatic alveolar echinococcosis/ex vivo liver resection/autologous liver transplantation/prolonged mechanical ventilation/risk factors/nomogram/prediction model分类
医药卫生引用本文复制引用
XU Jingnan,WANG Jingjie,ZHENG Qihang,ZHAO Hanyu,ZHANG Ruiqing,YU Xiangyou,WANG Yi..肝泡型棘球蚴病患者离体肝切除联合自体肝移植术后延迟拔管的危险因素分析及列线图预测模型构建[J].肝胆胰外科杂志,2025,37(12):814-821,8.基金项目
新疆围术期器官保护重点实验室开放课题(XJDX1411-2025-MZZ1) （XJDX1411-2025-MZZ1）
国家自然科学基金(82460372) （82460372）
中华国际医学交流基金(MF-Z-2016-23-1823). （MF-Z-2016-23-1823）
