1.Risk factors for concurrent hepatic hydrothorax before intervention in primary liver cancer and construction of a nomogram prediction model
Yuanzhen WANG ; Renhai TIAN ; Yingyuan ZHANG ; Danqing XU ; Lixian CHANG ; Chunyun LIU ; Li LIU
Journal of Clinical Hepatology 2025;41(1):75-83
ObjectiveTo investigate the influencing factors for hepatic hydrothorax (HH) before intervention for primary hepatic carcinoma (PHC), and to construct and assess the nomogram risk prediction model. MethodsA retrospective analysis was performed for the clinical data of 353 hospitalized patients who attended the Third People’s Hospital of Kunming for the first time from October 2012 to October 2021 and there diagnosed with PHC, and according to the presence or absence of HH, they were divided into HH group with 153 patients and non-HH group with 200 patients. General data and the data of initial clinical testing after admission were collected from all PHC patients. The independent-samples t test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. After the multicollinearity test was performed for the variables with statistical significance determined by the univariate analysis, the multivariate Logistic regression analysis was used to identify independent influencing factors. The “rms” software package was used to construct a nomogram risk prediction model, and the Hosmer-Lemeshow test and the receiver operating characteristic (ROC) curve were used to assess the risk prediction model; the “Calibration Curves” software package was used to plot the calibration curve, and the “rmda” software package was used to plot the clinical decision curve and the clinical impact curve. ResultsAmong the 353 patients with PHC, there were 153 patients with HH, with a prevalence rate of 43.34%. Child-Pugh class B (odds ratio [OR]=2.652, 95% confidence interval [CI]: 1.050 — 6.698, P=0.039), Child-Pugh class C (OR=7.963, 95%CI: 1.046 — 60.632, P=0.045), total protein (OR=0.947, 95%CI: 0.914 — 0.981, P=0.003), high-sensitivity C-reactive protein (OR=1.007, 95%CI: 1.001 — 1.014, P=0.025), and interleukin-2 (OR=0.801, 95%CI: 0.653 — 0.981, P=0.032) were independent influencing factors for HH before PHC intervention, and a nomogram risk prediction model was established based on these factors. The Hosmer-Lemeshow test showed that the model had a good degree of fitting (χ2=5.006, P=0.757), with an area under the ROC curve of 0.752 (95%CI: 0.701 — 0.803), a sensitivity of 78.40%, and a specificity of 63.50%. The calibration curve showed that the model had good consistency in predicting HH before PHC intervention, and the clinical decision curve and the clinical impact curve showed that the model had good clinical practicability within a certain threshold range. ConclusionChild-Pugh class, total protein, interleukin-2, and high-sensitivity C-reactive protein are independent influencing factors for developing HH before PHC intervention, and the nomogram model established based on these factors can effectively predict the risk of developing HH.
2.Influencing factors for recompensation in patients with decompensated hepatitis C cirrhosis
Danqing XU ; Huan MU ; Yingyuan ZHANG ; Lixian CHANG ; Yuanzhen WANG ; Weikun LI ; Zhijian DONG ; Lihua ZHANG ; Yijing CHENG ; Li LIU
Journal of Clinical Hepatology 2025;41(2):269-276
ObjectiveTo investigate the influencing factors for recompensation in patients with decompensated hepatitis C cirrhosis, and to establish a predictive model. MethodsA total of 217 patients who were diagnosed with decompensated hepatitis C cirrhosis and were admitted to The Third People’s Hospital of Kunming l from January, 2019 to December, 2022 were enrolled, among whom 63 patients who were readmitted within at least 1 year and had no portal hypertension-related complications were enrolled as recompensation group, and 154 patients without recompensation were enrolled as control group. Related clinical data were collected, and univariate and multivariate analyses were performed for the factors that may affect the occurrence of recompensation. The independent-samples t test was used for comparison of normally distributed measurement data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed measurement data between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. A binary Logistic regression analysis was used to investigate the influencing factors for recompensation in patients with decompensated hepatitis C cirrhosis, and the receiver operating characteristic (ROC) curve was used to assess the predictive performance of the model. ResultsAmong the 217 patients with decompensated hepatitis C cirrhosis, 63 (29.03%) had recompensation. There were significant differences between the recompensation group and the control group in HIV history (χ2=4.566, P=0.034), history of partial splenic embolism (χ2=6.687, P=0.014), Child-Pugh classification (χ2=11.978, P=0.003), grade of ascites (χ2=14.229, P<0.001), albumin (t=4.063, P<0.001), prealbumin (Z=-3.077, P=0.002), high-density lipoprotein (t=2.854, P=0.011), high-sensitivity C-reactive protein (Z=-2.447, P=0.014), prothrombin time (Z=-2.441, P=0.015), carcinoembryonic antigen (Z=-2.113, P=0.035), alpha-fetoprotein (AFP) (Z=-2.063, P=0.039), CA125 (Z=-2.270, P=0.023), TT3 (Z=-3.304, P<0.001), TT4 (Z=-2.221, P=0.026), CD45+ (Z=-2.278, P=0.023), interleukin-5 (Z=-2.845, P=0.004), tumor necrosis factor-α (Z=-2.176, P=0.030), and portal vein width (Z=-5.283, P=0.005). The multivariate analysis showed that history of partial splenic embolism (odds ratio [OR]=3.064, P=0.049), HIV history (OR=0.195, P=0.027), a small amount of ascites (OR=3.390, P=0.017), AFP (OR=1.003, P=0.004), and portal vein width (OR=0.600, P<0.001) were independent influencing factors for the occurrence of recompensation in patients with decompensated hepatitis C cirrhosis. The ROC curve analysis showed that HIV history, grade of ascites, history of partial splenic embolism, AFP, portal vein width, and the combined predictive model of these indices had an area under the ROC curve of 0.556, 0.641, 0.560, 0.589, 0.745, and 0.817, respectively. ConclusionFor patients with decompensated hepatitis C cirrhosis, those with a history of partial splenic embolism, a small amount of ascites, and an increase in AFP level are more likely to experience recompensation, while those with a history of HIV and an increase in portal vein width are less likely to experience recompensation.
3.Value of FibroScan, gamma-glutamyl transpeptidase-to-platelet ratio, S index, interleukin-6, and tumor necrosis factor-α in the diagnosis of HBeAg-positive chronic hepatitis B liver fibrosis
Yingyuan ZHANG ; Danqing XU ; Huan MU ; Chunyan MOU ; Lixian CHANG ; Yuanzhen WANG ; Hongyan WEI ; Li LIU ; Weikun LI ; Chunyun LIU
Journal of Clinical Hepatology 2025;41(4):670-676
ObjectiveTo investigate the value of noninvasive imaging detection (FibroScan), two serological models of gamma-glutamyl transpeptidase-to-platelet ratio (GPR) score and S index, and two inflammatory factors of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in predicting liver fibrosis in patients with HBeAg-positive chronic hepatitis B (CHB), as well as the consistency of liver biopsy in pathological staging, and to provide early warning for early intervention of CHB. MethodsA retrospective analysis was performed for 131 HBeAg-positive CHB patients who underwent liver biopsy in The Third People’s Hospital of Kunming from January 2019 to December 2023. The results of liver biopsy were collected from all patients, and related examinations were performed before liver biopsy, including total bilirubin, alanine aminotransferase, platelet count, gamma-glutamyl transpeptidase, albumin, IL-6, TNF-α, liver stiffness measurement (LSM), and abdominal ultrasound. An analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A Kappa analysis was used to investigate the consistency between LSM noninvasive histological staging and pathological staging based on liver biopsy, and the Spearman analysis was used to investigate the correlation between each variable and FibroScan in the diagnosis of liver fibrosis stage. The Logistic regression analysis was used to construct joint predictive factors. The receiver operating characteristic (ROC) curve was used to evaluate the value of each indicator alone and the joint predictive model in the diagnosis of liver fibrosis, and the Delong test was used for comparison of the area under the ROC curve (AUC). ResultsIn the consistency check, inflammation degree based on liver biopsy had a Kappa value of 0.807 (P<0.001), and liver fibrosis degree based on liver biopsy had a Kappa value of 0.827 (P<0.001), suggesting that FibroScan noninvasive histological staging and liver biopsy showed good consistency in assessing inflammation degree and liver fibrosis stage. Age was positively correlated with LSM, GPR score, S index, IL-6, and TNF-α (all P<0.05), and GPR score, S index, IL-6, and TNF-α were positively correlated with LSM (all P<0.05). GPR score, S index, IL-6, and TNF-α were all independent risk factors for diagnosing significant liver fibrosis (≥S2) and progressive liver fibrosis (≥S3) (all P<0.05). As for each indicator alone, GPR score had the highest value in the diagnosis of significant liver fibrosis (≥S2), followed by S index, IL-6, and TNF-α, while S index had the highest value in the diagnosis of progressive liver fibrosis (≥S3), followed by GPR score, TNF-α, and IL-6. The joint model had a higher predictive value than each indicator alone (all P<0.05). ConclusionThere is a good consistency between FibroScan noninvasive histological staging and pathological staging based on liver biopsy. GPR score, S index, IL-6, and TNF-α are independent risk factors for evaluating different degree of liver fibrosis in CHB, and the combined prediction model established by them can better diagnose liver fibrosis.
4.Efficacy and safety of coblopasvir hydrochloride combined with sofosbuvir in treatment of patients with genotype 3 hepatitis C virus infection
Yingyuan ZHANG ; Huan MU ; Danqing XU ; Chunyan MOU ; Yuanzhen WANG ; Chunyun LIU ; Weikun LI ; Li LIU
Journal of Clinical Hepatology 2025;41(6):1075-1082
ObjectiveTo investigate the efficacy and safety of the direct-acting antiviral agents coblopasvir hydrochloride/sofosbuvir (CLP/SOF) regimen used alone or in combination with ribavirin (RBV) in the treatment of patients with genotype 3 hepatitis C virus (HCV) infection in terms of virologic response rate, liver function recovery, improvement in liver stiffness measurement (LSM), and adverse drug reactions, and to provide a reference for clinical medication. MethodsA total of 98 patients with genotype 3 HCV infection who attended The Third People’s Hospital of Kunming from January 2022 to December 2023 were enrolled, and according to the treatment method, the patients were divided into CLP/SOF+RBV treatment group with 55 patients and CLP/SOF treatment group with 43 patients. The patients were observed in terms of rapid virologic response at week 4 (RVR4), sustained virologic response (SVR), previous treatment experience, underlying diseases, laboratory and imaging indicators, and adverse reactions during treatment. The course of treatment was 12 weeks, and the patients were followed up for 12 weeks after drug withdrawal. The independent-samples t test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Friedman test was used for comparison within each group at different time points, and the Bonferroni method was used for further comparison and correction of P value; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The univariate and multivariate Logistic regression analyses were used to investigate the influencing factors for SVR12. ResultsBefore treatment, there were significant differences between the CLP/SOF+RBV treatment group and the CLP/SOF treatment group in terms of LSM, total bilirubin (TBil), gamma-glutamyl transpeptidase (GGT), HCV genotype, and the presence or absence of liver cirrhosis and compensation (all P<0.05). The 98 patients with genotype 3 HCV infection had an RVR4 rate of 81.6% and an SVR12 rate of 93.9%. The patients with genotype 3a HCV infection had an RVR4 rate of 84.44% and an SVR12 rate of 97.78%, while the patients with genotype 3b HCV infection had an RVR4 rate of 79.25% and an SVR12 rate of 90.57%. There were significant differences in RVR4 and SVR12 rates between the patients without hepatocellular carcinoma and those with hepatocellular carcinoma, there was a significant difference in RVR4 rate between the patients without HIV infection and those with HIV infection, and there was a significant difference in SVR12 rate between the previously untreated patients and the treatment-experienced patients (all P<0.05). The univariate Logistic regression analysis showed that treatment history, hypertension, hepatocellular carcinoma, ascites, albumin (Alb), and platelet count were influencing factors for SVR12 (all P<0.05), and the multivariate Logistic regression analysis showed that hepatocellular carcinoma (odds ratio=0.034, 95% confidence interval: 0.002 — 0.666, P=0.026) was an independent influencing factor for SVR12. After treatment with CLP/SOF combined with RBV or CLP/SOF alone, the patients with genotype 3 HCV infection showed gradual reductions in the liver function parameters of TBil, GGT, and alanine aminotransferase (all P<0.05) and a gradual increase in the level of Alb (P<0.05). As for renal function, there were no significant changes in blood urea nitrogen and creatinine after treatment (P>0.05). For the patients with or without liver cirrhosis, there was a significant reduction in LSM from baseline after treatment for 12 weeks (P<0.05). Among the 98 patients with genotype 3 HCV infection, 9 tested positive for HCV-RNA at 12 weeks after treatment, 2 showed no response during treatment, 4 showed virologic breakthrough, and 3 experienced recurrence. The overall incidence rate of adverse events during treatment was 17.35% for all patients. ConclusionCLP/SOF alone or in combination with RBV has a relatively high SVR rate in the treatment of genotype 3 HCV infection, with good tolerability and safety in patients during treatment, and therefore, it holds promise for clinical application.
5.Establishment and Evaluation of a Risk Prediction Model for Chronic Liver Failure Complicated by Primary Hepatocellular Carcinoma Before Intervention
Yuanzhen WANG ; Hongyan WEI ; Renhai TIAN ; Yongzhen CHEN ; Danqing XU ; Yingyuan ZHANG ; Lixian CHANG ; Chunyun LIU ; Li LIU
Journal of Kunming Medical University 2025;46(3):139-147
Objective To analyze the influencing factors of chronic liver failure in patients with primary hepatic carcinoma(PHC)before intervention,and to establish and evaluate a nomogram risk prediction model.Methods A retrospective analysis was conducted by collecting general data and clinical test data within 24 hours of admission for PHC patients.Univariate analysis and Lasso regression were used for variable selection,followed by multivariate logistic regression analysis to identify independent influencing factors for CLF before PHC intervention,leading to the establishment of a nomogram risk prediction model.The model was evaluated using the Hosmer-Lemeshow test,receiver operating characteristic(ROC)curve,calibration curve,clinical decision curve,and clinical impact curve.Result A total of 353 cases of PHC patients were collected,including 153 cases in the liver failure group and 200 cases in the non-liver failure group,with a prevalence rate of 43.3%.Variables selected by Lasso regression included gastrointestinal bleeding,prothrombin time(PT),albumin(ALB),total bilirubin(TBIL),and gamma glutamyl transferase(GGT).Multivariate logistic regression analysis showed that gastrointestinal bleeding(OR=13.549,95%CI:2.899~63.322,P=0.001),PT(OR=1.599,95%CI:1.282~1.995,P<0.001),TBIL(OR=1.016,95%CI:1.006~1.025,P=0.002),and GGT(OR=1.002,95%CI:1.000~1.003,P=0.028)were independent risk factors for chronic liver failure prior to PHC intervention,leading to the establishment of a nomogram risk prediction model.The Hosmer Lemeshow test showed that the model had a good fit(x2=6.152,P>0.05);the area under ROC was 0.902(0.869-0.934),with a sensitivity of 80.4%and a specificity of 87.5%.The calibration curve indicated that the model predicts chronic liver failure prior to PHC intervention with good consistency.Clinical decision curve analysis and clinical impact curve analysis showed that the model has good clinical utility within a certain threshold range.Conclusion Gastrointestinal bleeding,PT ≥16.05s,TBIL≥37.80 mmol/L,and GGT≥ 99.00 U/L are independent risk factors for the occurrence of chronic liver failure before PHC intervention.The established nomogram risk prediction model has certain clinical application value in predicting the risk of chronic liver failure before PHC intervention.
6.Comparison of Efficacy of Tenofovir Amibufenamide and Tenofovir Disoproxil Fumarate on Chronic Hepatitis B
Yingyuan ZHANG ; Chunyan MOU ; Huan MU ; Danqing XU ; Lixian CHANG ; Yuanzhen WANG ; Chunyun LIU ; Li LIU
Journal of Kunming Medical University 2025;46(6):140-148
Objective To compare the efficacy of Tenofovir Alafenamide(TMF)and Tenofovir Disoproxil Fumarate(TDF)in terms of liver function restoration,virus clearance,immune regulation,anti liver fibrosis,lipid metabolism,bone and renal safety,and adverse reactions.Methods A retrospective analysis was conducted on 110 patients with chronic hepatitis B(CHB)admitted to Kunming Third People's Hospital from January 2022 to December 2022.Patients were divided into the TMF treatment group(n=55)and the TDF treatment group(n=55)based on their treatment regimen.We compared the levels of transaminase levels,antiviral efficacy,T cell subsets,renal function electrolytes,lipid metabolism,four liver fibrosis-related indicators,and changes in liver stiffness grading before and after treatment in two groups of patients.The incidence of adverse reactions post-treatment was also compared.Results After 48 weeks of treatment,the levels of TBIL,ALT,AST,GGT,and GLOB in both groups of patients were significantly lower than pre-treatment levels(P<0.05).The decrease in AST levels in the TMF group was lower than that in the TDF group(P<0.05).After 48 weeks of treatment,the HBV-DNA seroconversion rate in the TMF group(90.90%)was higher than that in the TDF group(83.64%).The serological HBsAg clearance rate in the TMF group(7.3%)was lower than that in the TDF group(9.1%),while the HBeAg clearance rate in the TMF group(38.2%)was significantly higher than that in the TDF group(18.2%),with statistical significance(P<0.05).After 48 weeks of treatment,levels of CD3+,CD4+,and CD8+in both groups were significantly elevated compared to pre-treatment levels(P<0.05);notably,the TMF group had higher post-treatment levels of CD3+,CD4+,and CD8+than the TDF group.After 48 weeks,the average values of HA,IV-C,and LN among the TMF group for liver fibrosis indicators were significantly lower than those in the TDF group(P<0.05).The proportions of F0 and F2 in both groups significantly increased post-treatment,while the proportions of F3 and F4 significantly decreased(P to be supplemented);furthermore,the proportions of F0 and F2 in the TMF group were significantly higher than those in the TDF group,and the proportions of F3 and F4 in the TMF group were significantly lower than those in the TDF group(P<0.05).After 48 weeks,HDL-C levels in the TMF group increased compared to pre-treatment(P<0.05).There were no significant differences in TG,TC,HDL-C,or LDL-C levels in the TDF group compared to pre-treatment(P>0.05).After 48 weeks of treatment,there was no difference in the levels of BUN、Cr、P+,and Ca+in the TMF group compared to pre-treatment(P>0.05);however,BUN and Cr levels in the TDF group were significantly higher than pre-treatment levels,while P+and Ca+levels were significantly lower(P<0.05).The incidence of elevated uric acid and bone pain was significantly higher in the TMF group compared to the TDF group(P<0.05);the incidence of diarrhea and abdominal pain was slightly higher in the TMF group compared to the TDF group(P>0.05).Conclusion Compared to TDF,TMF demonstrates a higher rate of liver function recovery,a greater virological response,enhanced anti fibrotic efficacy,and improved drug safety,making it worthy of clinical application in the future.
7.A clinical study on the treatment of refractory tennis elbow with arc-edge needle therapy based on zaodian theory
Xuejian MA ; Dongzhe ZHANG ; Chaoyang NIU ; Shuaigang DU ; Wuyang WANG ; Shilong CHENG ; Yingyuan XIAO ; Xuechang WANG
The Journal of Practical Medicine 2024;40(15):2161-2165
Objective To explore the clinical efficacy of arc-edge needle therapy based on Zaodian theory in the treatment of refractory tennis elbow.Methods 64 patients with refractory tennis elbow were collected and randomly divided into a control group and an observation group using a random number table method.Among them,32 cases in the control group were treated with local pain point injection.32 patients in the observation group were treated with arc-edge needle therapy once a week,with two treatments per group.The Number rating scale(NRS)Mayo,elbow joint performance score(MEPS)and Disabilities of the arm,shoulder and hand(DASH)score were recorded and compared between the two groups before treatment and at 1,2,4 and 24 weeks of follow-up after treatment,disease efficacy score(WDES)at 24 weeks of follow-up.Results During the treat-ment process,neither group of patients experienced serious adverse reactions.At each stage after treatment,two groups of NRS MEPS,DASH,and WDES at 24 weeks of follow-up all improved compared to before treatment.After one week of treatment,there was no statistically significant difference in NRS scores between the two groups(P>0.05).At follow-up visits at weeks 2,4,and 24,the NRS scores in the observation group were lower than those in the control group.After 1,2,4,and 24 weeks of follow-up after treatment,the DASH score was lower in the observation group than in the control group,and the MEPS score was higher in the observation group than in the control group,with statistically significant differences(P<0.05).After 24 weeks of treatment,the WDES of the observation group was better than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Local pain point injection and arc-edge Zaodian release can alleviate pain and improve elbow joint function in the early stage of refractory tennis elbow.However,the long-term effect of local pain point injection treatment is not good,and the treatment effect of the observation group gradually improves.
8.Comparison of clinical efficacy of TMF and TDF in the treatment of hepatitis B liver fibrosis
Yingyuan ZHANG ; Chunyan MOU ; Danqing XU ; Yuanzhen WANG ; Lixian CHANG ; Chunyun LIU ; Weikun LI ; Hong-Yan WEI ; Li LIU
The Journal of Practical Medicine 2024;40(22):3215-3220
Objective This study is to explore the clinical efficacy and common adverse reactions of PEG-IFN α-2b combined with TMF and TDF in the treatment of hepatitis B liver fibrosis,and provide more clinical reference for the treatment of chronic hepatitis B.Methods From January 2022 to December 2023,we selected 130 patients with chronic hepatitis B liver fibrosis who were admitted to Kunming Third People's Hospital.Divided into TMF combined group and TDF combined group,the virus reduction level,virus response rate,liver fibrosis four items,instantaneous elastography(FibroScan)and other indicators were compared between the two groups of patients after 48 weeks of treatment.The changes in liver fibrosis grading and adverse reactions before and after treatment were also compared.Results After 48 weeks of treatment,the TMF combined group showed a significant increase in HBV DNA seroconversion rate and HBeAg seroconversion rate compared to the TDF combined group,with statistical significance(P<0.05).However,there was no statistically significant difference in HBsAg seroconversion rate between the two groups of patients(P>0.05).After 48 weeks of treatment,the TMF combined group showed more significant efficacy in reducing the levels of HA,PC Ⅲ,Ⅳ-C,and LN,with a significant difference(P<0.05);After 48 weeks of treatment,both groups of patients showed improvement in the degree of liver tissue fibrosis.Compared with the TDF combined group,the TMF combined group had a more significant effect on tissue improvement.After 48 weeks of treatment,the incidence of dyslipidemia,hypothyroidism,and diarrhea was higher in the TMF combined group than in the TDF combined group(P<0.05);After 48 weeks of treatment,there was no statistically significant difference in the incidence of gingival bleeding,anemia,and thrombocytopenia between the two groups of patients(P>0.05);The incidence of elevated uric acid and joint pain in the TDF combined group was higher than that in the TMF combined group after 48 weeks of treatment(P<0.05).Conclusion TMF combined with PEG-IFN α-2b has better clinical efficacy in treating chronic hepatitis B,strong antiviral ability,greater inhibition of liver fibrosis,good drug safety,better prognosis,and can provide more effective medication basis for clinical cure of hepatitis B.
9.Establishment and validation of a risk prediction model for primary liver cancer complicated with pulmonary infection before intervention
Yuanzhen WANG ; Hongyan WEI ; Lixian CHANG ; Yingyuan ZHANG ; Chunyun LIU ; Li LIU
Tianjin Medical Journal 2024;52(9):940-945
Objective To analyze the influencing factors of pulmonary infection in patients with primary liver cancer(PHC)before intervention,and establish a nomogram risk prediction model to verify it.Methods A total of 1 635 patients with PHC diagnosed and hospitalized for the first time were selected and divided into the infected group(197 cases)and the non-infected group(1 438 cases)according to whether they had pulmonary infection.General data such as body mass index(BMI),chronic hepatitis B(CHB),chronic hepatitis C(CHC),Barcelona stage(BCLC),white blood cells(WBC),neutrophils(NEU),hemoglobin(Hb)and other blood routine indicators were collected.Total protein(TP),prealbumin(PA),aspartate aminotransferase(AST),gamma glutamylaminotransferase(GGT),alkaline phospholipase(ALP),abnormal prothrombin(PIVKA-Ⅱ),alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA),procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),cholinesterase(ChE),total cholesterol(TC)and other blood biochemical indicators,CD3 cell count(CD3+),CD4 cell count(CD4+),CD4/CD8 ratio(CD4+/CD8+),CD19 cell count(CD19+),interleukin(IL)-2,interferon(IFN)-α,tumor necrosis factor(TNF)-α and other cytokines were also collected.Univariate analysis and Lasso regression were used to screen variables,and binary Logistic regression analysis was used to determine risk factors for pulmonary infection in PHC patients before intervention.The risk prediction model was established and evaluated.Results Compared with the non-infected group,age,smoking rate,CHC,pleural effusion,gastrointestinal hemorrhage,Child-Pugh grade C,BCLC Phase A/C/D ratio,WBC,NEU,AST,GGT,ALP,PIVKA-Ⅱ,AFP,CEA,PCT,hs-CRP,IL-2,IL-5,IL-6,IL-8,IL-10,IL-12,IFN-γ and TNF-α levels were higher in the infected group,and levels of BMI,CHB ratio,Hb,TP,PA,ChE,TC,CD3+,CD4+,CD4+/CD8+,CD19+and IFN-α were lower(P<0.05).Lasso regression and binary Logistic regression analysis showed that pleural effusion,gastrointestinal hemorrhage,higher level of age,WBC,Hb and lower level of TP were independent risk factors for pulmonary infection in patients with PHC before intervention.The area under receiver operating curve(ROC)of the established nomogram model was 0.700(95%CI:0.659-0.740),and Hosmer-Lemeshow test results showed good goodness-fit of the model.Self-sampling was repeated 1 000 times for internal verification.The consistency of the model was good.Conclusion Pleural effusion,gastrointestinal hemorrhage,higher level of age,WBC,Hb and lower level of TP are independent risk factors for pulmonary infection in PHC patients before intervention.The established nomogram prediction model can effectively evaluate the risk of pulmonary infection in PHC patients before intervention.
10.Comparing the prognostic value of 3 diagnostic criteria of bronchopulmonary dysplasia in preterm infants
Xin WANG ; Jing GUO ; Yanyan WU ; Yangke LU ; Dapeng LIU ; Mingchao LI ; Rui LI ; Yingyuan WANG ; Wenqing KANG
Chinese Journal of Pediatrics 2024;62(1):36-42
Objective:To compare the prognostic value of 3 diagnostic criteria of bronchopulmonary dysplasia (BPD) in preterm infants with gestational age<32 weeks.Methods:The retrospective cohort study was conducted to collect the clinical data of 285 preterm infants with BPD admitted to the Department of Neonatology, Children′s Hospital Affiliated to Zhengzhou University from January 2019 to September 2021, who were followed up regularly after discharge. The primary composite adverse outcome was defined as death or severe respiratory morbidity from 36 weeks of corrected gestational age to 18 months of corrected age, and the secondary composite adverse outcome was defined as death or neurodevelopmental impairment. According to the primary or secondary composite adverse outcomes, the preterm infants were divided into the adverse prognosis group and the non-adverse prognosis group. The 2001 National Institute of Child Health and Human Development (NICHD) criteria, 2018 NICHD criteria, and 2019 Neonatal Research Network (NRN) criteria were used to diagnose and grade BPD in preterm infants. Chi-square test, Logistic regression analysis, receiver operating characteristic (ROC) curve and Delong test were used to analyze the prognostic value of the 3 diagnostic criteria.Results:The 285 preterm infants had a gestational age of 29.4 (28.1, 30.6) weeks and birth weight of 1 230 (1 000, 1 465) g, including 167 males (58.6%). Among 285 premature infants who completed follow-up, the primary composite adverse outcome occurred in 124 preterm infants (43.5%), and the secondary composite adverse outcome occurred in 40 preterm infants (14.0%). Multivariate Logistic regression analysis showed that severe BPD according to the 2001 NICHD criteria, gradeⅡand Ⅲ BPD according to the 2018 NICHD criteria and grade 2 and 3 BPD according to the 2019 NRN criteria were all risk factors for primary composite adverse outcomes (all P<0.05). ROC curve showed that the area under the curve (AUC) of the 2018 NICHD criteria and 2019 NRN criteria were both higher than that of the 2001 NICHD criteria (0.70 and 0.70 vs. 0.61, Z=4.49 and 3.35, both P<0.001), but there was no significant difference between the 2018 NICHD and 2019 NRN criteria ( Z=0.38, P=0.702). Multivariate Logistic regression analysis showed that the secondary composite adverse outcomes were all associated with grade Ⅲ BPD according to the 2018 NICHD criteria and grade 3 BPD according to the 2019 NRN criteria (both P<0.05). ROC curve showed that the AUC of the 2018 NICHD criteria and 2019 NRN criteria were both higher than that of the 2001 NICHD criteria (0.71 and 0.71 vs. 0.58, Z=2.93 and 3.67, both P<0.001), but there was no statistically significant difference between the 2018 NICHD and 2019 NRN criteria ( Z=0.02, P=0.984). Conclusion:The 2018 NICHD and 2019 NRN criteria demonstrate good and comparable predictive value for the primary and secondary composite adverse outcomes in preterm infants with BPD, surpassing the predictive efficacy of the 2001 NICHD criteria.

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