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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (05) : 400 -406. doi: 10.3877/cma.j.issn.2095-2015.2024.05.004

论著

血小板与淋巴细胞比值、免疫球蛋白、心肌酶谱及心电图对中老年肝硬化患者病情及预后的影响
崔健1, 夏青1, 林云2, 李光玲2, 李心娜2, 王位2,†()   
  1. 1. 100120　北京，中国人民解放军总医院京中医疗区医技保障科检验室
    2. 100120　北京，中国人民解放军总医院京中医疗区医技保障科心电超声室
  • 收稿日期:2024-01-15 出版日期:2024-10-01
  • 通信作者: 王位

Effects of platelet to lymphocyte ratio, immunoglobulin, myocardial enzyme spectrum and electrocardiogram parameters on the condition and prognosis of middle-aged and elderly patients with cirrhosis

Jian Cui1, Qing Xia1, Yun Lin2, Guangling Li2, Xinna Li2, Wei Wang2,†()   

  1. 1. Department of Laboratory, Medical Technology Security Section, Jingzhong Medical District, PLA General Hospital, Beijing 100120, China
    2. Department of Electrocardiogram and Ultrasound, Medical Technology Security Section, Jingzhong Medical District, PLA General Hospital, Beijing 100120, China
  • Received:2024-01-15 Published:2024-10-01
  • Corresponding author: Wei Wang
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引用本文：

崔健, 夏青, 林云, 李光玲, 李心娜, 王位. 血小板与淋巴细胞比值、免疫球蛋白、心肌酶谱及心电图对中老年肝硬化患者病情及预后的影响[J]. 中华消化病与影像杂志(电子版), 2024, 14(05): 400-406.

Jian Cui, Qing Xia, Yun Lin, Guangling Li, Xinna Li, Wei Wang. Effects of platelet to lymphocyte ratio, immunoglobulin, myocardial enzyme spectrum and electrocardiogram parameters on the condition and prognosis of middle-aged and elderly patients with cirrhosis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 400-406.

目的

探讨外周血血小板与淋巴细胞比值（PLR）、免疫球蛋白、心肌酶谱及心电图检测对中老年肝硬化患者病情及预后预测价值。

方法

采用前瞻性队列研究方法，选取2019年1月1日至2020年12月30日在我院接受治疗的中老年肝硬化患者83例为研究对象，根据Child-Pugh评分分为肝硬化代偿期组（45例）和肝硬化失代偿期组（38例）。所有患者随访至2023年12月1日，根据预后情况分为预后良好组（53例）和预后不良组（27例），对比不同组别PLR、免疫球蛋白、心肌酶谱及心电图指标，多元logistic回归分析危险因素，建立列线图预测病情和预后的模型，并进行验证与评估。

结果

肝硬化代偿组在PLR、IgA、IgG、CK、hs-TnT、心电图QT间期延长、传导阻滞、心律失常方面与肝硬化失代偿组对比，差异均有统计学意义（P<0.05）。logistic回归提示PLR（OR=3.099，95% CI 1.443～7.254）、IgG（OR=3.838，95% CI 1.677～7.228）、CK（OR=3.149，95% CI 1.847～8.374）、QT间期延长（OR=5.894，95% CI 2.276～9.086）是肝硬化病情的影响因素（P<0.05）。建立列线图预测模型显示总分范围为0～180分，对应风险率范围为0.25～0.8。该模型经验证，C-index指数为0.729（95% CI 0.682～0.836）。列线图模型预测肝硬化病情的ROC曲线提示：曲线下面积为0.869（95% CI 0.808～0.930），灵敏度为80.51%，特异度为74.74%。不同预后组别在PLR、IgA、IgG、IgM、CK、hs-TnT、QT间期延长、Q波异常方面对比，差异均有统计学意义（P<0.05）。logistic回归分析提示PLR（OR=2.726，95% CI 1.689～5.884）、IgA（OR=3.025，95% CI 2.169～6.484）、IgG（OR=5.306，95% CI 1.196～9.803）、CK（OR=4.632，95% CI 2.217～8.708）、QT间期延长（OR=2.998，95% CI 1.457～5.975）是肝硬化预后的影响因素（P<0.05）。建立列线图预测模型总分范围为0～260分，对应风险率范围为0.1～0.9。该模型经验证C-index指数为0.811（95% CI 0.788～0.892）。列线图模型预测肝硬化预后的ROC曲线提示：曲线下面积为0.844（95% CI 0.741～0.939），灵敏度为83.02%，特异度为70.37%。

结论

PLR、IgG、CK、QT间期延长是中老年肝硬化患者病情的影响因素，PLR、IgA、IgG、CK、QT间期延长是中老年肝硬化患者预后的影响因素，构建列线图模型有助于预测肝硬化的病情及预后。

关键词: 肝硬化, 血小板与淋巴细胞比值, 免疫球蛋白, 心肌酶谱, 心电图, 中老年人
Objective

To explore the predictive value of peripheral blood platelet to lymphocyte ratio (PLR), immunoglobulin, myocardial enzyme spectrum and electrocardiogram parameters for the condition and prognosis of middle-aged and elderly patients with liver cirrhosis.

Methods

A prospective cohort study method was used to select 83 middle-aged and elderly patients with liver cirrhosis who received treatment in the Jingzhong Medical District of the PLA General Hospital from January 1, 2019 to December 30, 2020 as the study subjects. According to the Child-Pugh score, they were divided into a compensatory phase group (45 cases) and a decompensated phase group (38 cases). All patients were followed up until December 1, 2023, and were divided into a good prognosis group (53 cases) and a poor prognosis group (27 cases) based on their prognosis. PLR, immunoglobulin, myocardial enzyme spectrum and electrocardiogram parameter indicators were compared between different groups. Multiple logistic regression analysis was used to identify risk factors, and a nomogram model was established to predict the condition and prognosis, which was validated and evaluated.

Results

Compared with the decompensated group of liver cirrhosis, the compensatory group of liver cirrhosis showed statistically significant differences in PLR, IgA, IgG, CK, hs-TnT, prolongation of QT interval on electrocardiogram, conduction block, and arrhythmia (P<0.05). The logistic regression results indicated that PLR (OR=3.099, 95% CI: 1.443-7.254), IgG (OR=3.838, 95% CI: 1.677-7.228), CK (OR=3.149, 95% CI: 1.847-8.374), and prolonged QT interval (OR=5.894, 95% CI: 2.276-9.086) were influencing factors of liver cirrhosis (P<0.05). The prediction model of nomogram showed that the total score ranged from 0 to 180, and the corresponding risk rate ranged from 0.25 to 0.8. The empirical evidence of this model showed that the C-index was 0.729 (95% CI: 0.682-0.836). The ROC curve results of the nomogram model for predicting liver cirrhosis indicated that the area under the curve was 0.869 (95% CI: 0.808-0.930), the sensitivity was 80.51%, and the specificity was 74.74%. The differences in PLR, IgA, IgG, IgM, CK, hs-TnT, QT interval prolongation, and Q wave abnormalities among different prognostic groups were statistically significant (P<0.05). The results of logistic regression analysis indicated that PLR (OR=2.726, 95% CI: 1.689-5.884), IgA (OR=3.025, 95% CI: 2.169-6.484), IgG (OR=5.306, 95% CI: 1.196-9.803), CK (OR=4.632, 95% CI: 2.217-8.708), and QT interval extension (OR=2.998, 95% CI: 1.457-5.975) were the influencing factors for the prognosis of liver cirrhosis (P<0.05). The total score range for establishing a nomogram prediction model was 0-260 points, corresponding to a risk rate range of 0.1-0.9. The C-index of this model was verified to be 0.811 (95% CI: 0.788-0.892). The ROC curve results of the nomogram model predicting the prognosis of liver cirrhosis indicated that the area under the curve was 0.844 (95% CI: 0.741-0.939), the sensitivity was 83.02%, and the specificity was 70.37%.

Conclusion

PLR, IgG, CK, and QT interval prolongation are influencing factors for the condition of middle-aged and elderly patients with liver cirrhosis. PLR, IgA, IgG, CK, and QT interval prolongation are influencing factors for the prognosis of middle-aged and elderly patients with liver cirrhosis. Constructing a nomogram model can help predict the condition and prognosis of liver cirrhosis.

Key words: Liver cirrhosis, Platelet to lymphocyte ratio, Immunoglobulin, Myocardial enzyme spectrum, Electrocardiogram, Middle-aged and elderly people
表1 患者临床基线资料对比
组别 例数 性别[例(%)] 年龄(岁,±s) 民族[例(%)]
男 女 汉族 其他
肝硬化代偿组 45例 27(60.00) 18(40.00) 57.28±9.88 38(84.44) 7(15.56)
肝硬化失代偿组 38例 21(55.26) 17(44.74) 60.93±10.75 30(78.95) 8(21.05)
χ2/t值   0.190 -1.611 0.420
P值   0.663 0.111 0.517
表2 不同病情组PLR、免疫球蛋白、心肌酶谱及心电图参数异常情况比较
组别 例数 PLR(±s) IgA(ng/mL,±s) IgG(ng/mL,±s) IgM(ng/mL,±s) LDH(U/L,±s) CK(U/L,±s)
肝硬化代偿组 45 104.26±27.19 2.31±0.36 11.22±2.84 1.47±0.25 227.80±47.09 101.56±27.46
肝硬化失代偿组 38 131.28±21.08 2.77±0.41 17.37±3.75 1.57±0.33 243.79±43.38 164.38±31.08
χ2/t值   -4.988 -5.442 -8.492 -1.569 -1.597 -9.775
P值   0 0 0 0.121 0.114 0
组别 例数 hs-TnT(U/L,±s) QT间期延长有/无(例) ST-T改变有/无(例) 心律失常有/无(例) 传导阻滞有/无(例) Q波异常有/无(例)
肝硬化代偿组 45 19.03±4.48 6/39 15/30 7/38 0/45 1/44
肝硬化失代偿组 38 28.37±3.58 13/25 12/26 15/23 4/34 4/34
χ2/t值   -10.356 5.087 0.029 6.05 4.977 2.51
P值   0 0.024 0.865 0.014 0.026 0.113
表3 肝硬化病情因素的二元logistic回归分析结果
指标 β SE Wald χ2 P OR 95% CI
PLR 1.131 0.355 8.708 0.003 3.099 1.443~7.254
IgA 0.779 0.035 3.357 0.067 2.179 1.897~8.715
IgG 1.345 0.244 6.441 0.011 3.838 1.677~7.228
CK 1.147 0.279 7.397 0.007 3.149 1.847~8.374
hs-TnT 0.224 0.048 2.288 0.130 1.251 1.117~2.435
QT间期延长 1.774 0.158 9.983 0.002 5.894 2.276~9.086
传导阻滞 0.763 0.169 2.467 0.116 2.145 1.537~4.273
心律失常 0.883 0.243 3.180 0.075 2.418 1.775~3.695
图1 肝硬化病情的列线图预测模型
图2 预测肝硬化病情列线图模型的验证曲线
图3 列线图模型预测肝硬化病情的ROC曲线
表4 不同预后的临床指标对比
组别 例数 PLR(±s) IgA(ng/mL,±s) IgG(ng/mL,±s) IgM(ng/mL,±s) LDH(U/L,±s) CK(U/L,±s)
预后良好组 53 112.73±22.57 2.36±0.45 11.79±2.10 1.44±0.23 225.46±33.19 98.70±23.44
预后不良组 27 145.58±28.80 2.85±0.57 15.74±2.77 1.72±0.38 241.09±37.49 166.58±57.38
χ2/t值   -5.597 -4.201 -7.125 -4.101 -1.906 -7.504
P值   0 0 0 0 0.06 0
组别 例数 hs-TnT(U/L,±s) QT间期延长有/无(例) ST-T改变有/无(例) 心律失常有/无(例) 传导阻滞有/无(例) Q波异常有/无(例)
预后良好组 53 20.11±4.17 8/45 12/41 14/29 4/49 5/48
预后不良组 27 29.38±3.76 16/11 9/18 8/19 3/24 7/20
χ2/t值   -9.709 16.614 1.056 0.066 0.285 5.095
P值   0 0 0.304 0.797 0.594 0.024
表5 肝硬化预后因素多元logistic回归分析结果
指标 β SE Wald χ2 P OR 95% CI
PLR 1.003 0.275 9.495 0.002 2.726 1.689~5.884
IgA 1.107 0.178 4.479 0.034 3.025 2.169~6.484
IgG 1.669 0.684 10.002 0.002 5.306 1.196~9.803
IgM 1.208 0.334 2.397 0.122 3.347 1.664~6.442
CK 1.533 0.476 5.696 0.017 4.632 2.217~8.708
hs-TnT 1.487 0.231 3.228 0.072 4.424 1.644~9.747
QT间期延长 1.098 0.311 8.797 0.003 2.998 1.457~5.975
Q波异常 1.282 0.445 3.441 0.064 2.604 1.357~5.457
图4 肝硬化预后的列线图预测模型
图5 预测肝硬化预后列线图模型的验证曲线
图6 列线图模型预测肝硬化病情的ROC曲线
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