HBV相关原发性肝癌患者经导管动脉化疗栓塞术后严重腹痛预测模型的构建及验证

doi:10.3877/cma.j.issn.2095-2015.2025.05.011

目的

探究分析HBV相关原发性肝癌患者经导管动脉化疗栓塞术（TACE）后严重腹痛的危险因素，构建Logistic回归预测模型。

方法

回顾性选取2021年3月至2023年3月东南大学附属中大医院溧水分院收治的180例经TACE治疗HBV相关原发性肝癌患者为研究对象，根据患者TACE术后腹痛视觉模拟量表（VAS）评分分为无/轻度腹痛组（VAS评分0~3分，45例）与严重腹痛组（VAS评分4~7分，135例）。收集分析两组患者的性别、年龄、TACE病史等临床资料，对HBV相关原发性肝癌经TACE治疗患者术后腹痛进行单因素分析、二元Logistic回归分析，根据因素分析结果构建Logistic模型，采用ROC曲线分析预测效能并验证拟合优度。

结果

单因素分析结果显示，TACE病史、血管侵犯、肿瘤数目、肿瘤最大直径均为HBV相关原发性肝癌经TACE治疗患者术后严重腹痛的影响因素（P<0.05）；二元Logistic回归分析结果显示，TACE病史、血管侵犯、肿瘤数目、肿瘤最大直径均为独立危险因素。构建Logistic预测模型，ROC曲线下面积为0.907，95% CI 0.854~0.945（P<0.001），敏感度为85.93%，特异度为84.44%。Hosmer-Lemeshow检验，拟合优度良好（χ²=7.239，P=0.511）。

结论

HBV相关原发性肝癌经TACE治疗患者术后严重腹痛与TACE病史、血管侵犯、肿瘤数目、肿瘤最大直径密切相关，通过构建预测模型能有效识别高危术后腹痛患者，降低严重腹痛风险。

关键词: 原发性肝癌, 经导管动脉化疗栓塞术, 腹痛, 影响因素, 预测模型

Objective

To explore and analyze the risk factors for severe abdominal pain after transcatheter arterial chemotherapy embolization (TACE) in patients with HBV related primary liver cancer, and to construct a Logistic regression predictive model.

Methods

A total of 180 patients with HBV related primary liver cancer treated by TACE in Lishui Branch of Zhongda Hospital Affiliated to Southeast University from March 2021 to March 2023 were selected as the study objects. The patients were divided into no/mild abdominal pain group (VAS: 0-3, 45 cases) and severe abdominal pain group (VAS: 4-7, 135 cases) according to the visual analogue scale (VAS) score after TACE. The gender, age, TACE history and other clinical data of the two groups of patients were retrospectively collected and analyzed. SPSS software was used to conduct univariate analysis and binary Logistic regression analysis for postoperative abdominal pain in patients with HBV related primary liver cancer treated with TACE, and a Logistic model was constructed according to the results of factor analysis. ROC curve was used to analyze the prediction efficiency and verify the goodness of fit.

Results

The results of univariate analysis showed that TACE history, vascular invasion, number of tumors, and maximum diameter of tumors were all influencing factors for postoperative severe abdominal pain in patients with HBV related primary liver cancer treated with TACE (P<0.05), and the results of binary Logistic regression analysis showed that TACE history, vascular invasion, number of tumors, and maximum diameter of tumors were all independent risk factors. Constructing a logistic prediction model, the AUC value of the area under the ROC curve was 0.907, 95% CI was 0.854-0.945 (P<0.001), sensitivity was 85.93%, and specificity was 84.44%. Hosmer-Lemeshow test showed good goodness of fit (χ²=7.239, P=0.511).

Conclusion

Severe postoperative abdominal pain in patients with HBV related primary liver cancer treated with TACE is closely related to TACE history, vascular invasion, number of tumors, and maximum tumor diameter. Constructing a predictive model can effectively identify high-risk postoperative abdominal pain patients and reduce the risk of severe abdominal pain.

Key words: Primary liver cancer, Transcatheter arterial chemoembolization, Abdominal pain, Influencing factors, Prediction model

表1 TACE治疗HBV相关原发性肝癌患者术后严重腹痛的单因素分析[例（%）]

因素	无/轻度腹痛组(n=45)	严重腹痛组(n=135)	χ²/t	P
性别[例(%)]			0.186	0.666
男	25(55.56)	70(51.85)
女	20(44.44)	65(48.15)
年龄[例(%)]			0.008	0.929
≥60岁	17(37.78)	52(38.52)
<60岁	28(62.22)	83(61.48)
TACE病史[例(%)]			11.045	0.001
是	28(62.22)	46(34.07)
否	17(37.78)	89(65.93)
合并症[例(%)]
高血压			0.067	0.796
是	21(46.67)	66(48.89)
否	24(53.33)	89(65.93)
糖尿病			0.133	0.715
是	16(35.56)	44(32.59)
否	29(64.44)	91(67.41)
血管侵犯[例(%)]			17.805	<0.001
是	9(20.00)	78(57.78)
否	36(80.00)	57(42.22)
肿瘤数目[例(%)]			41.569	<0.001
>2枚	7(15.56)	97(71.85)
≤2枚	38(84.44)	38(28.15)
栓塞材料[例(%)]			0.039	0.844
空白微球	34(75.56)	100(74.07)
聚乙烯醇颗粒	11(24.44)	35(25.93)
肿瘤最大直径(cm,±s)	4.60±0.53	5.31±0.65	6.632	<0.001
碘化油用量(mL,±s)	3.19±0.48	3.20±0.67	0.073	0.942
吸烟史[例(%)]			1.607	0.205
是	19(42.22)	43(31.85)
否	26(57.78)	92(68.15)
饮酒史[例(%)]			0.363	0.547
是	20(44.44)	67(49.63)
否	25(55.56)	68(50.37)
体重指数(kg/m²,±s)	23.57±2.31	22.97±2.02	1.663	0.098
Child-Pugh分级[例(%)]			1.714	0.190
A级	30(66.67)	75(55.56)
B级	15(33.33)	60(44.44)

表1 TACE治疗HBV相关原发性肝癌患者术后严重腹痛的单因素分析[例（%）]

因素	无/轻度腹痛组(n=45)	严重腹痛组(n=135)	χ²/t	P
性别[例(%)]			0.186	0.666
男	25(55.56)	70(51.85)
女	20(44.44)	65(48.15)
年龄[例(%)]			0.008	0.929
≥60岁	17(37.78)	52(38.52)
<60岁	28(62.22)	83(61.48)
TACE病史[例(%)]			11.045	0.001
是	28(62.22)	46(34.07)
否	17(37.78)	89(65.93)
合并症[例(%)]
高血压			0.067	0.796
是	21(46.67)	66(48.89)
否	24(53.33)	89(65.93)
糖尿病			0.133	0.715
是	16(35.56)	44(32.59)
否	29(64.44)	91(67.41)
血管侵犯[例(%)]			17.805	<0.001
是	9(20.00)	78(57.78)
否	36(80.00)	57(42.22)
肿瘤数目[例(%)]			41.569	<0.001
>2枚	7(15.56)	97(71.85)
≤2枚	38(84.44)	38(28.15)
栓塞材料[例(%)]			0.039	0.844
空白微球	34(75.56)	100(74.07)
聚乙烯醇颗粒	11(24.44)	35(25.93)
肿瘤最大直径(cm,±s)	4.60±0.53	5.31±0.65	6.632	<0.001
碘化油用量(mL,±s)	3.19±0.48	3.20±0.67	0.073	0.942
吸烟史[例(%)]			1.607	0.205
是	19(42.22)	43(31.85)
否	26(57.78)	92(68.15)
饮酒史[例(%)]			0.363	0.547
是	20(44.44)	67(49.63)
否	25(55.56)	68(50.37)
体重指数(kg/m²,±s)	23.57±2.31	22.97±2.02	1.663	0.098
Child-Pugh分级[例(%)]			1.714	0.190
A级	30(66.67)	75(55.56)
B级	15(33.33)	60(44.44)

表2 TACE术后严重腹痛的多因素二元Logistic回归分析

自变量	B	SE	Wald χ²	P	OR	95% CI
自变量	B	SE	Wald χ²	P	OR	下限	上限
常量	-8.821	2.094	17.747	<0.001	0.000	/
TACE病史	-1.104	0.486	5.169	0.023	0.331	0.128	0.859
血管侵犯	1.581	0.533	8.817	0.003	4.861	1.712	13.805
肿瘤数目	2.195	0.523	17.585	<0.001	8.980	3.219	25.052
肿瘤最大直径	1.795	0.416	18.587	<0.001	6.019	2.662	13.613

表2 TACE术后严重腹痛的多因素二元Logistic回归分析

自变量	B	SE	Wald χ²	P	OR	95% CI
自变量	B	SE	Wald χ²	P	OR	下限	上限
常量	-8.821	2.094	17.747	<0.001	0.000	/
TACE病史	-1.104	0.486	5.169	0.023	0.331	0.128	0.859
血管侵犯	1.581	0.533	8.817	0.003	4.861	1.712	13.805
肿瘤数目	2.195	0.523	17.585	<0.001	8.980	3.219	25.052
肿瘤最大直径	1.795	0.416	18.587	<0.001	6.019	2.662	13.613

图1 经导管动脉化疗栓塞术后严重腹痛的各影响因素ROC曲线分析

表3 TACE术后严重腹痛的各影响因素ROC曲线分析

变量	AUC	SE	P	Youden J	最佳截断值	敏感度(%)	特异度(%)	阳性预测值(%)	阴性预测值(%)
TACE病史	0.641	0.042	0.001	0.282	≤0	65.93%	62.22	83.96	37.84
血管侵犯	0.689	0.037	<0.001	0.378	>0	57.78%	80.00	89.66	38.71
肿瘤数目	0.781	0.034	<0.001	0.563	>0	71.85%	84.44	93.27	50.00
肿瘤最大直径	0.804	0.037	<0.001	0.563	>4.96 cm	76.30%	80.00	93.64	54.29

表3 TACE术后严重腹痛的各影响因素ROC曲线分析

变量	AUC	SE	P	Youden J	最佳截断值	敏感度(%)	特异度(%)	阳性预测值(%)	阴性预测值(%)
TACE病史	0.641	0.042	0.001	0.282	≤0	65.93%	62.22	83.96	37.84
血管侵犯	0.689	0.037	<0.001	0.378	>0	57.78%	80.00	89.66	38.71
肿瘤数目	0.781	0.034	<0.001	0.563	>0	71.85%	84.44	93.27	50.00
肿瘤最大直径	0.804	0.037	<0.001	0.563	>4.96 cm	76.30%	80.00	93.64	54.29

图2 预测经导管动脉化疗栓塞术后严重腹痛的ROC曲线

图3 预测经导管动脉化疗栓塞术后严重腹痛的列线图模型建立

图4 经导管动脉化疗栓塞术后严重腹痛预测模型校准曲线

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Construction and validation of a predictive model for severe abdominal pain in patients with HBV related primary liver cancer after transcatheter arterial chemoembolization

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Construction and validation of a predictive model for severe abdominal pain in patients with HBV related primary liver cancer after transcatheter arterial chemoembolization