关键词: 乙型肝炎肝硬化, 失代偿期, 肝肾综合征, 列线图

Abstract: Objective To construct an early prediction model for hepatorenal syndrome (HRS) complicating the decompensated stage of hepatitis B cirrhosis, and to provide a reference basis for the prediction of HRS and the development of early prevention and treatment programs. Method This is a retrospective study, 256 patients with hepatitis B cirrhosis in decompensated stage admitted to our hospital from June 2021 to December 2023 were randomly selected as the study subjects, clinical data of the patients were collected, and they were randomly divided into modelling and validation groups in a ratio of 4:1, unifactorial and multifactorial analyses were performed based on the clinical data of the patients in the modelling group, and a nomogram prediction model was constructed and validated based on independent risk factors for the complication of HRS in patients with hepatitis B cirrhosis in decompensated stage. independent risk factors of HRS in patients with hepatitis B cirrhosis in the decompensated stage of liver cirrhosis. Result Out of 256 patients included in this study, 45 had HRS with an incidence of 17.58%. The results of univariate analysis showed that non-HRS and HRS patients had statistically significant differences in white blood cell count, neutrophil to lymphocyte ratio, haemoglobin, glutamate aminotransferase, glutamyl transferase, alkaline phosphatase, total bilirubin (TB), urea nitrogen, serum creatinine (Scr), prothrombin time, arterial blood lactic acid (LA), and maximum diameter of shunt vein. Lactic acid (LA), and maximum diameter of shunt vein were statistically significant (all P<0.05). The results of multifactorial analysis showed that elevated TB (OR=1.109, 95%CI:1.051-1.170), elevated Scr (OR=1.029, 95%CI:1.004-1.056), elevated arterial blood LA (OR=3.426, 95%CI:1.550-7.574), increased shunt vein maximum diameter (OR=1.127, 95%CI:1.009-1.259) were all independent risk factors (all P<0.05) for the complication of HRS in the decompensated stage of cirrhosis in hepatitis B. ROC curve analysis showed that the AUC of the modelling group and the validation group were 0.942 (95%CI:0.908-0.976) and 0.897 (95%CI:0.770-1.000), respectively, with Hosmer- Lemeshow test P=0.586. The DCA and CIC analyses showed a positive benefit from intervening with patients using the model in the range of 0 to 1 high-risk thresholds, and the number of cases predicted to develop HRS was higher than the number of cases that actually developed HRS. Conclusion Complicated HRS in patients with hepatitis B cirrhosis in the decompensated stage is associated with a number of factors, and the construction of a nomogram prediction model based on the relevant independent risk factors can help in the early diagnosis of HRS and the development of treatment plans, which is important for improving the prognosis of patients.

Key words: Hepatitis B cirrhosis, Decompensated stage, Hepatorenal syndrome, Nomogram