甲状腺功能亢进症患者肝损害发生的危险因素及预测模型的构建与验证-东南大学学报医学版

甲状腺功能亢进症患者肝损害发生的危险因素及预测模型的构建与验证

单位：1. 石家庄市第三医院院前急救科, 河北石家庄 050000;
2. 武安市第一人民医院内分泌科, 河北邯郸 056300

分类号：R581.1

出版年·卷·期（页码）：2024·43·第五期（655-661）

摘要：

目的: 探究甲状腺功能亢进症(HT)患者肝损害发生的危险因素,并建立有效预测HT患者发生肝损害的列线图模型。方法: 选取2022年1月至2023年12月石家庄市第三医院收治的263例HT患者为研究对象,分为建模组(184例)和验证组(79例)。建模组根据患者是否发生肝损害分为肝损害组(78例)和非肝损害组(106例)。通过Logistic回归分析筛选HT患者发生肝损害的危险因素;采用R软件及rms程序包构建HT患者发生肝损害的列线图风险预测模型;采用ROC曲线、校准图形验证模型的区分度以及一致性。结果: 与非肝损害组相比,肝损害组患者年龄及病程≥1年、已婚、文化水平高中及以下、有饮酒史、疾病认知情况存在偏差、有药物不良反应的占比明显升高(P<0.05);患者的年龄(95%CI 1.220~1.521)、病程(95%CI 1.222~8.320)、婚姻状况(95%CI 1.067~7.011)、文化水平(95%CI 1.389~9.664)、饮酒史(95%CI 1.013~6.849)、疾病认知情况(95%CI1.278~10.196)、药物不良反应(95%CI 1.234~10.019)为HT患者发生肝损害的独立危险因素(P<0.05)。基于以上危险因素建立预测HT患者发生肝损害风险的列线图模型,ROC曲线的曲线下面积为0.936(95%CI 0.900~0.972),具有较好的区分度,并且校正曲线与理想曲线拟合性良好。结论: HT患者的年龄、病程、婚姻状况、文化水平、饮酒史、疾病认知情况、药物不良反应为发生肝损害的危险因素,可用于预测HT患者发生肝损害的风险,为患者制定针对性的治疗方案,有利于降低肝损害的发生率。

Objective: To explore and analyze the risk factors for liver damage in patients with hyperthyroidism(HT), and to establish an effective column chart model for predicting liver damage in HT patients. Methods: A total of 263 HT patients admitted to Shijiazhuang Third Hospital from January 2022 to December 2023 were regarded as the study subjects, they were separated into a modeling group(184 cases) and a validation group(79 cases). The modeling group was separated into a liver damage group(78 cases) and a non liver damage group(106 cases) based on whether the patient had liver damage. Logistic regression analysis was applied to screen for risk factors for liver damage in HT patients; R software and rms package were applied to construct a column chart risk prediction model for liver damage in HT patients; ROC curve and calibration graph were applied to verify the discrimination and consistency of the model. Results: Compared with the non liver damage group, the age, proportions of course of disease≥1 year, married, high school education or below, history of alcohol consumption, biased disease cognition, and adverse drug reactions were obviously increased in liver damage group(P<0.05). The age(95%CI 1.220-1.521), disease duration(95%CI 1.222-8.320), marital status(95%CI 1.067-7.011), educational level(95%CI 1.389-9.664), alcohol consumption history(95%CI 1.013-6.849), disease awareness(95%CI 1.278-10.196), and adverse drug reactions(95%CI 1.234-10.019) of patients with HT were independent risk factors for liver damage(P<0.05). A column chart model was established to predict the risk of liver damage in HT patients based on the above risk factors, the area under the ROC curve(AUC) was 0.936(95%CI 0.900-0.972), with good discrimination and good fitting between the correction curve and the ideal curve. Conclusion: The age, course of disease, marital status, educational level, drinking history, disease cognition, and adverse drug reactions of HT patients are risk factors for liver damage. Based on the above factors, a column chart model can be constructed to accurately predict the risk of liver damage in HT patients, and targeted treatment plans can be developed for patients, which is conducive to reducing the incidence of liver damage.

参考文献：

[1] WIERSINGA W M,POPPE K G,EFFRAIMIDIS G.Hyperthyroidism:aetiology,pathogenesis,diagnosis,management,complications,and prognosis[J].Lancet Diabetes Endocrinol,2023,11(4):282-298.
[2] ZHAO P,HU Z,MA W,et al.Quercetin alleviates hyperthyroidism-induced liver damage via Nrf2 signaling pathway[J].Biofactors,2020,46(4):608-619.
[3] 何晓红,林雁萍,黄咏梅.探讨规范化干预性护理在甲状腺功能亢进并发肝损害治疗中的应用[J].中外医疗,2021,40(35):150-154.
[4] 李舒祺,张海清.甲状腺功能异常相关性肝损害研究进展[J].中国实用内科杂志,2022,42(2):164-167.
[5] MARIANI G,TONACCHERA M,GROSSO M,et al.The role of nuclear medicine in the clinical management of benign thyroid disorders,part 1:hyperthyroidism[J].J Nucl Med,2021,62(3):304-312.
[6] 盛秋菊,丁洋,张翀,等.甲状腺功能亢进症合并肝损伤患者的临床特点分析[J].中华肝脏病杂志,2021,29(10):967-971.
[7] 中华医学会内分泌学分会,中国医师协会内分泌代谢科医师分会,中华医学会核医学分会,等.中国甲状腺功能亢进症和其他原因所致甲状腺毒症诊治指南[J].国际内分泌代谢杂志,2022,42(5):401-450.
[8] 张彦,夏文芳,杨小雷,等.甲状腺功能亢进症合并肝损害患者临床特点及影响肝损害发生的危险因素分析[J].实用肝脏病杂志,2023,26(2):238-241.
[9] PIANTANIDA E,IPPOLITO S,GALLO D,et al.The interplay between thyroid and liver:implications for clinical practice[J].J Endocrinol Invest,2020,43(7):885-899.
[10] YANG Q,LIU W,SUM D,et al.Yinning Tablet,a hospitalized preparation of Chinese herbal formula for hyperthyroidism,ameliorates thyroid hormone-induced liver injury in rats:regulation of mitochondria-mediated apoptotic signals[J].J Ethnopharmacol,2020,252(1):2602-2613.
[11] 郭庆霞.两种药物对甲状腺功能亢进症肝功能的影响对比[J].中国城乡企业卫生,2023,38(8):6-8.
[12] KOTWAL A,CORTES T,GENERE N,et al.Treatment of thyroid dysfunction and serum lipids:a systematic review and meta-analysis[J].J Clin Endocrinol Metab,2020,105(12):672-685.
[13] ANTONIJEVIC N,MATIC D,BELESLIN B,et al.The influence of hyperthyroidism on the coagulation and on the risk of thrombosis[J].J Clin Med,2024,13(6):1756-1763.
[14] 王芳,盛吉芳,赵瑞红,等.甲状腺功能亢进症伴肝功能损害患者的相关因素分析[J].中华危重症医学杂志(电子版),2020,13(6):462-465.
[15] LEE S Y,PEARCE E N.Hyperthyroidism:a review[J].JAMA,2023,330(15):1472-1483.
[16] RIVAS A M,PENA C,KOPEL J,et al.Hypertension and hyperthyroidism:association and pathogenesis[J].Am J Med Sci,2021,361(1):3-7.
[17] 谭鑫,乌仁娜,于奇宁,等.非霍奇金淋巴瘤合并肝功能损害患者的危险因素及风险预测模型的建立[J].河北医药,2021,43(4):510-513,517.
[18] 李子玲,杨宁.甲状腺功能亢进患者治疗依从性的影响因素[J].慢性病学杂志,2023,24(1):122-124.
[19] 吴亮,周慧,杨社珍,等.甲状腺功能亢进症患者治疗前后糖代谢及胰岛素抵抗变化的研究[J].南通大学学报(医学版),2023,43(5):436-438.

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