Analysis Of Risk Factors For Minimal Hepatic Encephalopathy And Establishment Of Nomogram Prediction Model And Internal Verification

Objective: The detection rate and clinical characteristics of MHE in patients with liver cirrhosis were analyzed,and the risk factors of liver cirrhosis complicated with MHE were screened.Based on the independent risk factors of liver cirrhosis complicated with MHE,anomogram prediction model was constructed and the model was internally validated to evaluate the performance of the model predictive value,looking for a rapid and effective MHE screening method to help clinical medical staff to effectively and conveniently identify the high-risk patients of MHE from the group of patients with liver cirrhosis,so as to identify the subgroup of patients with high risk of MHE in patients with liver cirrhosis.Carry out targeted screening to provide clinical evidence for early intervention in MHE patients.Methods: Selected patients with liver cirrhosis between 18 and 65 years old in the Inpatient Department of Infectious Diseases,Yan’an University Affiliated Hospital from August 2020 to December 2021.According to the inclusion and exclusion criteria,a total of 278 patients with liver cirrhosis were finally selected as research object.the subjects were divided into MHE group and non-MHE group according to the three test results of NCT-A,modified NCT-B,and S-ANT1.The detection rate and the clinical characteristics of MHE patients were summarized.The possible risk factors of MHE were first screened out by univariate analysis,and then these factors with statistical significance were subjected to binary logistic regression analysis to screen out the independent factors of MHE.And further use R software to build a nomogram prediction model for liver cirrhosis combined with MHE,and conduct internal verification and analysis of the nomogram prediction model.Plot the ROC curve to evaluate the predictive effect of the model.In addition,the relationship between hepatitis Betiological indicators and MHE in patients with hepatitis B cirrhosis was analyzed.Result: In this study,the detection rate of MHE in patients with liver cirrhosis was 45.32%,and the detection rates of MHE in male and female patients were 44.50% and 47.13%,respectively.9 patients(7.10%)were younger than 40 years old,and 30 patients were 40-49 years old.There were 56 patients(44.40%)between the ages of 50 and 59,and 31 patients(24.6%)between the ages of 60 and 65,of which the largest number of patients were between the ages of 50 and 59;the education level was less than 7 years and 7 years and The number of patients above is similar,64 cases(50.80%)and 62 cases(49.20%)respectively;among the causes of MHE,HBV infection is the most common,with 113 cases(89.70%);patients with decompensated cirrhosis combined with MHE More than the compensation period,there are 102 cases(81.00%).The results of univariate analysis showed that the MHE group and the non-MHE group were significantly different in age,education level,course of liver cirrhosis,ascites,history of splenectomy,nutritional risk,total protein,aspartate aminotransferase,albumin,and prothrombin.There were statistically significant differences in prothrombin time,plasma prothrombin activity,hyaluronic acid,AST/ALT,Child-Pugh grade,and MELD score.The results of multivariate analysis showed that age,hyaluronic acid greater than 120ng/ml,Child-Pugh grades B and C,and years of education less than 7 years were independent risk factors for MHE in patients with liver cirrhosis;the ROC curve of each independent risk factor was drawn,under the curve The areas are: 0.636,0.597,0.581,0.603.Based on age,hyaluronic acid greater than 120ng/ml,Child-Pugh grades B and C,and years of education less than 7 years,a nomogram prediction model for liver cirrhosis combined with MHE was constructed.The predicted calibration curve is roughly between the standard curve and the acceptable line,the model Hosmer-Lemeshow goodness of fit test results P>0.05,the area under the ROC curve is 0.738,suggesting that this model predicts liver cirrhosis with MHE has better calibration and discrimination,and the nomogram model has better predictive ability than each independent risk factor.In hepatitis B cirrhosis,the quantification of hepatitis B e antibody between the nonMHE group and the MHE group was statistically significant,and the family history of hepatitis B,high-sensitivity HBV DNA quantification,and other indicators of hepatitis B series showed no significant difference between the non-MHE group and the MHE group.Conclusion: 1.The detection rate of MHE in patients with liver cirrhosis in this study is 45.32%,The detection rate of MHE do not differ by gender,the number of patients aged 50-59 years was the largest,and HBV infection is the most common.2.Binary logistic regression analysis shows that age,hyaluronic acid greater than 120ng/ml,Child-Pugh B and C grades,and years of education less than 7 years are independent risk factors for MHE in patients with liver cirrhosis.3.The predictive ability of this nomogram prediction model for liver cirrhosis complicated with MHE is better than that of independent risk factors,and it has a good degree of calibration and discrimination,which can provide a certain guiding value for the prevention of MHE in liver cirrhosis.4.In hepatitis B cirrhosis,the quantification of hepatitis B e-antibody may be associated with MHE in patients with hepatitis B cirrhosis.