HIV/AIDS患者出现肝损伤的预测模型初步建立和验证

文丽娟; 雷学忠; 司果; 龙波; 何易佳

doi:10.16016/j.2097-0927.202209114

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HIV/AIDS患者出现肝损伤的预测模型初步建立和验证

临床医学 | 更新时间：2026-01-09

- HIV/AIDS患者出现肝损伤的预测模型初步建立和验证
- Establishment and validation of a prediction model for liver injury in HIV/AIDS patients
- 陆军军医大学学报 2023年45卷第8期页码：817-824
- 作者机构：
  
  1.621000 四川绵阳，四川绵阳四〇四医院感染科
  2.610044 成都，四川大学华西医院感染性疾病中心
- 作者简介：
  
  [雷学忠；E-mail：18980601317@163.comLEI Xuezhong, E-mail: 18980601317@163.com
- 基金信息：
  
  国家科技重大专项(2017ZX10202203-008-005);四川省科技计划重点研发项目(2018SZ0137)
- DOI：10.16016/j.2097-0927.202209114
  中图分类号： R195.4;R512.91;R575.06
- 收稿：2022-09-13，
  
  修回：2022-11-06，
  
  纸质出版：2023-04-30
- 稿件说明：
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文丽娟, 雷学忠, 司果, 等. HIV/AIDS患者出现肝损伤的预测模型初步建立和验证[J]. 陆军军医大学学报, 2023,45(8):817-824.

Lijuan WEN, Xuezhong LEI, Guo SI, et al. Establishment and validation of a prediction model for liver injury in HIV/AIDS patients[J]. Journal of Army Medical University, 2023, 45(8): 817-824.
文丽娟, 雷学忠, 司果, 等. HIV/AIDS患者出现肝损伤的预测模型初步建立和验证[J]. 陆军军医大学学报, 2023,45(8):817-824. DOI： 10.16016/j.2097-0927.202209114.

Lijuan WEN, Xuezhong LEI, Guo SI, et al. Establishment and validation of a prediction model for liver injury in HIV/AIDS patients[J]. Journal of Army Medical University, 2023, 45(8): 817-824. DOI： 10.16016/j.2097-0927.202209114.

摘要

目的

调查HIV/AIDS患者出现肝损伤发生情况，建立其预测模型并进行验证。

方法

选择2021年1~12月四川绵阳四○四医院接诊的290例新确诊HIV/AIDS患者，以7 ∶3分为模型组203例与验证组87例。收集可能影响HIV/AIDS患者肝损伤的因素，根据有无出现肝损伤将患者分为2组，比较2组患者性别、年龄、BMI等各因素，采用LASSO回归筛选变量后行多因素Logistic回归筛选出独立性影响因素，根据Logistic回归结果构建列线图模型。

结果

肝损伤组与无肝损伤组患者饮酒史、CD4

T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、使用其他类型抗反转录病毒药物、磺胺类药物使用情况、糖尿病、心血管病、营养状况差异均具有统计学意义(

0.05)。LASSO回归模型筛选出7个潜在影响因素：饮酒史、CD4

T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况。多因素Logistic回归分析显示：饮酒史、CD4

T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况是HIV/AIDS患者肝损伤的独立影响因素(

0.05)。基于上述影响因素构建HIV/AIDS患者肝损伤风险预测的列线图模型，模型组列线图模型预测HIV/AIDS患者肝损伤的受试者操作曲线下面积(area under the subject curve，AUC)为0.969(95%

：0.904，0.988)；验证组AUC为0.971(95%

：0.905，0.992)。Bootstrap法重复抽样1 000次，并以验证组进行验证，校准曲线结果显示：模型组与验证组预测曲线与标准曲线基本拟合；H-L拟合优度检验结果显示，该列线图模型预测HIV/AIDS患者肝损伤的概率与实际概率比较，差异无统计学意义(

=2.088，

=0.148)。模型组决策曲线分析结果显示：当该列线图模型预测HIV/AIDS患者肝损伤的概率阈值为0.15~0.95时，患者的净受益率＞0；验证组决策曲线分析结果显示：当该列线图模型预测HIV/AIDS患者肝损伤的概率阈值为0.10~0.95时，患者的净受益率＞

0。

结论

饮酒史、CD4

T淋巴细胞水平、抗真菌药物使用情况、合并结核感染、糖尿病、心血管病、营养状况是HIV/AIDS患者肝损伤的独立影响因素，基于上述因素构建的列线图模型用于HIV/AIDS肝损伤风险预测具有较高的准确度。

Abstract

Objective

To investigate the occurrence of liver injury in HIV/AIDS patients

and establish and verify its prediction model.

Methods

A total of 290 newly-diagnosed HIV/AIDS patients admitted to Mianyang 404 Hospital from January to December 2021 were subjected

and then assigned into a test group (

=203) and validation group (

=87) at a ratio of 7 ∶3. The factors that may affect the liver injury in HIV/AIDS patients were collected. The patients were divided into 2 groups according to the presence or absence of liver injury. Their gender

age

BMI and other factors were compared between the 2 groups. LASSO regression analysis was used to screen variables

then multivariate logistic regression analysis was employed to screen out independent influencing factors

and a nomogram model was constructed according to the logistic regression results.

Results

There were statistical differences between the patients with and without liver injury in history of alcohol drinking

CD4

T lymphocyte level

use of antifungal drugs

other types of antiretroviral drugs and sulfonamides

complications of tuberculosis

diabetes

cardiovascular disease

and nutritional status (

0.05). LASSO regression model screened out 7 potential influencing factors

including drinking history

CD4

T lymphocyte level

antifungal drug use

comorbid tuberculosis infection

diabetes

cardiovascular disease

and nutritional status. Multivariate logistic regression analysis showed that drinking history

CD4

T lymphocyte level

use of antifungal drugs

comorbid tuberculosis

diabetes

cardiovascular disease

and nutritional status were independent

influencing factors of liver injury in HIV/AIDS patients (

0.05). Based on the above influencing factors

a nomogram model for predicting the risk of liver injury in HIV/AIDS patients was constructed. The results of ROC curve analysis showed that the area under the subject curve (AUC) of the model group was 0.969 (95%

: 0.904~0.988)

and the AUC of the validation group was 0.971 (95%

: 0.905~0.992) for predicting liver injury in HIV/AIDS patients. After Bootstrapping was conducted for repeated sampling 1 000 times

and the verification group was used for verification. The results of the calibration curve indicated that the prediction curve of the model group and the verification group basically fitted the standard curve. The results of the H-L goodness of fit test suggested that the nomogram model predicted the probability of liver injury in HIV/AIDS patients was not significantly different from the actual probability (

Chi

-square=2.088

=0.148). The analysis results of decision curve of model group showed that when the probability threshold of predicting liver injury of HIV/AIDS patients by the nomograph model was 0.15~0.95

the net benefit rate of patients was greater than 0. While

the analysis results of the decision curve of the validation group showed that when the probability threshold of predicting the liver injury of HIV/AIDS patients by the nomograph model was 0.10~0.95

the net benefit rate of the patients was greater than 0.

Conclusion

History of drinking

CD4

T lymphocyte level

use of antifungal drugs

comorbid tuberculosis infection

diabetes

cardiovascular disease

and nutritional status are independent influencing factors of liver injury in HIV/AIDS patients. Our nomogram model constructed based on the above factors has high accuracy and discrimination for HIV/AIDS liver injury risk prediction.

关键词

Keywords

references

CAMPOS-VARELA I, DODGE J L, TERRAULT N A, et al . Nonviral liver disease is the leading indication for liver transplant in the United States in persons living with human immunodeficiency virus[J ] . Am J Transplant, 2021, 21(9): 3148-3156. DOI: 10.1111/ajt.16569.

CERVO A, MILIC J, MAZZOLA G, et al . Prevalence, predictors, and severity of lean nonalcoholic fatty liver disease in patients living with human immunodeficiency virus[J ] . Clin Infect Dis, 2020, 71(10): e694-e701. DOI: 10.1093/cid/ciaa430.

陈婧怡, 徐立然, 马秀霞, 等. HIV/TB相关肝损伤中西医认识[J]. 中国艾滋病性病, 2021, 27(10): 1162-1165. DOI: 10.13419/j.cnki.aids.2021.10.29.

CHEN J Y, XU L R, MA X X, et al . Understanding of related liver injury by HIV/TB co-infection between traditional Chinese medicine and western medicine[J ] . Chin J AIDS STD, 2021, 27(10): 1162-1165. DOI: 10.13419/j.cnki.aids.2021.10.29.

KHALILI M, KING W C, KLEINER D E, et al . Fatty liver disease in a prospective North American cohort of adults with human immunodeficiency virus and hepatitis B virus coinfection[J ] . Clin Infect Dis, 2021, 73(9): e3275-e3285. DOI: 10.1093/cid/ciaa1303.

中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2018年版)[J]. 中华内科杂志, 2018, 57(12): 867-884.

AIDS and Hepatitis C Professional Group, Society of Infectious Diseases of Chinese Medical Association, Chinese Center for Disease Control and Prevention. Chinese guidelines for diagnosis and treatment of HIV/AIDS (2018)[J]. Chin J Intern Med, 2018, 57(12): 867-884.

于乐成, 茅益民, 陈成伟. 药物性肝损伤诊治指南[J]. 临床肝胆病杂志, 2015, 31(11): 1752-1769.

YU Y C, MAO Y M, CHEN C W. Guidelines for the management of drug-induced liver injury[J]. J Clin Hepatol, 2015, 31(11): 1752-1769.

黄志忠, 吕建楠, 覃江龙, 等. HIV/AIDS患者伴发肝损伤的肝脏病理学分析[J]. 新发传染病电子杂志, 2021, 6 (4): 285-288. DOI: 10.19871/j.cnki.xfcrbzz.2021.04.004.

HUANG Z Z, LYU J N, QIN J L, et al . Liver pathological analysis in human immunodeficiency virus or acquired immune deficiency syndrome patients with liver damage[J ] . Electron J Emerg Infect Dis, 2021, 6(4): 285-288. DOI: 10.19871/j.cnki.xfcrbzz.2021.04.004.

DANDACHI D, GEIGER G, MONTGOMERY M W, et al . Characteristics, comorbi dities, and outcomes in a multicenter registry of patients with human immunodeficiency virus and coronavirus disease 2019[J ] . Clin Infect Dis, 2021, 73(7): e1964-e1972. DOI: 10.1093/cid/ciaa1339.

PILLAYE J N, MARAKALALA M J, KHUMALO N, et al . Mechanistic insights into antiretroviral drug-induced liver injury[J ] . Pharmacol Res Perspect, 2020, 8(4): e00598. DOI: 10.1002/prp2.598.

KIRKEGAARD-KLITBO D M, FUCHS A, STENDER S, et al . Prevalence and risk factors of moderate-to-severe hepatic steatosis in human immunodeficiency virus infection: the Copenhagen co-morbidity liver study[J ] . J Infect Dis, 2020, 222(8): 1353-1362. DOI: 10.1093/infdis/jiaa246.

MOCROFT A, LUNDGREN J, GERSTOFT J, et al . Clinical outcomes in persons coinfected with human immunodeficiency virus and hepatitis C virus: impact of hepatitis C virus treatment[J ] . Clin Infect Dis, 2020, 70(10): 2131-2140. DOI: 10.1093/cid/ciz601.

GRAVIER-HERNÁNDEZ R, GIL-DEL VALLE L, VALDES-ALONSO L, et al . Oxidative stress in hepatitis C virus-human immunodeficiency virus co-infected patients[J ] . Ann Hepatol, 2020, 19(1): 92-98. DOI: 10.1016/j.aohep.2019.05.009.

MODI A R, KOVAL C E, TAEGE A J, et al . Coronavirus disease 2019 in an orthotopic liver transplant recipient living with human immunodeficiency virus[J ] . Transpl Infect Dis, 2020, 22(5): e13351. DOI: 10.1111/tid.13351.

MAKI Y, KIMIZUKA Y, SASAKI H, et al . Hepatitis A virus-associated fulminant hepatitis with human immunodeficiency virus coinfection[J ] . J Infect Chemother, 2020, 26(2): 282-285. DOI: 10.1016/j.jiac.2019.08.010.

COLLINS L F, SHETH A N, MEHTA C C, et al . The preva-lence and burden of non-AIDS comorbidities among women living with or at risk for human immunodeficiency virus infection in the United States[J ] . Clin Infect Dis, 2021, 72(8): 1301-1311. DOI: 10.1093/cid/ciaa204.

GERETTI A M, STOCKDALE A J, KELLY S H, et al . Outcomes of coronavirus disease 2019 (COVID-19) related hospitalization among people with human immunodeficiency virus (HIV) in the ISARIC World Health Organization (WHO) clinical characterization protocol (UK): a prospective observational study[J ] . Clin Infect Dis, 2021, 73(7): e2095-e2106. DOI: 10.1093/cid/ciaa1605.

ISHIZAKA A, KOGA M, MIZUTANI T, et al . Prolonged gut dysbiosis and fecal excretion of hepatitis A virus in patients infected with human immunodeficiency virus[J ] . Viruses, 2021, 13(10): 2101. DOI: 10.3390/v13102101.

MOED S, SUPRENANT M, ODJIDJA E N, et al . Economic evaluation of screening interventions for drug-induced liver injury[J ] . Clin Infect Dis, 2021, 73(11): e3959-e3965. DOI: 10.1093/cid/ciaa1347.

张瑞, 吴苑妮, 韩晓旭, 等. 抗艾滋病病毒药物相关性肝损伤的研究[J]. 胃肠病学和肝病学杂志, 2021, 30(5): 490-495. DOI: 10.3969/j.issn.1006-5709.2021.05.003.

ZHANG R, WU Y N, HAN X X, et al . Research of anti-HIV drug-related liver injury[J ] . Chin J Gastroenterol Hepatol, 2021, 30(5): 490-495. DOI: 10.3969/j.issn.1006-5709.2021.05.003.

AKKINA R, BARBER D L, BILITY M T, et al . Small animal models for human immunodeficiency virus (HIV), hepatitis B, and tuberculosis: proceedings of an NIAID workshop[J ] . Curr HIV Res, 2020, 18(1): 19-28. DOI:10.2174/1570162X18666191223114019.

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