[薬物誘発性肝不全の患者に対する予後因子の分析とロジスティック回帰モデルの構築]

薬物誘発性肝不全（DILF）の患者の予後因子を調査し、ロジスティック回帰モデル（LRM）を構築します。
方法：2009年1月から2018年1月まで、Xiangya病院、第2 Xiangya病院、第3 Xiangya病院でXiangya病院でDILFと診断された183人の入院患者で臨床データの遡及的分析が実施されました。単変量解析を実施して、年齢、TBIL、SCR、PT、合併症などの予後因子の可能性をスクリーニングしました。単変量解析の結果によれば、多変量解析を実行して、独立した予後因子を決定し、LRMを構築しました。LRMは、末期肝疾患（MELD）のモデルと比較され、LRMとMELDの予測値をレシーバー動作特性曲線（ROC）、ROC（AUC）の面積などのパラメーターを2つのモデル間で比較し、別の独立したサンプルで検証しました。
結果：単変量解析によると、年齢、臨床型、肝脳症、肝症候群、WBCカウントに有意差がありました。多変量解析により、AFP、PT、AST/ALT、肝脳症、および肝腎症候群は、LRMの構築に適用できるDILFの独立した予後因子であることが明らかになりました。LRMとMELDのAUCは、それぞれ0.917（95％CI 0.876〜0.959）および0.709（95％CI 0.633から0.786）でした。LRMの総正確性率はそれぞれ86.7％および68.3％でした。LRMはメルドよりも優れていました。
結論：AFP、PT、AST/ALT、肝性脳症、および肝臓症候群は、DILFの独立した予後因子でした。LRMは、MELDよりも優れているDILF患者の予後をよく予測できます。

To explore the prognostic factors for patients with drug-induced liver failure (DILF) and construct a logistic regression model (LRM).
 Methods: A retrospective analysis of clinical data was performed in 183 hospitalized patients, who were diagnosed with DILF in Xiangya Hospital, the Second Xiangya Hospital and the Third Xiangya Hospital, Central South University from January 2009 to January 2018. The patients were divided into an improved group (n=67) and an ineffective group (n=116) according to their prognosis. Univariate analysis was performed to screen for possible prognostic factors such as age, Tbil, SCr, PT and complications. According to the results of univariate analysis, the multivariate analysis was performed to determine the independent prognostic factors and construct a LRM. The LRM was compared with the model for end-stage liver disease (MELD), the predictive value of LRM and MELD was evaluated by receiver operating characteristic curve (ROC), the parameters such as area under the ROC (AUC) and total accuracy were compared between the 2 models and verified by another independent sample.
 Results: According to univariate analysis, there was significant differences in age, clinical type, hepatic encephalopathy, hepatorenal syndrome, WBC count, the ratio of aspartic acid transaminase (AST) to glutamine transaminase (ALT) (AST/ALT), Tbil, SCr, PT and alpha-fetoprotein (AFP) between the 2 groups (all P<0.05). Multivariate analysis revealed that: AFP, PT, AST/ALT, hepatic encephalopathy and hepatorenal syndrome were independent prognostic factors for DILF, which could be applied to constructing a LRM. The AUC of LRM and MELD was 0.917 (95% CI 0.876 to 0.959) and 0.709 (95% CI 0.633 to 0.786) respectively, the total accuracy rate of prediction for the LRM and the MELD was 86.7% and 68.3% respectively, there was significant difference in AUC and total accuracy rate between the LRM and the MELD (P<0.05). LRM was superior to MELD.
 Conclusion: AFP, PT, AST/ALT, hepatic encephalopathy and hepatorenal syndrome were independent prognostic factors for DILF; the LRM can well predict the prognosis in the DILF patients, which is superior to the MELD.