Analysis of the influencing factors of lesion activity in hepatic cystic echinococcosis patients

doi:10.12140/j.issn.1000-7423.2022.03.005

Abstract

Abstract:

Objective To identify the main factors affecting the active state of lesions in patients with hepatic cystic echinococcosis and provide the basis for decision-making to improve the diagnosis and treatment of cystic echinococcosis. Methods A total of 251 patients with hepatic cystic echinococcosis receiving surgical treatment at the First Affiliated Hospital of Xinjiang Medical University from between January 2018 and June 2020 were enrolled, and their demographic information and clinical data were collected, Based on the imaging and biological characteristics, the cysts classified as CE1, CE2 and CE3 were grouped as active group, and CE4 and CE5 inactive group. Using the cyst activity as the dependent variable, univariate analysis was performed, based on which unconditinal logistic regression model was constructed to analyze the independent factors influencing the cyst activity status. Results In this study, clinical data of 251 patients with hepatic cystic echinococcosis meeting the inclusion criteria were collected, with 57.0% (143 cases) female and 43.0% (108 cases) male. The age of the patients ranged from 4 to 85 years old, and the average age was (41.31 ± 15.05) years old. Most of the patients had a low educational level, with high school or below accounting for 79.3% (199 cases); the rural resident accounted for 66.9% (168 cases), which is higher than that of the urban resident 33.1% (83 cases). The percentage of CE in Han nationality was 42.2% (106 cases), while that in other minority nationalities was 57.8% (145 cases). The percentage of patients with their first infection was 78.1% (196 cases), which is higher than that of the recurrent infection (21.9%, 55 cases). The active lesions accounted for 76.9% (193 cases), and the inactive lesions accounted for 23.1% (58 cases). The results of the univariate analysis showed that there were significant differences among patients with different age groups, ethnic groups, the active state of lesions between patients with hepatic cystic echinococcosis and those without recurrence, the number of lesions, the size of lesions, red blood cell count, prothrombin time, direct bilirubin and alkaline phosphatase (χ² = 17.110, 7.797, 2.906, 4.702, 16.520, Z = -1.989, 2.446, 2.003, 1.914, P < 0.1). Unconditional Logistic regression results showed that the main factors affecting the active status of lesions in patients with hepatic cystic echinococcosis were age and lesion size. Larger lesions tend to occur in younger patients(P < 0.05). Conclusion The analysis on the clinical data of 251 hepatic cystic echinococcosis patients receiving surgical treatment demonstrated that younger age and larger cyst size were the independent factors affecting the activity status of cysts.

Key words: Cystic echinococcosis, Clinical features, Lesion activity, Influencing factors

CLC Number:

R532.32

HOU Jiao, WEN Hao, WANG Ming-kun, JIANG Tie-min, FANG Bin-bin, LI Jing, ZHANG Chuan-shan, WANG Hui. Analysis of the influencing factors of lesion activity in hepatic cystic echinococcosis patients[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2022, 40(3): 309-314.

Figures/Tables 4

Table 1

Table 2

Univariate analysis of basic characteristics and clinical parameters and lesion activities in patients with hepatic cystic echinococcosis

特征Feature	有活性例数（占比/%）（n = 193） No. active case (Proportion/%) (n = 193)	无活性例数（占比/%）（n = 58） No. inactive case (Proportion/%) (n = 58)	χ²值 χ² value	P值P value
性别Gender			1.432	> 0.1
男Male	87（45.1）	21（36.2）
女Female	106（54.9）	37（63.8）
年龄组/岁Age group/Year			17.110	< 0.1
0~29	57（29.5）	4（6.9）
30~59	123（63.7）	43（74.1）
60~90	13（6.7）	11（19.0）
民族Nationality			7.797	< 0.1
汉族Han	88（45.6）	18（31.0）
维吾尔族Uygur	37（19.2）	16（27.6）
哈萨克族Kazak	25（13.0）	4（6.9）
其他Others	43（22.3）	20（34.5）
职业Occupation			0.473	> 0.1
农、牧民Farmer and herdsman	67（34.7）	23（39.7）
其他Others	126（65.3）	35（60.3）
文化程度Education level			0.000	> 0.1
高中及以下High school and below	153（79.3）	46（79.3）
大专及以上College and above	40（20.7）	12（20.7）
城乡分布Urban and rural distribution			0.336	> 0.1
乡村Rural areas	131（67.9）	37（63.8）
城市Urban areas	62（32.1）	21（36.2）
有无复发Recurrence			2.906	< 0.1
初发Initial onset	146（75.6）	50（86.2）
复发Recurrence	47（24.4）	8（13.8）
肝占位Liver lesion			0.577	> 0.1
左半肝Left liver	29（15.0）	10（17.2）
右半肝Right liver	108（56.0）	34（58.6）
全肝Whole liver	56（29.0）	14（24.1）
病灶数Number of lesions			4.702	< 0.1
单发Single lesion	120（62.2）	45（77.6）
多发Multiple lesions	73（37.8）	13（22.4）
病灶大小/cm Leision size/cm			16.520	< 0.1
直径 < 5 Diameter < 5	12（6.2）	5（8.6）
直径5~10 Diameter 5~10	102（52.8）	46（79.3）
直径 > 10 Diameter > 10	79（40.9）	7（12.1）

Table 2

Table 3

Table 4

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变量 Variable	赋值及含义 Assignment and meaning
因变量Dependent varible
CE病灶活性分型 CE lesion active typing	0 = 无活性 0 = Inactivity 1 = 有活性 1 = Activity
自变量Independent varible
年龄/岁Age/Year	1 = 0~29
	2 = 30~59
	3 = 60~90
民族Nationality	1 = 汉族 1 = Han
	2 = 维吾尔族 2 = Uygur
	3 = 哈萨克族 3 = Kazak
	4 = 其他4 = Others
有无复发Recurrence	1 = 初发 1 = Initial onset
	2 = 复发 2 = Recurrence
病灶数Number of lesions	1 = 单发 1 = Single lesion
	2 = 多发 2 = Multiple lesions
病灶大小/cm Leision size/cm	1 = 直径 < 5 1 = Diameter < 5
	2 = 直径5~10 2 = Diameter 5~10
	3 = 直径 > 10 3 = Diameter > 10
红细胞RBC/× 10⁹/L	计量资料Measurement data
凝血酶原时间PT/s	计量资料Measurement data
直接胆红素DBIL/μmol·L^-1	计量资料Measurement data
碱性磷酸酶ALP/U·L^-1	计量资料Measurement data

指标 Indexes	有活性病灶的中位数（Q25,Q75）（n = 193） Median of active lesions (Q25,Q75) (n = 193)	无活性病灶的中位数（Q25,Q75）（n = 58） Median of inactive lesions (Q25,Q75) (n = 58)	Z	P值 P value
白细胞WBC/× 10⁹/L	6.10（4.98,7.60）	6.05（5.09,7.46）	0.010	> 0.1
中性粒细胞 NEU/× 10⁹/L	3.25（2.56,4.22）	3.39（2.47,4.59）	-0.368	> 0.1
淋巴细胞 LYM/× 10⁹/L	1.96（1.57,2.35）	2.05（1.57,2.34）	-0.394	> 0.1
单核细胞 MD/× 10⁹/L	0.45（0.35,0.55）	0.41（0.35,0.49）	1.317	> 0.1
红细胞 RBC/× 10¹²/L	4.62（4.28,4.95）	4.76（4.47,5.18）	-1.989	< 0.1
血红蛋白Hb/g·L^-1	135.00（123.00,147.00）	139.00（128.75,151.25）	-1.268	> 0.1
血小板PLT/× 10⁹/L	253.00（209.00,311.00）	249.50（206.00,311.75）	0.234	> 0.1
凝血酶原时间PT/s	11.80（11.30,12.60）	11.50（11.08,12.10）	2.446	< 0.1
直接胆红素DBIL/μmol·L^-1	3.05（1.21,4.51）	2.31（0.30,3.80）	2.003	< 0.1
间接胆红素IBIL/μmol·L^-1	7.60（4.72,11.52）	7.73（4.80,12.26）	-0.462	> 0.1
总胆红素TBIL/μmol·L^-1	11.40（7.79,15.68）	10.23（7.58,15.16）	0.699	> 0.1
白蛋白ALB/g·L^-1	41.50（38.54,44.40）	41.60（38.56,44.19）	-0.096	> 0.1
总蛋白TP/g·L^-1	72.30（68.85,76.16）	74.00（68.48,77.63）	-0.702	> 0.1
门冬氨酸氨基转移酶AST/U·L^-1	21.50（17.01,27.37）	22.28（17.75,27.05）	-0.806	> 0.1
丙氨酸氨基转移酶ALT/U·L^-1	21.00（14.90,34.43）	23.50（16.23,32.88）	-0.782	> 0.1
γ-谷氨酰转移酶γ-GGT/U·L^-1	28.00（16.00,70.23）	26.15（18.15,38.58）	0.968	> 0.1
碱性磷酸酶ALP/U·L^-1	81.51（63.34,122.50）	73.00（58.11,92.08）	1.914	< 0.1

变量 Variable	偏回归系数B	标准误S.E.	Wald统计量Wald χ²	P值 P value	OR值 OR value	OR95%可信区间95% CI for OR
变量 Variable	偏回归系数B	标准误S.E.	Wald统计量Wald χ²	P值 P value	OR值 OR value	下限Lower	上限Upper
年龄/岁Age/Year
0~29					1.000
30~59	-1.770	0.588	9.046	< 0.05	0.170	0.054	0.540
60~90	-2.414	0.725	11.100	< 0.05	0.089	0.022	0.370
病灶大小/cm Leision size/cm
直径 < 5 Diameter < 5					1.000
直径5~10 Diameter 5~10	0.229	0.660	0.121	> 0.05	1.258	0.345	4.582
直径 > 10 Diameter > 10	1.806	0.772	5.472	< 0.05	6.083	1.340	27.614
常量Constant	0.913	3.344	0.075	> 0.05	2.493