摘要
目的探讨胆总管结石合并慢性胆囊疾病患者经内镜逆行性胰胆管造影术(ERCP)后急性胆囊炎(PEC)的危险因素;分析发病时间特征以及建立列线图预测模型用于评估术前合并慢性胆囊疾病患者发生PEC的风险。方法回顾性分析2011年1月—2019年12月在兰州大学第一医院因胆管结石接受ERCP患者的临床资料,使用Logistic回归模型分析PEC的危险因素,绘制受试者工作特征(ROC)曲线,评价模型的预测效能,利用R语言建立列线图预测模型。结果对纳入符合条件的550例患者资料进行统计学分析,其中发生PEC患者76例,未发生PEC患者474例,基线资料差异无统计学意义。多因素分析中显示术前白细胞计数、术前淀粉酶、内镜下奥狄括约肌扩张术(EPBD)、内镜下胆道支架置入术(ERBD)、机械碎石术、术后胆管结石残留为PEC的独立危险因素。PEC患者ERCP术后发病占比分别为1个月内38.2%,> 1~2个月18.4%,> 2~3个月14.5%,> 3~4个月13.2%,> 4~5个月10.5%,> 5~6个月5.2%。综合以上独立危险因素绘制ROC曲线,曲线下面积为0.836 (95%CI:[0.790, 0.882])。结论术前白细胞计数、术前淀粉酶、EPDB、ERBD、机械碎石术、术后胆管结石残留为胆总管结石合并慢性胆囊疾病患者发生PEC的独立危险因素。ERCP术后时间越早,发生PEC比率越高。建立的列线图预测模型用于评估术前合并慢性胆囊疾病患者发生PEC的风险,模型具有良好的预测效能。
Objective To investigate the risk factors of post endoscopic retrograde cholangiopancreatography(ERCP) acute cholecystitis(PEC) in patients with choledocholithiasis and chronic gallbladder disease. Analysis was made of the characteristics of onset time. A nomogram prediction model was established to evaluate the risk of PEC in patients with chronic gallbladder disease before surgery. Methods A retrospective casecontrol study was conducted to collect clinical data of patients who had received ERCP for bile duct stones in the First Hospital of Lanzhou University from January 2011 to December 2019. The Logistic regression model was used to analyze the risk factors of PEC. Receiver operating characteristic curve was used to evaluate the prediction ability of the model, and the nomogram prediction model was established by R. Results 76 patients with and 474 patients without PEC were enrolled. There was no statistical difference in the basic-line data. Univariate and multivariate analysis showed that preoperative white blood cell count, preoperative amylase, endoscopic papillo-sphincter ballon dilatation(EPBD), endoscopic retrograde biliary drainage(ERBD), mechanicallithotripsy and postoperative bile duct stone residue were independent risk factors for PEC. The incidence rate of PEC was 38.2% in the first month after ERCP, 18.4% in > 1~2 months, 14.5% in >2~3 months, 13.2% in > 3~4 months, 10.5% in > 4~5 months, and 5.2% in > 5~6 months. The ROC curve was calculated based on the independent risk factors, and the area under the curve was 0.836(95% CI: [0.790,0.882). Conclusion Preoperative white blood cell count, preoperative amylase, EPDB, ERBD, mechanical lithotripty and postoperative bile duct stone residue were independent risk factors of PEC in patients with chronic gallbladder disease. The incidence of PEC would get higher, if the postoperative time of ERCP became earlier. The established nomogram prediction model was used to evaluate the risk of PEC in patients with chronic gallbladder disease before surgery, and the model had a good predictive ability.
作者
裴兆吉
张旭
张金铎
何玉龙
刘浩然
岳平
白冰
林延延
孟文勃
李汛
Pei Zhao-ji;Zhang Xu;Zhang Jin-duo;He Yu-long;Liu Hao-ran;Yue Ping;Bai Bing;Lin Yan-yan;Meng Wen-bo;Li Xun(The First School of Clinical Medicine,Lanzhou University,Lanzhou 730000,China;Department of General Surgery,The First Hospital of Lanzhou University,Lanzhou 730000,China;Key Laboratory of Biotherapy and Regenerative Medicine of Gansu Province,Lanzhou 730000,China;Gansu Institute of Hepatobiliary and Pancreatic Surgery,Lanzhou 730000,China)
出处
《兰州大学学报（医学版）》
2021年第6期41-47,共7页
Journal of Lanzhou University（Medical Sciences）
基金
国家自然科学基金资助项目(32160255)
甘肃省科技重大专项(1602FKDA001)
兰州市人才创新创业项目(2018-RC-13)
兰州大学第一医院院内基金项目(ldyyyn2018-16)。
作者简介
通信联系人:孟文勃,男,主任医师,教授,博士,研究方向为肝胆胰外科疾病、微创外科疾病、内镜外科疾病、器官移植,e-mail:mengwb@lzu.edu.cn。
