摘要
目的:由胆囊结石诱发的急性胆源性胰腺炎(ABP)起病急,进展迅速,严重时危及生命。然而目前对于胆囊结石诱发ABP的机制及危险因素并非十分明确,且缺乏预测手段。因此,本研究探讨胆囊结石患者并发ABP的相关危险因素,并构建ABP发生风险的预测模型。方法:选取江苏省太仓市第一人民医院2018年1月—2021年3月期间收治的503例因腹痛入院并确诊为胆囊结石的患者为研究对象,收集患者临床资料、实验室指标以及ABP发生的情况。用单因素与多因素分析筛选ABP发生的危险因素,用ROC曲线分析各因素预测ABP的曲线下面积(AUC)与最佳截断值,构建列线图预测模型量化患者风险,并用校准曲线及决策曲线分析评估其临床预测效能。结果:503例胆囊结石患者中,119例(23.66%)并发ABP。与无ABP的患者比较,发生ABP的患者的APACHEⅡ评分、胆囊大小异常比例、多发胆囊结石比例、胆总管结石比例、血清淀粉酶(AMS)、C-反应蛋白(CRP)、降钙素原(PCT)以及中性粒细胞和淋巴细胞计数比值(NLR)均升高,而胆囊壁厚度减低(均P<0.05);ROC曲线分析结果显示,APACHEⅡ评分、胆囊壁厚度、AMS、CRP、PCT、NLR的AUC分别为0.681、0.769、0.886、0.734、0.869、0.822,最佳截断值分别为13.89、1.89 mm、382.10 U/L、18.69 mg/L、5.76μg/L、3.05;多因素Logistic回归分析显示,胆囊壁厚度(<1.89 mm)、多发胆囊结石、AMS(≥382.10 U/L)、CRP(≥18.69 mg/L)、PCT(≥3.68 g/dL)及NLR(≥3.05)是胆囊结石患者并发ABP发生的独立危险因素(均P<0.05);根据上述独立影响因素构建的列线图的C指数为0.691(95%CI=0.661~0.735),风险阈值0.14,并且列线图模型的临床净收益显著高于任何单个指标预测结果。结论:胆囊壁厚度、多发胆囊结石、AMS、CRP、PCT以及NLR为胆囊结石患者并发ABP密切相关,基于以上因素构建的列线图模型对胆囊结石患者ABP发生的早期识别与预警有一定的临床价
Background and Aims:Acute biliary pancreatitis(ABP)secondary to gallbladder stones has a rapid onset and swift progression,which can be life threatening in severe cases.However,the mechanism and risk factors for ABP induced by gallbladder stones are not entirely clear at present.Therefore,this study was conducted to investigate the risk factors for ABP in patients with cholecystolithiasis,and to construct a predictive model for the risk of ABP.Methods:A total of 503 patients admitted for abdominal pain and diagnosed as cholecystolithiasis from January 2018 to March 2021 were enrolled as study subjects.The general clinical data,laboratory data and the occurrence of ABP of the patients were gathered.The risk factors for ABP were screened by univariate and multivariate analyses.The area under curve(AUC)and best cut-off value of each risk factor were determined by ROC curve analysis.A nomogram predictive model was constructed to quantify patient risk,and its clinical predictive ability was assessed by calibration curve and decision curve analyses.Results:Among the 503 patients with cholecystolithiasis,119 cases(23.66%)developed ABP.In patients with ABP compared with those without ABP,the APACHEⅡscore,proportion of cases with abnormal gallbladder size,proportion of cases with multiple gallbladder stones,proportion of cases with common bile duct stones,amylase(AMS),C-reactive protein(CRP),procalcitonin(PCT)and neutrophil to lymphocyte ratio(NLR)were increased(P<0.05),while the gallbladder wall thickness was decreased significantly(all P<0.05).Results of ROC curve analysis showed that the AUC values for APACHEⅡscore,gallbladder wall thickness,AMS,CRP,PCT and NLR were 0.681,0.769,0.886,0.734,0.869 and 0.822,and the best cut-off values were 13.89,1.89 mm,382.10 U/L,18.69 mg/L,5.76μg/L and 3.05,respectively.Multivariate Logistic regression analysis showed that gallbladder wall thickness(<1.89 mm),multiple gallstones,AMS(≥382.10 U/L),CRP(≥18.69 mg/L),PCT(≥3.68 g/dL)and NLR(≥3.05)were independent risk factors fo
作者
陆颖超
黄锦山
徐红星
沈丹枫
LU Yingchao;HUANG Jinshan;XU Hongxing;SHEN Danfeng(Department of Hepatobiliary Surgery,the First People's Hospital of Taicang,Taicang,Jiangsu 215400,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2023年第8期1199-1207,共9页
China Journal of General Surgery
关键词
胆囊结石病
胰腺炎
危险因素
列线图
Cholecystolithiasis
Pancreatitis
Risk Factors
Nomograms
