摘要
目的探讨急性化脓性胆囊炎的高危因素并建立预测模型,为临床早期明确诊断提供指导。方法回顾性分析2015-12-01-2021-11-01胜利油田中心医院肝胆外科收治的1035例急性胆囊炎患者,其中急性化脓性胆囊炎患者357例(研究组),急性非化脓性胆囊炎678例(对照组)。通过单因素分析筛选出发生急性化脓性胆囊炎的有统计意义的指标,将有统计意义的指标进行多因素logistic回归分析,整合结果代入R软件,建立预测急性化脓性胆囊炎发生风险的列线图。结果单因素分析结果,年龄(P=0.398)、高血压(P=0.434)、糖尿病(P=0.074)、冠心病(P=0.838)、发病次数(P=0.111)、胆囊结石(P=0.205)、结石性质(P=0.641)、淋巴细胞(P=0.151)、间接胆红素(P=0.140)、直接胆红素(P=0.052)、血小板(P=0.695)、谷丙转氨酶(P=0.055)、谷草转氨酶(P=0.088)、K^(+)(P=0.288)、Ca2+(P=0.168)、Mg^(2+)(P=0.055)方面差异无统计学意义,均P>0.05。性别(χ^(2)=21.482,P<0.001)、应用阿片类强效止痛药物(χ^(2)=8.730,P=0.004)、白细胞计数(t=-11.879,P<0.001)、中性粒细胞计数(t=-11.392,P<0.001)、粒淋比(t=-3.447,P=0.001)、红细胞计数(t=-2.010,P=0.045)、白蛋白(t=3.466,P=0.001)、Na+(t=3.923,P<0.001)、Cl-(t=2.031,P=0.043)、身体质量指数(t=-3.816,P<0.001)方面差异有统计学意义。多因素logistic回归分析结果显示,男性(P=0.009,95%CI:1.099~1.958)、白细胞升高(P=0.035,95%CI:1.016~1.518)、中性粒细胞升高(P=0.018,95%CI:1.044~1.591)、身体质量指数升高(P=0.006,95%CI:1.017~1.104)、白蛋白降低(P=0.002,95%CI:0.912~0.978)为急性化脓性胆囊炎的独立危险因素。列线图模型预测急性化脓性胆囊炎发生风险的校准C-index为0.741,表明其区分度和预测准确性良好。绘制受试者工作特征(ROC)曲线评估该模型具有较高的灵敏度和特异度。结论男性、白细胞升高、中性粒细胞升高、身体质量指数升高、白蛋白降低是急性化脓性胆囊炎的�
Objective To explore the high risk factors of acute suppurative cholecystitis and establish a prediction model to provide a guidance for early diagnosis.Methods A retrospective analysis was made of 1,035patients with acute cholecystitis admitted to the Department of Hepatobiliary Surgery of Shengli Oilfield Central Hospital from December 1,2015to November 1,2021,including 357patients with acute suppurative cholecystitis(study group)and 678patients with acute non-suppurative cholecystitis(control group).The statistically significant indicators of acute suppurative cholecystitis were screened out through single-factor analysis,and the statistically significant indicators were analyzed by multi-factor logistic regression,and the results were integrated into R software to establish a nomogram to predict the risk of acute suppurative cholecystitis.Results The results of univariate analysis showed that there were no significant differences in age(P=0.398),hypertension(P=0.434),diabetes(P=0.074),coronary heart disease(P=0.838),incidence frequency(P=0.111),gallstone(P=0.205),stone nature(P=0.641),lymphocytes(P=0.151),indirect bilirubin(P=0.140),direct bilirubin(P=0.052),platelets(P=0.695),Alanine transaminase(P=0.055),glutamic Transaminase(P=0.088),K^(+)(P=0.288),Ca^(2+)(P=0.168)Mg^(2+)(P=0.055)(P>0.05).There were significant differences in gender(χ^(2)=21.482,P<0.001),use of powerful opioid analgesic drugs(χ^(2)=8.730,P=0.004),white blood cell count(t=-11.879,P<0.001),neutrophil count(t=-11.392,P<0.001),dNLR(t=-3.447,P=0.001),red blood cell count(t=-2.010,P=0.045),albumin(t=3.466,P=0.001),Na+(t=3.923,P<0.001),Cl-(t=2.031,P=0.043),BMI(t=-3.816,P<0.001).Multivariate logistic regression analysis results showed that males(P=0.009,95%CI:1.099-1.958),increased white blood cells(P=0.035,95%CI:1.016-1.518),increased neutrophils(P=0.018,95%CI:1.044-1.591),increased BMI(P=0.006,95%CI:1.017-1.104),and decreased albumin(P=0.002,95%CI:0.912-0.978)were independent risk factors for acute suppurative cholecystitis.The calibration C-i
作者
杨辰欣
王哲
张云伟
潘国政
由法平
袁庆忠
YANG Chenxin;WANG Zhe;ZHANG Yunwei;PAN Guozheng;YOU Faping;YUAN Qingzhong(Binzhou Medical University,Binzhou,Shandong256600,China;Shengli Oilfield Central Hospital,Binzhou Medical university,Dongying,Shandong257100,Chin)
出处
《社区医学杂志》
CAS
2023年第21期1136-1141,共6页
Journal Of Community Medicine
关键词
急性化脓性胆囊炎
危险因素
预测模型
病例对照研究
acute suppurative cholecystitis
risk factors
predictive model
case-control study
