摘要
目的 调查内镜逆行胰胆管造影(ERCP)术后胰腺炎的危险因素,并开发一款可视化强、操作简便的列线图模型用于临床实践。方法 回顾选择2017年1月-2021年1月于本院行ERCP患者共410例为建模组,另选择2021年3月-2022年3月100例ERCP患者为验证组,根据亚特兰大标准诊断胰腺炎,建模组45例,验证组10例。首先比较建模组胰腺炎患者与无胰腺炎患者的临床资料和生化指标,多因素Logistic回归分析筛选胰腺炎的危险因素,然后建立列线图模型并进行验证。结果 单因素比较发现,胰腺炎患者年龄增加,胃切除术史和胆总管结石增多,内镜显示乳头孔为绒毛型和结节型增多,胰腺导丝通道和前括约肌切开术增多,血清总胆红素升高,白蛋白下降(P<0.05)。多因素Logistic回归分析显示,胆总管结石(OR=2.821,95%CI=2.236~3.965,P<0.001)、乳头孔结节型(OR=2.524,95%CI=2.001~3.232,P<0.001)、胰腺导丝通道(OR=2.987,95%CI=2.326~3.567,P<0.001)、总胆红素≥250 μmol/L(OR=1.626,95%CI=1.124~2.329,P=0.008)和白蛋白<35 g/L(OR=1.329,95%CI=1.052~1.959,P=0.010)是ERCP术后胰腺炎的独立危险因素。R软件建立列线图模型,总分220分,受试者工作曲线(ROC)显示,列线图在建模组与验证组预测胰腺炎的曲线下面积(AUC)分别为0.895(95%CI=0.812~0.944,P<0.001)和0.864(95%CI=0.801~0.936,P<0.001),敏感度和特异度也较好。结论 ERCP术后胰腺炎的发生率较高,涉及临床多个因素,我们开发一款可视化强、操作简便的列线图模型用于指导临床早期筛查高风险术后胰腺炎患者,有较好的预测效能和临床应用潜力。
Objective To investigate the risk factors of pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP),and establish a nomogram model with strong visualization and easy operation to guide clinical practice.Methods A total of 410 patients who underwent ERCP in our hospital from January 2017 to January 2021 were retrospectively summarized as the model group,and another 100 patients received ERCP from March 2021 to March 2022 were selected as the validation group.Pancreatitis was diagnosed according to the Atlanta standard,and there were 45 cases in model group and 10 cases in validation group.Firstly,the clinical data and biochemical indexes of patients with pancreatitis and non-pancreatitis in model group were compared,the risk factors of pancreatitis were screened by multivariate Logistic regression analysis.Then,the nomogram model was established and verified.Results Univariate comparison showed that the age of patients with pancreatitis was elder,history of gastrectomy and choledocholithiasis were increased,and there were more villous and nodular types of papillary orifice by endoscopy,more pancreatic guidewire channel and anterior sphincterotomy,serum total bilirubin was higher,and less albumin(P<0.05).Multivariate Logistic regression analysis showed that choledocholithiasis(OR=2.821,95%CI=2.236~3.965,P<0.001),nodule type of papillary orifice(OR=2.524,95%CI=2.001~3.232,P<0.001),pancreatic guidewire channel(OR=2.987,95%CI=2.326~3.567,P<0.001),total bilirubin over or equal to 250μmol/L(OR=1.626,95%CI=1.124~2.329,P=0.008)and albumin less than 35g/L(OR=1.329,95%CI=1.052~1.959,P=0.010)were all the independent risk factors to pancreatitis after ERCP.The nomograph model was established by R software with a total score of 220 points.Receiver operating curve(ROC)showed that area under the curve(AUC)of the model for predicting pancreatitis in model group and validation group were 0.895(95%CI=0.812-0.944,P<0.001)and 0.864(95%CI=0.801~0.936,P<0.001),respectively,the sensitivity and specificity were also good.Conclusions The incidence of pancreatitis after ERCP is at high level,which involves many clinical factors.We have developed a nomogram model with strong visualization and easy operation to guide clinical early screening of patients with high-risk postoperative pancreatitis,which has good predictive efficiency and important clinical potential.
作者
秦幼娟
沙杰
朱明辉
凌峰
Qin Youjuan;Sha Jie;Zhu Minghui;Ling Feng(Department of gastroenterology,Jingjiang people's hospital,Jingjiang,Jiangsu,214500,China.)
出处
《齐齐哈尔医学院学报》
2023年第18期1746-1750,共5页
Journal of Qiqihar Medical University
关键词
内镜逆行胰胆管造影
胰腺炎
列线图
Endoscopic retrograde cholangiopancreatography
Pancreatitis
Nomogram
