摘要
目的分析并构建胆总管结石患者经内镜下逆行胰胆管造影术(ERCP)后恶性梗阻性黄疸(MOJ)发生风险的列线图预测模型。方法选取2021年6月至2024年2月吉安市中心人民医院行ERCP手术的285例胆总管结石患者为研究对象,据其术后是否出现MOJ分为黄疸组(n=51)和非黄疸组(n=234),比较两组基线资料,采用ROC和logistic回归分析影响ERCP术后患者MOJ发生的相关因素并构建列线图预测模型。结果单因素分析结果显示,患者术后发生MOJ与年龄、体重指数、糖尿病、脂肪肝、胆囊切除史、胆总管直径、结石直径及手术时间有关,差异有统计学意义(P<0.05)。多因素分析结果显示,年龄(β=0.046,OR=1.047,95%CI:1.010~1.085),糖尿病(β=1.095,OR=2.988,95%CI:1.312~6.805),脂肪肝(β=1.135,OR=3.111,95%CI:1.373~7.047),胆总管直径(β=0.180,OR=1.197,95%CI:1.033~1.387),结石直径(β=0.203,OR=1.225,95%CI:1.072~1.401),手术时间(β=0.033,OR=1.034,95%CI:1.017~1.051)是胆总管结石ERCP术后患者MOJ的独立危险因素(P<0.05)。年龄、脂肪肝、胆总管直径、手术时间对患者术后MOJ的发生有预测价值,AUC为0.614、0.595、0.616、0.686(P<0.05);C-index=0.792(0.722~0.861)显示一致性较好;Hosmer-Lemeshow检验显示χ^(2)=7.167,P=0.519,表明逻辑回归模型对数据的拟合效果良好。结论年龄、糖尿病、脂肪肝、胆总管直径、结石直径及手术时间是患者术后发生MOJ的影响因素,且模型有较好的预测能力。
Objective To analyze and construct a nomogram prediction model for the risk of malignant obstructive jaundice(MOJ)after endoscopic retrograde cholangiopancreatography(ERCP)in patients with common bile duct stones.Methods A total of 285 patients with common bile duct stones who underwent ERCP surgery in Ji'an Central People's Hospital from June 2021 to February 2024 were selected as the research subjects.They were divided into the jaundice group(n=51)and the non-jaundice group(n=234)according to whether MOJ occurred after the operation.The baseline data of the two groups were compared.ROC and logistic regression were used to analyze the related factors influencing the occurrence of MOJ in patients after ERCP,and a nomogram prediction model was constructed.Results The results of univariate analysis showed that the occurrence of MOJ in patients after surgery was related to age,body mass index,diabetes,fatty liver,history of cholecystectomy,common bile duct diameter,stone diameter and operation time,and the differences were statistically significant(P<0.05).The results of multivariate analysis showed that age(β=0.046,OR=1.047,95%CI:1.010-1.085),diabetes(β=1.095,OR=2.988,95%CI:1.312-6.805),fatty liver(β=1.135,OR=3.111,95%CI:1.373-7.047),common bile duct diameter(β=0.180,OR=1.197,95%CI:1.033-1.387),stone diameter(β=0.203,OR=1.225,95%CI:1.072-1.401),operation time(β=0.033,OR=1.034,95%CI:1.017-1.051)were independent risk factor for MOJ in patients with common bile duct stones after ERCP(P<0.05).Age,fatty liver,common bile duct diameter and operation time had predictive value for the occurrence of postoperative MOJ in patients,with AUC of 0.614,0.595,0.616 and 0.686(P<0.05).C-index=0.792(0.722-0.861)showed good consistency.The Hosmer-Lemeshow test showed χ^(2)=7.167,P=0.519,indicating that the logistic regression model had a good fitting effect on the data.Conclusion Age,diabetes,fatty liver,common bile duct diameter,stone diameter and operation time are the influencing factors of MOJ in patients after surgery,and the model has a good predictive ability.
作者
李义安
张伟
马朝建
LI Yian;ZHANG Wei;MA Chaojian(Department of Gastroenterology,Ji'an Central People's Hospital,Jiangxi Province,Ji'an343000,China;Department of Pharmacy,Ji'an Central People's Hospital,Jiangxi Province,Ji'an343000,China)
出处
《中国当代医药》
2026年第2期9-13,共5页
China Modern Medicine
基金
江西省卫生健康委科技计划项目(202212824)。
关键词
胆总管结石
内镜下逆行胰胆管造影术
恶性梗阻性黄疸
列线图预测模型
Common bile duct stones
Endoscopic retrograde cholangiopancreatography
Malignant obstructive jaundice
Line chart prediction model
