| 段惠潇,于双颖,席海旭,等.恶性胆管梗阻病人经内镜逆行胰胆管造影术置入支架术后发生胆管炎的影响因素分析[J].安徽医药,2024,28(3):547-551. |
| 恶性胆管梗阻病人经内镜逆行胰胆管造影术置入支架术后发生胆管炎的影响因素分析 |
| Analysis of influencing factors of cholangitis after endoscopic retrograde cholangiopancreatography stent placement in patients with malignant biliary obstruction |
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| DOI：10.3969/j.issn.1009-6469.2024.03.026 |
| 中文关键词: 胆汁淤积 胆管肿瘤 胆管梗阻 经内镜逆行胰胆管造影术 支架 胆管炎 影响因素 |
| 英文关键词: Cholestasis Bile duct neoplasms Bile duct obstruction ERCP Stent Cholangitis Influencing factors |
| 基金项目:2019年承德市科学技术研究与发展计划项目( 201903A007) |
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| 中文摘要: |
| 目的分析恶性胆管梗阻病人经内镜逆行胰胆管造影术( ERCP)置入支架术后胆管炎的危险因素。方法收集 2016年 1月至 2021年 12月于承德市中心医院行 ERCP支架置入的 263例恶性胆管梗阻病人临床资料，纳入可能导致胆管炎发生的影响因素，应用 logistic回归分析出相关危险因素，依据危险因素建立列线图预测模型。结果 263例病人有 49例( 18.63%)发生胆管炎。单因素分析显示， γ-谷氨酰转移酶( GGT)、白蛋白、困难插管、梗阻部位、吸烟与恶性胆管梗阻病人 ERCP置入支架术后胆管炎发生相关( P<0.05)；多因素分析显示 GGT［OR=1.001，95%CI:(1.000，1.001)］、白蛋白［ OR=6.199，95%CI:(1.625，23.641)］、困难插管［ OR=19.734，95%CI:(2.900，134.267)］、梗阻部位［ OR=6.865，95%CI:(2.911，16.190)］、吸烟［ OR=3.877， 95%CI:(1.722，8.727)］是胆管炎发生的独立危险因素。模型区分度用受试者操作特征曲线(ROC曲线)评价， ROC曲线下面积(AUC)为 0.83［95%CI:(0.77，0.90)P<0.001］提示模型有较高的区分度。校准曲线中列线图模型预测恶性胆管梗阻病人 ER. |
| 英文摘要: |
| Objective To analyze the risk factors of cholangitis after stent placement by endoscopic retrograde cholangiopancreatogra.phy (ERCP) in patients with malignant biliary obstruction.Methods The clinical data of 263 patients with malignant biliary obstruc.tion who underwent ERCP stent placement in Chengde Central Hospital from January 2016 to December 2021 were collected, the influ.encing factors that may lead to cholangitis were included, and the relevant risk factors were analyzed by logistic regression. A nomo.gram prediction model was established according to the risk factors.Results Of the 263 patients, 49 (18.63%) had cholangitis.. Uni. variate analysis showed that gamma-glutamyltransferase (GGT), albumin, difficult intubation, obstruction site, smoking (P<0.05) wereassociated cholangitis after ERCP stent placement in patients with malignant biliary obstruction; multivariate analysis showed that GGT[OR=1.001, 95% CI: (1.000,1.001)], albumin [OR=6.199, 95% CI: (1.625,23.641)], difficult intubation [OR=19.734, 95% CI: (2.900, 134.267)], obstruction site [OR=6.865, 95%CI: (2.911,16.190)] and smoking [OR=3.877, 95% CI: (1.722,8.727)] were independent riskfactors for cholangitis. The model discrimination was evaluated by ROC curve, and the area under the ROC curve (AUC) was 0.83 [95%CI: (0.77, 0.90), P<0.001], indicating that the model had a higher discrimination. The nomogram model in the calibration curve predictsthe probability of cholangitis after ERCP stent placement in patients with malignant biliary obstruction had a high consistency with theactual probability.Conclusion High GGT, low albumin, difficult intubation, high biliary obstruction, and smoking are independentrisk factors for cholangitis after ERCP stent placement in patients with malignant biliary obstruction, the nomogram model establishedaccording to the above risk factors has a strong ability to predict the occurrence of cholangitis, individual preventive measures can betaken according to the predicted probability of a patient developing cholangitis. |
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