内镜逆行胰胆管造影术后急性胆管炎的危险因素研究及其列线图的构建

Risk factors for acute cholangitis after endoscopic retrograde cholangiopancreatography and construction of the nomogram

摘要:

目的 探讨内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography， ERCP）后急性胆管炎的危险因素及其列线图的构建。方法 回顾性分析2014年1月—2019年12月在兰州大学第一医院因胆总管结石接受ERCP的患者临床资料，纳入术后发生急性胆管炎的患者95例（胆管炎组），以1∶3比例通过软件随机抽样选择术后未发生急性胆管炎的患者285例（无胆管炎组）。采用Logistic回归模型分析影响ERCP术后急性胆管炎的独立危险因素，根据多因素分析结果，建立预测ERCP术后急性胆管炎发生率的列线图模型。结果 单因素比较发现 ERCP术后发生胆管炎患者和未发生胆管炎患者在年龄、合并糖尿病、丙氨酸转氨酶、碱性磷酸酶、葡萄糖、胆囊壁粗糙、胆管直径、胆管下端狭窄、行经内镜胆道内支架放置术比例、行经内镜鼻胆管引流术比例方面差异均有统计学意义（P<0.05）。Logistic多因素回归分析显示，高龄（OR=1.108， 95%CI：1.079~1.138，P<0.001）、合并糖尿病（OR=4.524，95%CI：1.299~15.758， P=0.018）、胆囊壁粗糙（OR=2.495，95%CI：1.106~5.630，P=0.028）、胆管直径增加（OR=1.303，95%CI：1.181~1.437， P<0.001）、胆管下端狭窄（OR=4.192，95%CI：2.508~7.005， P<0.001）为ERCP术后急性胆管炎的独立危险因素。根据多因素分析结果建立的列线图，受试者工作特征曲线的曲线下面积为0.887。结论 高龄、糖尿病病史、胆囊壁粗糙、胆管直径增加和胆管下端狭窄为ERCP术后急性胆管炎的独立危险因素，临床医师可依据上述危险因素建立的列线图进行临床干预，改善患者预后。

Abstract:

Objective To investigate the risk factors for acute cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) and to construct its nomogram. Methods Clinical data of patients who underwent ERCP for common bile duct stones in the First Hospital of Lanzhou University from January 2014 to December 2019 were retrospectively analyzed. A total of 95 patients with acute cholangitis after the operation (the acute cholangitis group) were included and 285 patients without acute cholangitis after the operation (the non-acute cholangitis group) were selected by random sampling at 1∶3 via the software. Logistic regression analysis was used to evaluate the risk factors for acute cholangitis after ERCP. A nomogram model was established to predict the incidence of acute cholangitis after ERCP based on the results of multivariate analysis. Results Univariate analysis showed that there were significant differences in age, combination with diabetes, levels of alanine aminotransferase, alkaline phosphatase and glucose, roughness in gallbladder wall, bile duct diameter, stenosis in lower bile duct, proportion of patients who underwent endoscopic retrograde biliary drainage and endoscopic nasobiliary drainage between the two groups (P<0.05). Logistic multivariate regression analysis showed that advanced age (OR=1.108, 95%CI:1.079-1.138, P<0.001), combination with diabetes (OR=4.524, 95%CI:1.299-15.758, P=0.018), roughness in gallbladder wall (OR=2.495, 95%CI:1.106-5.630, P=0.028), increased bile duct diameter (OR=1.303, 95%CI:1.181-1.437, P<0.001), and stenosis in lower bile duct (OR=4.192, 95%CI:2.508-7.005, P<0.001) were independent risk factors for acute cholangitis after ERCP. Based on the results of multivariate analysis, the nomogram of acute cholangitis after ERCP was established. The area under the receiver operator characteristic curve was 0.887. Conclusion Advanced age, combination with diabetes, rough gallbladder wall, increased diameter of bile duct and stenosis in lower bile duct are independent risk factors for acute cholangitis after ERCP. Clinicians can make clinical intervention based on the nomogram of risk factors above to improve the prognosis of patients.