胰十二指肠切除术后临床相关型延迟胃排空危险因素分析及风险评分模型构建

Clinical-relevant delayed gastric emptying after pancreaticoduodenectomy:analysis for risk factors and creation of risk scoring model

目的:研究胰十二指肠切除术(PD)后临床相关型延迟胃排空(CR-DGE)的危险因素并构建风险评分模型。方法:收集2014年6月至2019年6月于东南大学附属中大医院肝胆胰中心行PD并符合纳入标准的108例患者临床数据,根据诊断标准分为CR-DGE组及NCR-DGE组,采用Logistic回归分析PD术后CRDGE独立危险因素,并以此构建风险评分模型。结果:多因素分析显示术前天门冬氨酸氨基转移酶(AST)水平(P=0.007,OR=1.018)、有胃肠道疾病史(P=0.031,OR=3.450)、体质量指数(BMI)≥24 kg·m^(-2)(P=0.047,OR=2.869)、术后血糖水平(P=0.044,OR=1.173)为CR-DGE发生独立危险因素。基于上述危险因素构建风险评分模型,并据此绘制受试者工作特征曲线,其曲线下面积为0.729(95%CI:0.632~0.826),表明该评分模型预测能力良好。结论:本研究筛选出4个CR-DGE危险因素,以此构建的风险评分模型预测性能良好,可用于识别CR-DGE高危患者。

Objective:To analyze the risk factors for clinical-relevant delayed gastric emptying(CR-DGE)after pancreaticoduodenectomy(PD)and establish risk scoring model.Methods:We retrospectively collected clinical data of 108 patients underwent PD in the Zhongda Hospital Affiliated to Southeast University from June 2014 to June2019.Univariable and multivariable Logistic regression analysis were performed to investigate independent risk factors for CR-DGE.A risk scoring model was established according to risk factors.Results:The multivariable Logistic regression analysis showed that high level of preoperative aspartate transaminase(P=0.007,OR=1.018),history of gastrointestinal disease(P=0.031,OR=3.450),body mass index≥24 kg·m^(-2)(P=0.047,OR=2.869),postoperative blood glucose(P=0.044,OR=1.173)were independent risk factors of CR-DGE.A risk scoring model was established by above four risk factors and proved effective in predicting incidence of CR-DGE.The area under curve of receiver operating characteristic curve was 0.729(95%CI:0.632-0.826).Conclusion:Four variables were identified as risk factors for CR-DGE,and the risk scoring model established by these risk factors was effective in predicting formation of CR-DGE.