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

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ERCP置入支架术后胆管炎的概率与实际发生概率具有较高的一致性。结论 高GGT、低白蛋白、困难插管、高位胆管梗阻、吸烟是恶性胆管梗阻病人ERCP置入支架后胆管炎发生的独立危险因素,根据上述危险因素建立的列线图模型预测病人发生胆管炎能力较强,可根据预测病人发生胆管炎的概率采取个体化预防措施。

Objective To analyze the risk factors of cholangitis after stent placement by endoscopic retrograde cholangiopancreatography(ERCP) in patients with malignant biliary obstruction.Methods The clinical data of 263 patients with malignant biliary obstruction who underwent ERCP stent placement in Chengde Central Hospital from January 2016 to December 2021 were collected,the influencing factors that may lead to cholangitis were included,and the relevant risk factors were analyzed by logistic regression.A nomogram prediction model was established according to the risk factors.Results Of the 263 patients,49(18.63%) had cholangitis..Univariate analysis showed that gamma-glutamyltransferase(GGT),albumin,difficult intubation,obstruction site,smoking(P<0.05) were associated 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 risk factors 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 predicts the probability of cholangitis after ERCP stent placement in patients with malignant biliary obstruction had a high consistency with the actual probability.Conclusion High GGT,low albumin,difficult intubation,high biliary obstruction,and smoking are independent risk factors for cholangitis after ERCP stent placement in patients with malignant biliary obstruction,the nomogram model established according to the above risk factors has a strong ability to predict the occurrence of cholangitis,individual preventive measures can be taken according to the predicted probability of a patient developing cholangitis.