经内镜逆行胰胆管造影术后并发胰腺炎和高淀粉酶血症的危险因素分析

Risk factors of post-operative pancreatitis and hyperamylosis after endoscopic retrograde cholangiopancreatography

目的分析经内镜逆行胰胆管造影(ERCP)术后发生胰腺炎和高淀粉酶血症的危险因素,为其临床防治提供依据。方法回顾性分析该院2015年6月-2017年6月收治并以ERCP治疗的230例患者的临床资料。其中,47例发生高淀粉酶血症和胰腺炎,以Execl表格详细统计患者资料,采用单因素分析和Logistic回归分析确立高淀粉酶血症和胰腺炎的危险因素,并建立数学预测模型,采用受试者工作特征曲线(ROC)分析该模型对高淀粉酶血症和胰腺炎的预测价值。结果单因素分析结果显示体质指数(BMI)、糖尿病、白细胞数量、血小板计数、白蛋白、谷氨酰转肽酶水平、凝血酶原时间、乳头开口类型、胆总管狭窄、酗酒、乳头插管时间、ERCP操作时间、进胰管次数及乳头旁憩室均能够影响ERCP术后胰腺炎和高淀粉酶血症的发生率(P<0.05)。Logistic回归分析结果显示胆总管狭窄、凝血酶原时间≥12 s、非绒毛型乳头开口类型、谷氨酰转肽酶≥50 u/L、乳头插管时间≥5 min、进胰管次数≥3次是导致ERCP术后胰腺炎和高淀粉酶血症的独立危险因素。根据Logistic回归结果建立数学预测模型Logit=0.964X_3+0.772X_7+1.021X_(10)+1.004X_9+0.912X_(11)+1.534X_(13)-1.306,ROC显示该模型对ERCP术后胰腺炎和高淀粉酶血症的预测价值较高[曲线下面积(AUC)=0.790,P<0.05]。结论针对各项危险因素建立数学预测模型能对胰腺炎和高淀粉酶血症的发生风险做出较准确的预测,便于及时采取防治措施。

Objective To analyze the risk factors of post-operative pancreatitis and hyperamylosis after endoscopic retrograde cholangiopancreatography,so as to provide basis for its clinical prevention and treatment.Methods The clinical data of 230 patients after ERCP from June 2015 to June 2017 were analyzed retrospectively used excel spreadsheet statistics,47 in which occurred pancreatitis and hyperamylosis.The risk factors of pancreatitis and hyperamylosis were analyzed by single factor and Logistic regression analysis,and mathematical prediction model was established,which predictive value was analyzed by ROC curve.Results Single factor analysis showed that body mass index,diabetes,white blood cell,blood platelet count,albumin,glutamyltranspeptidase level,prothrombin time,nipple opening type,common bile duct stricture,alcoholism,intubation time,ERCP operation time,intubation times of pancreatic ductnumber and parapillary diverticulum can affect the incidence of pancreatitis and hyperamylosis after ERCP(P<0.05).Logistic regression analysis results showed that the common bile duct stricture,prothrombin time≥12 s,non-villi nipple opening type,intubation time≥5 min,and intubation times of pancreatic ductnumber≥3 were all independent risk factor for postoperative pancreatitis and hyperamylosis.According to the Logistic regression results,the mathematical prediction model was made:Logit=0.964X3+0.772X7+1.021X10+1.004X9+0.912X11+1.534X13-1.306,and the ROC curve showed that the model had high value to predict pancreatitis and hyperamylosis after ERCP(AUC=0.790,P<0.05).Conclusion The mathematical prediction model can be used to predict the occurrence risk of pancreatitis and hyperamylosis,and is benefit for making prevention and control measures timely.