胆总管结石术后发生肝内胆管结石预测模型的建立与评价

Establishment and evaluation of prediction model of hepatolithiasis after choledocholithiasis

目的探究影响胆总管结石术后发生肝内胆管结石的危险因素,同时建立预测模型并评价。方法选取2016年6月至2018年6月武汉市第一医院收治的305例行胆总管结石术病人作为研究对象,专人负责对病人进行随访、调查,观察病情进展情况,根据胆总管结石术后是否发生肝内胆管结石,将研究对象分为发生肝内胆管结石组(26例)与未发生肝内胆管结石组(279例),收集两组病人相关临床资料,行多因素Logistic回归分析,依据分析结果探究影响胆总管结石术后发生肝内胆管结石的相关危险因素,同时建立相应的预测模型。结果①胆总管结石术后发生肝内胆管结石与胆总管直径、结石数量、胆道炎症、胆管硬化、术中出血、手术时间、术前血总胆红素、术前血清白蛋白、术前丙氨酸转氨酶等因素有关(均P<0.05)。②以胆总管结石术后是否发生肝内胆管结石作为因变量,将组间比较差异有统计学意义的单因素作为自变量,行多因素Logistic回归分析,结果显示:胆总管直径、结石数量、胆道炎症、术前血总胆红素、术前丙氨酸转氨酶是胆总管结石术后发生肝内胆管结石的危险因素(均P<0.05)。③构建胆总管结石术后发生肝内胆管结石预测模型结果显示,模型预测灵敏度和特异度分别为86.67%、96.69%,准确度为95.59%。结论胆总管直径、结石数量、胆道炎症、术前血总胆红素、术前丙氨酸转氨酶是胆总管结石术后发生肝内胆管结石的危险因素,依据上述因素建立模型,可为胆总管结石术后是否发生肝内胆管结石提供一定参考。

Objective To explore the risk factors of hepatolithiasis after choledocholithiasis,and to establish and evaluate a prediction model.Methods 305 patients with choledocholithiasis who underwent choledocholithiasis from June 2016 to June 2018 were selected as the study subjects.A specially-assigned person was responsible for follow-up and investigation of the patients to observe the progression of the disease.According to whether the patients had intrahepatic cholelithiasis occurs after choledocholithiasis,the study subjects were divided into secondary intrahepatic bile duct stones group(26 cases)and non-secondary intrahepatic bile duct stones group(279 cases).The clinical data of the two groups were collected and multivariate logistic regression analysis was performed to explore the risk factors of hepatolithiasis after choledocholithiasis,and the corresponding prediction model was established.Results①The occurrence of choledocholithiasis after choledocholithiasis surgery was related to the diameter of common bile duct,the number of stones,cholangitis,choledochosclerosis,intraoperative bleeding,operation time,total bilirubin,preoperative serum albumin,preoperative alanine aminotransferase and other factors(all P<0.05).②Multivariate logistic regression analysis was performed with the presence or absence of bile duct stones after choledocholithiasis surgery as the dependent variable and the univariate factors with statistically significant differences as the independent variables.The results showed that the diameter of the common bile duct,the number of stones,biliary inflammation,the total bilirubin of the blood,and the preoperative alanine aminotransferase were the risk factors for the occurrence of bile duct stones after choledocholithiasis surgery(all P<0.05).③The results of constructing the prediction model of bile duct stones after choledocholithiasis surgery showed that the sensitivity and specificity of the model prediction were 86.67%and 96.69%,respectively,and the accuracy was 95.59%.Conclusion Diameter of common bile duct,size of intrahepatic stones,location of stones,inflammation of biliary tract,preoperative total bilirubin and alanine aminotransferase are the risk factors of hepatolithiasis after choledocholithiasis.The establishment of a model based on the above factors can provide some reference for the occurrence of secondary intrahepatic stones after choledocholithiasis.