胆囊腺瘤和胆固醇息肉的临床特征分析及意义

Clinical characteristics and significance of gallbladder adenoma and cholesterol polyps

目的 胆囊腺瘤具有恶变潜能,胆囊切除术前很难与胆固醇息肉鉴别,本研究旨在探讨胆囊腺瘤的临床特征,建立胆囊腺瘤与胆固醇息肉鉴别模型,为两种疾病临床诊治提供理论依据.方法 回顾性收集2019年5月至2021年12月海军军医大学第三附属医院行胆囊切除术,术后病理证实为腺瘤和胆固醇息肉并且术前超声检查胆囊息肉≥1cm的患者.根据患者临床特征和超声参数行单因素及多因素分析并建立胆囊腺瘤鉴别模型.结果 共纳入189例患者,其中胆固醇息肉100例,胆囊腺瘤89例.多因素logistic回归分析显示,年龄≥55岁(OR=2.409,P<0.05)单发性息肉病变(OR=2.580,P<0.05)、息肉≥15mm(OR=9.298,P<0.05)、息肉形状不规则(OR=9.547,P<0.05)血清 CA19-9≥7.2U/ml(OR=2.240,P<0.05)是胆囊腺瘤的独立危险因素.根据结果建立Logit(P)=-9.199+0.879 *年龄≥55岁+0.948 *单发性息肉病变+2.23 *息肉≥15mm+2.256 *病变形状不规则+0.806* CA19-9≥7.2U/ml的回归方程.曲线下面积为0.838(P<0.05).当P≥0.411时,诊断胆囊腺瘤的敏感性为78.7%,特异性为74.0%,整体正确率为76.2%.结论 年龄≥55岁、单发息肉病变、息肉≥15mm、病变形状不规则、CA19-9≥7.2U/ml是胆囊腺瘤的危险因素.本研究建立的预测模型可鉴别腺瘤和胆固醇息肉,指导最佳的治疗方案.

Objective Gallbladder adenomatous polyp is a pre-cancerous neoplasm,and it is difficult to classify from cholesterol polyps before cholecystectomy.The study aimed to explore the clinical characteristics of gallbladder adenomas and establish a prediction-model to differentiate gallbladder adenomas from cholesterol polyps.Methods From May 2019 to December 2021,the patients with polyps≥1cm on preoperative ultrasonography,who underwent cholecystectomy in the Third Hospital Afiliated to Naval Military Medical University and pathologically confirmed to be adenomas and cholesterol polyps after surgery were retrospectively reviewed.Univariate and multivariate analyses were performed according to the clinical characteristics and ultrasound parameters of the patients,and a prediction-model of gallbladder adenoma was established.Results A total of 189 patients were enrolled,including 100 cases of cholesterol polyps and 89 cases of gallbladder adenomas.Multivariate logistic regression analysis showed that age≥55 years old(OR=2.409,P<0.05),solitary polyp(OR=2.580,P<0.05),diameter of polyps≥15mm(0R=9.298,P<0.05),polyps with irregular shape(OR=9.547,P<0.05),serum CA19-9≥7.2U/ml(OR=2.240,P<0.05)were independent risk factors for gallbladder adenomas.According to the results,the regression equation of Logit(P)=-9.199+0.879*age≥55 years+0.948*solitary polyp+2.23*diameter of polyps≥15mm+2.256*irregular shape+0.806*CA19-9≥7.2U/ml was established.The area under the curve was 0.838(P<0.05).When P≥0.411,the sensitivity,specificity and accuracy of diagnosing gallbladder adenoma were 78.7%,74.0%and 76.2%,respectively.Conclusion The risk factors of age≥55 years,solitary polyp,diameter of polyp≥15mm,irregular shape,CA19-9≥7.2U/ml were significantly associated with gallbladder adenomas.And the prediction-model established in the study can effectively identify adenomas from cholesterol polyps and help patients to select the optimal treatment protocol.