急性坏疽性胆囊炎的临床危险因素分析及诊断预测

Clinical risk factors analysis and diagnostic prediction of acute gangrenous cholecystitis

目的分析影响急性坏疽性胆囊炎发生的危险因素,并探索该病的诊断预测指标。方法本回顾性研究纳入2017年1月至2022年6月期间315例因胆囊结石伴胆囊炎发作在包头市中心医院行腹腔镜胆囊切除术的患者,所有患者均符合纳入排除标准。收集患者一般资料、既往病史、临床资料以及术后胆囊病理资料等。结果(1)急性坏疽性胆囊炎组(坏疽组,n=170)白细胞计数、胆囊长轴、胆囊宽轴、胆囊壁厚等水平以及在高血压、糖尿病、冠心病、胆囊周围炎、结石嵌顿的比例方面均高于非急性坏疽性胆囊炎组(非坏疽组,n=145),差异具有统计学意义(P<0.05)。(2)年龄(OR=1.17,95%CI 1.12-1.23)、白细胞计数(OR=2.88,95%CI 1.51-5.51)、胆囊周围炎(OR=5.57,95%CI 1.84-16.83)、胆囊长轴(OR=3.56,95%CI 1.95-6.49)、胆囊壁厚(OR=3.23,95%CI 1.76-5.95)是急性坏疽性胆囊炎发生的独立危险因素。(3)年龄、白细胞计数、胆囊周围炎、胆囊长轴、胆囊壁厚对急性坏疽性胆囊炎均具有较好的诊断预测价值,其ROC曲线下面积均高于0.70。五项指标联合诊断的ROC曲线下面积为0.98(95%CI 0.96-0.99),灵敏度92.94%,特异度91.72%,约登指数0.85,5项指标联合对急性坏疽性胆囊炎的发生具有很好的诊断预测价值。结论本研究表明,患者年龄、白细胞计数、胆囊周围炎、胆囊长轴和胆囊壁厚是急性坏疽性胆囊炎发生的危险因素,5项指标联合诊断能很好地预测急性坏疽性胆囊炎的发生。

Objective To analyze the risk factors affecting the occurrence of acute gangrenous cholecystitis and to explore the diagnostic and predictive indexes of the disease.Methods A total of 315 patients with cholecystolithiasis and cholecystitis,who underwent laparoscopic cholecystectomy in Baotou Central Hospital from Jan.2017 to Jun.2022,were retrospectively analyzed.All patients met the inclusion and exclusion criteria.The general data,past medical history,clinical data and postoperative gallbladder pathological data were collected.Results(1)The white blood cell count,gallbladder long axis,gallbladder wide axis,gallbladder wall thickness,and the proportion of hypertension,diabetes,coronary heart disease,pericholecystitis and stone incarceration in acute gangrenous cholecystitis group(gangrenous group,n=170)were higher than those in nonacute gangrenous cholecystitis group(non-gangrenous group,n=145).The differences were all statistically significant(P<0.05).(2)Age(OR=1.17,95%CI 1.12-1.23),white blood cell count(OR=2.88,95%CI 1.51-5.51),pericholecystitis(OR=5.57,95%CI 1.84-16.83),gallbladder long axis(OR=3.56,95%CI 1.95-6.49)and gallbladder wall thickness(OR=3.23,95%CI 1.76-5.95)were independent risk factors for acute gangrenous cholecystitis.(3)Age,white blood cell count,pericholecystitis,gallbladder long axis and gallbladder wall thickness had good predictive value in the diagnosis of acute gangrenous cholecystitis,and the area under ROC curve were all higher than 0.70.The area under the ROC curve for the combined diagnosis of above 5 indexes was 0.98(95%CI 0.96-0.99),the sensitivity was 92.94%,the specificity was 91.72%,and the Yoden index was 0.85.The combination of 5 indexes had a good diagnostic predictive value for the occurrence of acute gangrenous cholecystitis.Conclusion This study shows that age,white blood cell count,pericholecystitis,gallbladder long axis and gallbladder wall thickness are risk factors for acute gangrenous cholecystitis.The combined diagnosis of these 5 indexes can well predict the occurrence of acute gangrenous cholecystitis.