胆囊切除术围手术期G-17、MOT、CCK的变化及联合预测术后综合征的价值

Changes of G-17,MOT,CCK during the perioperative period of cholecystectomy and the value of their combination in prediction of postoperative syndrome

目的探究胆囊切除术患者围手术期胃泌素17(G-17)、胃动素(MOT)、胆囊收缩素(CCK)的变化,并分析其对术后综合征的预测价值。方法前瞻性选取2020年2月至2021年12月南阳市第一人民医院肝胆胰脾外科收治的160例行胆囊切除术的胆囊良性病变患者,检测围手术期(术前、术后1 d、术后7 d、1个月)血清G-17、MOT、CCK水平,术后接受为期12个月随访,根据胆囊切除术后综合征(PCS)发生情况分为PCS发生组(42例)和PCS未发生组(118例)。比较两组患者的临床资料及血清G-17、MOT、CCK水平。采用Spearman相关分析法分析血清G-17、MOT、CCK与PCS发生的关系。采用受试者工作特征曲线(ROC)分析三项血清指标联合预测PCS的价值。采用Logistic回归方程分析PCS发生的影响因素。结果所有患者术后1个月的血清G-17、MOT水平<术后7 d<术后1 d<术前,所有患者术后1个月的血清CCK水平>术后7 d>术后1 d>术前,差异均有统计学意义(P<0.05);PCS发生组患者术前肝外胆管直径水平、血清G-17、MOT水平、疾病类型中胆囊结石伴胆囊炎所占比例、术式中传统开腹胆囊切除术所占比例均高于PCS未发生组,血清CCK水平明显低于PCS未发生组,差异均有统计学意义(P<0.05);PCSⅠ级患者的血清G-17、MOT水平<Ⅱ级<Ⅲ级,PCSⅠ级患者的血清CCK水平>Ⅱ级>Ⅲ级,差异均有统计学意义(P<0.05);经Spearman相关分析法分析结果显示,PCS发生、PCS严重程度分级与血清G-17、MOT呈正相关,与血清CCK呈负相关,差异有统计学意义(P<0.05);经Logistic回归方程分析结果显示,患病类型、术前肝外胆管直径、术式及血清G-17、MOT、CCK水平均为PCS发生的独立危险因素(P<0.05);ROC分析结果显示,胆囊切除术术后7 d血清G-17、MOT、CCK水平联合预测PCS发生的曲线下面积(AUC值)为0.917(95%CI:0.863~0.955),大于三项血清指标单独预测的AUC值(P<0.05)。结论血清G-17、MOT、CCK水平是PCS发生的影响因素,围手术期G-17、MOT、CCK联合预测PCS具有较高预测效能,可为临床预防PCS提供参考。

Objective To explore the changes of gastrin 17(G-17),motilin(MOT),and cholecystokinin(CCK)in perioperative period of cholecystectomy,and analyze their predictive value for postoperative syndrome.Methods We prospectively selected 160 patients with benign gallbladder lesions who admitted to the Department of Hepatobiliary,Pancreatic and Splenic Surgery,the First People's Hospital of Nanyang City from February 2020 to December 2021 and underwent cholecystectomy.The serum G-17,MOT,and CCK levels were measured during the perioperative period(before surgery,1 day,7 days,and 1 month after surgery).The patients were followed up for 12 months after surgery and were divided into two groups based on the incidence of post cholecystectomy syndrome(PCS):the PCS group(42 cases)and the non-PCS group(118 cases).The clinical data,and serum levels of G-17,MOT,and CCK were compared between the two groups.Spearman correlation analysis was used to analyze the relationship between serum G-17,MOT,and CCK and the occurrence of PCS.Receiver operating characteristic curve(ROC)was used to analyze the value of three serum indicators in combination for predicting PCS.Logistic regression equation was used to analyze the influencing factors of PCS occurrence.Results The serum G-17 and MOT levels of all patients increased successively at 1 month after surgery,7 days after surgery,1 day after surgery,and before surgery,while the serum CCK levels decreased successively,with statistically significant differences(P<0.05).The preoperative extrahepatic bile duct diameter,serum G-17,and MOT levels,the proportion of cholecystolithiasis with cholecystitis in the disease type,and the proportion of traditional open cholecystectomy in the operation mode in the PCS group were significantly higher than those in the non-PCS group,and the serum CCK level was significantly lower than that in the non-PCS group,with statistically significant differences(P<0.05).The serum G-17 and MOT levels were increased successively in patients with PCS grade Ⅰ,grade Ⅱ,and grade Ⅲ,while the serum CCK levels were decreased successively,with statistically significant differences(P<0.05).Spearman correlation analysis showed that the occurrence and severity grading of PCS were positively correlated with serum G-17 and MOT and negatively correlated with serum CCK(P<0.05).Logistic regression equation analysis showed that the disease type,preoperative extrahepatic bile duct diameter,surgical procedure,and serum G-17,MOT,and CCK levels were all independent risk factors for the occurrence of PCS(P<0.05).ROC analysis showed that the combination of serum G-17,MOT,and CCK levels at 7 days after cholecystectomy for predicting the occurrence of PCS had an area under the curve(AUC)of 0.917(95%CI:0.863-0.955),which was significantly greater than the AUC values of three serum indicators alone(P<0.05).Conclusion Serum G-17,MOT,and CCK levels are influencing factors for the occurrence of PCS,and the combination of G-17,MOT,and CCK in perioperative period has high predictive efficacy,which can provide reference for clinical prevention of PCS.