经内镜逆行胰胆管造影术后胆道感染危险因素及风险模型构建

Risk factors for postoperative biliary tract infection in patients undergoing endoscopic retrograde cholangiopancreatography and establishment of risk model

目的探讨经内镜逆行胰胆管造影术(ERCP)后胆道感染危险因素及其风险模型构建,并分析其预测价值.方法对2019年9月-2022年9月九江市九江学院附属医院收治的235例ERCP术后患者的临床资料进行回顾性分析,将发生胆道感染的患者纳入感染组(29例),未发生胆道感染的患者纳入未感染组(206例).分析ERCP术后胆道感染病原学特点,单因素及多因素Logistic回归分析ERCP术后胆道感染的危险因素,绘制受试者工作特征(ROC)曲线对构建的回归模型进行评估.结果29例ERCP术后胆道感染患者共检出49株病原菌,革兰阳性菌、革兰阴性菌占比分别为18.37%、81.63%,其中革兰阴性菌主要为大肠埃希菌(34.69%);多因素Logistic回归分析结果显示,合并糖尿病、术后胆汁引流不充分是ERCP术后胆道感染的危险因素(P<0.05);根据筛选的危险因素构建回归方程模型:Logit(P)=-2.078+糖尿病×0.897+术后胆汁引流不充分×0.934,ROC曲线分析显示,当Logit(P)>13.08时,曲线下面积(AUC)为0.871(95%CI:0.821~0.911),诊断敏感度为75.86%,特异度为86.41%.结论合并糖尿病、术后胆汁引流不充分是ERCP术后胆道感染的危险因素,根据其构建回归模型对ERCP术后胆道感染预测价值较高,且胆道感染病原菌以革兰阴性菌为主.

OBJECTIVE To explore the risk factors for postoperative biliary tract infection in the patients undergoing endoscopic retrograde cholangiopancreatography(ERCP),establish the risk model and analyze the predictive value.METHODS The clinical data were collected from 235 patients who underwent ERCP in the Affiliated Hospital of Jiujiang University from Sep 2019 to Sep 2022 and were retrospectively analyzed.The patients who had biliary tract infection were assigned as the infection group(29 cases),and the patients who did not have biliary tract infection were assigned as the no infection group(206 cases).The etiological characteristics of the postoperative biliary tract infection in the ERCP patients were analyzed,univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the postoperative biliary tract infection,and the predictive value of the regression model was evaluated by means of receiver operating characteristic(ROC)curves.RESULTS A total of 49 strains of pathogens were isolated from the 29 ERCP patients with postoperative biliary tract infection,18.37%of which were gram-positive bacteria,and 81.63%were gram-negative bacteria;Escherichia coli was the predominant species of the gram-negative bacteria,accounting for 34.69%.The result of multivariate logistic regression analysis showed that complication with diabetes mellitus and inadequate biliary drainage after surgery were the risk factors for the postoperative biliary tract infection in the ERCP patients(P<0.05).The regression equation model was established based on the risk factors:Logit(P)=-11.544+diabetes mellitus×0.897+inadequate biliary drainage after surgery×0.934.ROC curve analysis showed that when Logit(P)was more than 13.08,the area under curve(AUC)was 0.871(95%CI:0.821~0.911),with the sensitivity 75.86%,the specificity 86.41%.CONCLUSION The complication with diabetes mellitus and inadequate postoperative biliary drainage are the risk factors for the postoperative biliary tract infection in the ERCP patients.The regression model has high value in prediction of the postoperative biliary tract infection in the ERCP patients.The gram-negative bacteria are dominant among the pathogens causing the biliary tract infection.