肝门部胆管癌患者经内镜金属支架植入术后胆道感染的危险因素分析及预测模型构建

Risk factors analysis and prediction model establishment of biliary tract infection in patients with hilar cholangiocarcinoma after endoscopic metal stent implantation

目的探讨影响肝门部胆管癌(HCCA)患者经内镜金属支架植入术(EMBE)后发生胆道感染的危险因素并建立预测模型。方法回顾性分析某医院接受EMBE术的164例HCCA患者,根据是否发生胆道感染将其分成感染组(n=38)与未发生感染组(n=126)。先进行单因素分析,再对P<0.05的变量进行多因素logistic回归分析并构建Nomogram预测模型,用受试者工作特征曲线(ROC)、校准曲线及DCA曲线评价该模型的性能。结果共有38例患者发生胆道感染,发病率为23.2%,多因素分析结果显示年龄、术前黄疸天数、梗阻长度、糖尿病病史是胆道感染发生的独立危险因素(P<0.05),KPS评分是独立保护因素(P<0.05),Nomogram预测模型ROC曲线下面积为0.885(95%CI 0.825~0.929)。结论年龄、术前黄疸天数、梗阻长度和糖尿病病史是胆道感染发生的独立危险因素,KPS评分是胆道感染发生的独立保护因素,构建的Nomogram预测模型具有良好的区分度及准确性。

Objective To explore the risk factors of biliary tract infection in patients with hilar cholangiocarcinoma after endoscopic metal stent implantation,and to establish Nomogram prediction model.Methods A total of 164 patients with HCCA who underwent EMBE in our hospital were retrospectively analyzed.They were divided into infection group(n=38)and non infection group(n=126)according to whether biliary tract infection occurred.Univariate analysis was first performed,then multivariate logistic analysis was performed on the variables with P<0.05,and nomogram prediction model was constructed.The performance of the model was evaluated by C index,receiver operating characteristic curve(ROC),calibration curve and DCA curve.Results A total of 38 patients had biliary tract infection,with a incidence rate of 23.2%.Multivariate analysis showed that age,preoperative jaundice days,obstruction length,and diabetes history were independent risk factors for biliary tract infection(P<0.05),and KPS score was an independent protective factor(P<0.05).In Nomogram prediction model,the area under the ROC curve was 0.885(95%CI 0.825-0.929).Conclusion Age,preoperative jaundice days,obstruction length and diabetes history are independent risk factors for biliary tract infection.KPS score is an independent protective factor,and the nomogram prediction model has good differentiation and accuracy.