慢性胰腺炎局灶性肿块术前病变性质预测因子  

Preoperative predictors for the nature of lesion in patients with focal masses in the setting of chronic pancreatitis

作　　者：陈燕[1] 蔡全才[1] 朱伟[1] 徐勤丰[2] 钟良[3] 陈世耀[4] 郭爱珍[1] 李兆申[1] 

机构地区：[1]第二军医大学长海医院消化内科,上海200433 [2]复旦大学管理学院统计学系 [3]复旦大学华山医院消化内科 [4]复旦大学中山医院消化内科

出　　处：《中华胰腺病杂志》2009年第4期222-225,共4页Chinese Journal of Pancreatology

摘　　要：目的建立慢性胰腺炎（CP）局灶性肿块病变性质预测模型，分析其主要预测因子。方法收集上海市7家三级甲等医院1998年7月至2007年4月收治的CP局灶性肿块病变性质不明患者121例，经病理（97例）或随访（24例）判断肿块性质，分为胰腺癌组和CP组。通过查阅病历等方式记录患者性别、年龄、既往疾病史、初诊时的主要临床表现、实验室检查和影像学检查结果，采用病例对照研究设计，应用χ^检验、t检验等方法进行单因素分析。选择单因素分析中P≤0．25的因素进行多因素分析，建立病变性质Logistic回归预测模型，计算各因素的OR值及95％可信限。结果121例患者最终确诊为胰腺癌21例，CP100例。腹部压痛、直接胆红素、CA19-9和CEA是肿块病变性质的独立预测因子，它们的OR值分别为5．691、1．011、1．003、1．019；95％可信限分别为1．468，22．070、1．001，1．021、1．001，1．005和0．988，1．051；P值分别为0．012、0．030、0．003和0．23。结论本研究的Logistic回归模型可以较为准确地预测CP局灶性肿块的病变性质，可能有一定的临床应用价值。Objective To establish a predictive model and to find the preoperative predictors for the nature of lesion in the setting of chronic pancreatitis. Methods The 121 patients from 7 tertiary medical centers in Shanghai from July 1998 to April 2007 with focal mass lesions in the setting of chronic pancreatitis were selected as the study population. The final diagnosis had to be confirmed histologically by surgical specimens （ n = 97 ） or by follow-up （ n = 24）. A case control study was conducted ; the patients were divided into pancreatic cancer group and chronic pancreatitis group. The age, sex, past history, initial clinical presentations, lab results and imaging exams were collected by reviewing the medical records of these patients.χ^2 test and t test was used for univariate analysis, then the factors with P ≤ 0.25 were selected for further multivariate analysis, and multivariate logistic regression model was used to estimate odds ratio and 95% CI. Results Of 121, 21 patients had a final diagnosis of pancreatic cancer and other 90 patients had a final diagnosis of chronic pancreatitis. Abdominal tenderness, direct bilirubin, CA19-9 and CEA were independent predictors of cancer in patients with focal mass lesions. Their odds ratios （95% CI） were 5. 691 （ 1. 468, 22.070）, 1.011 （1.001, 1.021）, 1.003 （1.001, 1.005）, 101.9 （0.988, 1.051）, respectively. Their P values were 0.012, 0.030, 0. 003 and 0.23, respectively. Conclusions The logistic regression model may accurately predict the nature of lesion in the setting of chronic pancreatitis and may have certain clinical implication.

关 键 词：胰腺炎 慢性 胰腺肿瘤 诊断 鉴别 LOGISTIC回归 预测模型 

分 类 号：R576[医药卫生—消化系统]