胆总管结石患者ERCP术后早期胆道感染的动态预测工具开发及验证  

Development and validation of a dynamic prediction tool for post-endoscopic retrograde cholangiopancreatography early biliary tract infection in patients with choledocholithiasis

作　　者：李鹏[1] 梁超[2] 颜家凤 高春辉[4] 马志杰[5] 谢占涛[4] 孙明洁[1] LI Peng;LIANG Chao;YAN Jia-feng;GAO Chun-hui;MA Zhi-jie;XIE Zhan-tao;SUN Ming-jie(Office of Healthcare-associated Infection Management,Henan Provincial People’s Hospital,Zhengzhou 450001,China;Department of Infection Management,People’s Hospital of Yuxi City,Yuxi 653100,China;Department of Infection Management,Qianxinan People’s Hospital,Qianxinan 562400,China;Department of Hepatobiliary Pancreatic Surgery,Henan Provincial People’s Hospital,Zhengzhou 450001,China;Digestive Endoscopy Center,Henan Provincial People’s Hospital,Zhengzhou 450001,China)

机构地区：[1]河南省人民医院医院感染管理办公室,河南郑州450001 [2]玉溪市人民医院感染管理科,云南玉溪653100 [3]黔西南州人民医院感染管理科,贵州黔西南州562400 [4]河南省人民医院肝胆胰腺外科,河南郑州450001 [5]河南省人民医院消化内镜中心,河南郑州450001

出　　处：《中国感染控制杂志》2024年第6期692-699,共8页Chinese Journal of Infection Control

基　　金：国家卫生健康委科学研究基金-河南省医学科技攻关计划省部共建项目(SBGJ202103021)。

摘　　要：目的开发胆总管结石患者经内镜逆行性胰胆管造影术(ERCP)后发生早期胆道感染(PEEBI)的预测工具,以期辅助临床进行ERCP术前决策和术后早期个性化干预。方法采用观察性双向队列研究方法,选取某医院接受ERCP的胆总管结石住院患者,分别采用有向无环图(DAGs)和最小绝对收缩与选择算子法(LASSO)进行基于logistic回归的PEEBI预测,比较预测模型,并进行内外部验证。结果2020年1月1日—2023年9月30日,共纳入接受ERCP的胆总管结石患者2121例,其中77例(3.6%)发生了PEEBI,且主要集中在术后前2天(66.2%)。影响PEEBI的主要因素为非医源的患者相关因素,即糖尿病(OR=2.43,95%CI:1.14~4.85)、胆管恶性肿瘤(OR=3.95,95%CI:1.74~8.31)和十二指肠乳头憩室(OR=4.39,95%CI:1.86~9.52)。DAGs模型较LASSO模型的综合判别能力高3.0%(P=0.007),且DAGs模型外部验证中的区分性能(D=0.133,P=0.894)和校准性能(χ^(2)=5.499,P=0.703)均表现良好。结论本研究构建的DAGs模型具有良好的预测性能,临床可在该工具的协助下采取针对性的围手术期早期预防措施,以减少PEEBI的发生。Objective To develop a prediction tool for post-endoscopic retrograde cholangiopancreatography(ERCP)early biliary tract infection(PEEBI)in patients with choledocholithiasis,and assist clinical decision-making before ERCP and early personalized intervention after ERCP.Methods An observational bidirectional cohort study was adopted to select inpatients with choledocholithiasis who underwent ERCP in a hospital.Directed acyclic graph(DAGs)and the least absolute shrinkage and selection operator(LASSO)were used to predict PEEBI based on logistic regression,and the models were compared and validated internally and externally.Results From January 1,2020 to September 30,2023,a total of 2121 patients with choledocholithiasis underwent ERCP were enrolled,of whom 77(3.6%)developed PEEBI,mostly in the first 2 days after surgery(66.2%).The major influencing factors for PEEBI were non-iatrogenic patient-related factors,namely diabetes mellitus(OR=2.43,95%CI:1.14-4.85),bile duct malignancy(OR=3.95,95%CI:1.74-8.31)and duodenal papillary diverticulum(OR=4.39,95%CI:1.86-9.52).Compared with the LASSO model,the DAGs model showed higher ability(3.0%)in comprehensive discrimination(P=0.007),as well as good differentiation performance(D=0.133,P=0.894)and calibration performance(χ^(2)=5.499,P=0.703)in external validation.Conclusion The DAGs model constructed in this study has good predictive performance.With the help of this tool,targeted early preventive measures in clinical practice can be taken to reduce the occurrence of PEEBI.

关 键 词：胆总管结石 经内镜逆行性胰胆管造影术 胆道感染 有向无环图 预测 

分 类 号：R181.32[医药卫生—流行病学]