经内镜逆行胰胆管造影术后胰腺炎发生的预测模型及关键因子研究  

Prediction model and key factors of pancreatitis after endoscopic retrograde cholangiopancreatography

作　　者：武振东 金鹏飞 董源 WU Zhendong;JIN Pengfei;DONG Yuan(Department of Hepatobiliary Surgery,Hebei Petro China Central Hospital,Langfang 065000,China)

机构地区：[1]河北中石油中心医院肝胆外科,河北廊坊065000

出　　处：《腹腔镜外科杂志》2024年第12期903-908,共6页Journal of Laparoscopic Surgery

基　　金：河北省廊坊市科学技术研究与发展计划(2023013042)。

摘　　要：目的:建立血清淀粉酶、胰蛋白酶原-2(Tr-2)、血小板活化因子(PAF)预测经内镜逆行胰胆管造影(ERCP)术后发生胰腺炎的列线图模型,并分析预测价值。方法:选择2023年7月至2024年3月接受ERCP诊疗且存在术后胰腺炎高危因素的300例患者,其中53例术后发生胰腺炎(胰腺炎组),247例术后未发生胰腺炎(对照组),对比两组术后3 h血清淀粉酶、Tr-2、PAF水平,并统计分析两组患者一般资料、临床病理资料,建立ERCP术后发生胰腺炎的风险因素Logistic回归模型,对具有统计学意义的变量建立列线图模型,分析各项指标预测ERCP术后发生胰腺炎的价值。结果:胰腺炎组淀粉酶、Tr-2、PAF测定值高于对照组,差异均有统计学意义(P<0.05);两组术前AST、ALT、TBIL、WBC、乳头旁憩室占比、胰管显影占比、合并胆管结石占比、恶性梗阻占比、鼻胆管引流占比差异均无统计学意义(P>0.05);胰腺炎组ERCP时间≥45 min、乳头插管时间≥7.5 min、进入胰管次数≥3次、球囊扩张占比均高于对照组,差异有统计学意义(P<0.05)。Logistic回归模型结果显示,淀粉酶增高(OR=1.735,P<0.001)、Tr-2增高(OR=1.626,P=0.047)、PAF增高(OR=1.486,P=0.048)、ERCP时间≥45 min(OR=1.829,P<0.001)、进入胰管次数≥3次(OR=1.667,P=0.042)是ERCP术后发生胰腺炎的独立危险因素(P<0.05)。淀粉酶、Tr-2、PAF、ERCP时间、进入胰管次数建立列线图对ERCP患者术后发生胰腺炎具有较好的预测价值(C指数=0.803,95%CI=0.644~0.863),模型预测发生胰腺炎的受试者工作特征曲线下面积为0.906,95%CI=0.841~0.978,预测临界值总分为160分。结论:淀粉酶、Tr-2、PAF增高与ERCP后发生胰腺炎具有密切关系,是预测患者ERCP术后发生胰腺炎模型的重要指标。Objective:To establish a nomogram model for predicting the occurrence of pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP)using serum amylase,trypsinogen-2(Tr-2),and platelet-activating factor(PAF),and analyze the predictive value.Methods:From Jul.2023 to Mar.2024,300 patients underwent ERCP and were at high risk of post-ERCP pancreatitis.Among them,53 patients developed pancreatitis after the surgery(pancreatitis group),while the remaining 247 patients did not e xperience pancreatitis(control group).The levels of serum amylase,Tr-2,and PAF were compared between the two groups at 3 h after surgery.A statistical analysis was conducted on the general information and clinicopathological factors of both groups.A logistic regression model was established to identify risk factors for pancreatitis after ERCP.For variables with statistical significance,a nomogram model was developed to assess the predictive value of various indicators for pancreatitis following ERCP.Results:The measured values of amylase,Tr-2,and PAF in the pancreatitis group were significantly higher than those in the control group,with statistically significant differences(P<0.05).There were no statistically significant differences between the two groups in preoperative AST,ALT,TBIL,WBC,the proportion of patients with periampullary diverticulum,the proportion of patients with pancreatic duct visualization,the proportion of patients with concomitant bile duct stones,the proportion of patients with malignant obstruction,and the proportion of patients undergoing nasobiliary drainage(P>0.05).The pancreatitis group had a significantly higher proportion of patients with an ERCP duration≥45 min,cannulation time≥7.5 min,≥3 entries into the pancreatic duct,and balloon dilation compared to the control group,with statistically significant differences(P<0.05).The logistic regression model revealed that increased amylase(OR=1.735,P<0.001),increased Tr-2(OR=1.626,P=0.047),increased PAF(OR=1.486,P=0.048),ERCP duration≥45 min(OR=1.829,P<0

关 键 词：胰腺炎 胰胆管造影术 内窥镜逆行 淀粉酶 胰蛋白酶原-2 血小板活化因子 列线图 预测 

分 类 号：R657.51[医药卫生—外科学]