视黄醇结合蛋白4联合胆囊收缩素A受体对肝内胆管结石术后复发的预测价值  

Predictive value of combining serum levels of retinol binding protein 4 and cholecystokinin A receptor for postoperative recurrence of intrahepatic choledocholithiasis

作　　者：靳高超 王玉 任伟[3] 刘波[2] 赵倩 Jin Gaochao;Wang Yu;Ren Wei;Liu Bo;Zhao Qian(Department of Pancreaticobiliary Surgery,Xingtai People's Hospital,Hebei Xingtai 054000,China;Department of Critical Medicine,Xingtai People's Hospital,Hebei Xingtai 054000,China;Department of Gastrointestinal Tumor Surgery,Xingtai People's Hospital,Hebei Xingtai 054000,China;Department of Laboratory Medicine,Xingtai People's Hospital,Hebei Xingtai 054000,China)

机构地区：[1]邢台市人民医院胰胆外科,河北邢台054000 [2]邢台市人民医院重症医学科,河北邢台054000 [3]邢台市人民医院胃肠肿瘤外科,河北邢台054000 [4]邢台市人民医院检验科,河北邢台054000

出　　处：《腹部外科》2025年第1期43-48,共6页Journal of Abdominal Surgery

基　　金：2024年度河北省卫生健康委医学科学研究课题计划项目(20241233)。

摘　　要：目的 分析血清视黄醇结合蛋白4(retinol binding protein 4,RBP4)、胆囊收缩素A受体(cholecystokinin A receptor,CCKAR)联合对肝内胆管结石术后复发的预测价值。方法 选择于2021年4月至2022年3月邢台市人民医院收治的100例肝内胆管结石病人作为研究对象;根据腹腔镜联合胆道镜胆管切开取石术后24个月是否复发将其分为复发组(36例)和无复发组(64例);利用酶联免疫吸附试验法检测血清RBP4、CCKAR水平;采用Pearson相关分析复发组血清RBP4、CCKAR与总胆红素(TBIL)、肿瘤坏死因子-α(TNF-α)的相关性;采用多元logistic回归分析术后复发的影响因素;绘制受试者操作特征曲线分析预测价值,并采用Z检验比较其曲线下面积(area under the curve,AUC)。结果 复发组与无复发组比较,TBIL、TNF-α、RBP4[(9.97±2.85) mg/L比(7.81±2.19) mg/L]显著升高(均P<0.05),CCKAR[(91.56±26.49)ng/L比(116.40±29.69)ng/L]显著降低(P<0.05);复发组血清RBP4水平与TBIL、TNF-α呈正相关(r分别为0.543、0.498,P<0.05),CCKAR水平与TBIL、TNF-α呈负相关(r分别为-0.511、-0.576,P<0.05)。TNF-α、RBP4是肝内胆管结石病人术后复发的危险因素(OR分别为4.168、4.550,P<0.05),CCKAR是保护因素(OR=0.301,P<0.05)。血清RBP4、CCKAR水平联合预测肝内胆管结石病人术后复发的AUC为0.905(95%CI:0.835~0.975),RBP4、CCKAR水平单独预测肝内胆管结石病人术后复发的AUC分别为0.787(95%CI:0.696~0.879)、0.802(95%CI:0.715~0.890),二者联合预测价值较RBP4(Z=1.993,P=0.023)、CCKAR(Z=1.787,P=0.037)单独预测更高。结论 肝内胆管结石术后复发病人血清RBP4升高,CCKAR降低,二者联合预测肝内胆管结石病人术后复发的价值较高。Objective To explore the predictive values of combining serum levels of retinol binding protein 4(RBP4)and cholecystokinin A receptor(CCKAR)for postoperative recurrence of intrahepatic choledocholithiasis.Methods Between April 2021 and March 2022,100 patients hospitalized with intrahepatic choledocholithiasis were selected as study subjects.According to whether or not recurrence occurred at 24 months post-operation,they were assigned into two groups of recurrence(n=36)and non-recurrence(n=64).Serum levels of RBP4 and CCKAR were measured by enzyme-linked immunosorbent assay(ELISA).The correlation of serum level of RBP4/CCKAR with total bilirubin(TBIL)and tumor necrosis factor-alpha(TNF-α)in recurrence group was examined by Pearson’s correlation analysis.Multiple logistic regression was utilized for examining the influencing factors of postoperative recurrence.Predictive value of subjects was analyzed by plotting receiver operating characteristic curves and the area under the curve(AUC)compared by Z-test.Results The levels of TBIL,TNF-αand RBP4 were obviously higher in recurrence group than those in non-recurrence group[(9.97±2.85)vs.(7.81±2.19)mg/L,P<0.05].And CCKAR was obviously lower than that in non-recurrence group[(91.56±26.49)vs.(116.40±29.69)ng/L,P<0.05].Serum level of RBP4 in recurrence group was correlated positively with TBIL and TNF-α(r=0.543,0.498,P<0.05)while CCKAR level was correlated negatively with TBIL and TNF-α(r=-0.511,-0.576,P<0.05).TNF-αand RBP4 were risk factors for postoperative recurrence(OR:4.168,4.550,P<0.05).CCKAR was a protective factor of postoperative recurrence(OR=0.301,P<0.05).Combining serum levels of RBP4 and CCKAR in predicting postoperative recurrence had an AUC of 0.905(95%CI:0.835-0.975).AUC of RBP4 or CCKAR alone in predicting postoperative recurrence was 0.787(95%CI:0.696-0.879)or 0.802(95%CI:0.715-0.890)respectively.Combined predictive value of both was higher than RBP4(Z=1.993,P=0.023)or CCKAR(Z=1.787,P=0.037)alone.Conclusion Serum level of RBP4 rises while that

关 键 词：肝内胆管结石 视黄醇结合蛋白4 胆囊收缩素A受体 复发 

分 类 号：R446.1[医药卫生—诊断学]