胆总管结石患者ERCP术后并发胰腺炎影响因素及列线图模型构建  

Influencing Factors of Postoperative Pancreatitis in Patients with Choledocholithiasis after ERCP and Construction of the Nomogram Model

作　　者：周怿 朱恒波 汪浩鹏 丁耀昆 ZHOU Yi;ZHU Hengbo;WANG Haopeng;DING Yaokun(Department of Gastroenterology,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China;Department of Emergency Medicine,Nanjing Hospital(The First Hospital of Nanjing),Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学第四附属医院消化内科,南京210000 [2]南京医科大学附属南京医院(南京市第一医院)急诊科,南京210000

出　　处：《临床误诊误治》2025年第5期59-65,共7页Clinical Misdiagnosis & Mistherapy

基　　金：2022年度南京市卫生科技发展专项资金项目(YKK22213)。

摘　　要：目的基于Lasso-logistic回归模型探讨胆总管结石患者内镜逆行胰胆管造影(ERCP)术后并发胰腺炎的影响因素及列线图模型,为预防ERCP术后并发胰腺炎提供依据。方法选取2021年1月至2024年1月收治的ERCP术后并发胰腺炎患者80例和ERCP术后未发生胰腺炎患者160例。比较2组一般资料、实验室指标,采用Lasso-logistic回归分析胆总管结石患者ERCP术后并发胰腺炎的影响因素;构建列线图模型,并通过受试者工作特征(ROC)曲线、校准曲线及决策曲线分析(DCA)对列线图模型进行验证。结果Lasso-logistic回归分析显示,急慢性胰腺炎史、Oddi括约肌功能障碍(SOD)史、Toll样受体4(TLR4)、插管困难、ERCP时间、miR-25-3p、胰管显影、miR-181a-5p是胆总管结石患者ERCP术后并发胰腺炎的影响因素(P<0.01);列线图模型预测ERCP术后并发胰腺炎的曲线下面积为0.851(95%CI:0.801,0.901),校正曲线与理想曲线基本一致,DCA提示该模型具有较好的临床净获益。结论胆总管结石患者ERCP术后并发胰腺炎的影响因素涉及急慢性胰腺炎史、SOD史、miR-25-3p、miR-181a-5p、TLR4、插管困难、ERCP时间、胰管显影,据此构建列线图模型预测效能较好,有助于指导临床诊疗。Objective To investigate the influencing factors of postoperative pancreatitis in patients with choledocholithiasis after endoscopic retrograde cholangiopancreatography(ERCP)based on Lasso-logistic regression model,and to provide evidence for the prevention of postoperative pancreatitis after ERCP.Methods From January 2021 to January 2024,80 patients with postoperative pancreatitis after ERCP and 160 patients without postoperative pancreatitis were selected.The general data and laboratory indexes of the two groups were compared,and the influencing factors of postoperative pancreatitis in patients with choledocholithiasis after ERCP were analyzed by Lasso-logistic regression.The model was constructed and verified by receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA).Results Lasso-logistic regression analysis showed that history of acute and chronic pancreatitis,history of SOD,TLR4,difficulty in intubation,ERCP time,miR-25-3p,pancreatic duct imaging and miR-181a-5p were the influencing factors of postoperative pancreatitis after choledocholithiasis ERCP(P<0.01).The AUC predicted by the nomogram model for postoperative pancreatitis after ERCP was 0.851(95%CI:0.801,0.901),the correction curve was basically consistent with the ideal curve,and the DCA suggested that this model had a good clinical net benefit.Conclusion The influencing factors of postoperative pancreatitis after choledocholithiasis with ERCP include history of acute and chronic pancreatitis,history of SOD,miR-25-3p,miR-181a-5p,TLR4,difficulty in intubation,ERCP time,and pancreatic duct imaging.Therefore,the construction of a nomographic model is effective in predicting and guiding clinical diagnosis and treatment.

关 键 词：胆总管结石 内镜逆行胰胆管造影 胰腺炎 列线图 Lasso-logistic回归模型 影响因素分析 

分 类 号：R657.4[医药卫生—外科学]