PCT、CRP对急性胆管炎严重程度的早期预测价值及列线图模型构建  

Early prediction value of PCT and CRP on severity of acute cholangitis and construction of nomogram model

作　　者：沈丹枫 常鹏 陆颖超 徐红星[1] 顾强[1] Shen Danfeng;Chang Peng;Lu Yingchao;Xu Hongxing;Gu Qiang(Taicang First People's Hospital(Suzhou University Affiliated Taicang Hospital),Suzhou Jiangsu Province 215400,China)

机构地区：[1]太仓市第一人民医院(苏州大学附属太仓医院),江苏苏州215400

出　　处：《中华普外科手术学杂志(电子版)》2025年第2期192-195,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：苏州市基础研究计划(医学创新应用研究,SKYD2023068);太仓市基础研究计划(医疗卫生应用基础研究,TC2023JCYL12)。

摘　　要：目的探究降钙素原(PCT)、C反应蛋白(CRP)对急性胆管炎严重程度的早期预测价值,并基于构建列线图(Nomogram)模型。方法回顾性分析2021年1月至2023年6月162例急性胆管炎患者的临床资料,根据患者病情严重程度分为轻度组(n=67例)和中重度组(n=95例)。采用SPSS 21.0统计学软件处理数据。通过多因素Logistic回归分析筛选影响急性胆管炎严重程度的独立风险因素;R软件“rms”包构建Nomogram模型。结果与轻度组相比,中重度组患者年龄、高血压病史占比、总胆红素(TBIL)、白细胞(WBC)、PCT、CRP明显升高,白蛋白(ALB)明显降低(P<0.05)。年龄、WBC、ALB、PCT、CRP是影响急性胆管炎严重程度的独立危险因素(P<0.05)。ROC曲线分析显示,PCT、CRP联合预测急性胆管炎严重程度的AUC为0.931,明显高于PCT(P<0.001)、CRP(P=0.002)、年龄+WBC+ALB(P=0.014)。将多因素Logistic回归分析显示筛选出的5个危险因素构建Nomogram模型,定义为Model 1,将年龄、WBC、ALB三个指标联合构建的模型定义为Model 2。Model 1预测急性胆管炎严重程度的能力更高(AUC:0.955 vs.0.788)。结论PCT、CRP对急性胆管炎严重程度的早期预测价值较高,基于此构建的Nomogram具有较高的预测效能及临床获益。Objective To explore the early prediction value of procalcitonin(PCT)and C-reactive protein(CRP)in the severity of acute cholangitis,and establish a Nomogram model.Methods Clinical data of 162 patients with acute cholangitis from January 2021 to June 2023 were retrospectively analyzed,and they were divided into mild group(n=67 cases)and moderate and severe group(n=95 cases)according to the severity of their disease.SPSS 21.0 statistical software was used to process the data.The independent risk factors influencing the severity of acute cholangitis were screened by multivariate Logistic regression analysis.R software“rms”package to build Nomogram model.Results Compared with mild group,age,history of hypertension,total bilirubin(TBIL),white blood cell(WBC),albumin(ALB),PCT and CRP in moderate to severe group were significantly increased,and ALB was significantly decreased(P<0.05).Age,WBC,ALB,PCT and CRP were independent risk factors for acute cholangitis severity(P<0.05).ROC curve analysis showed that the AUC of PCT and CRP in predicting the severity of acute cholangitis was 0.931,which was significantly higher than that of PCT(P<0.001),CRP(P=0.002),age+WBC+ALB(P=0.014).The five risk factors selected by multivariate Logistic regression analysis were defined as Nomogram Model 1,and the combined Model of age,WBC and ALB was defined as Model 2.Model 1 was better at predicting the severity of acute cholangitis(AUC:0.955 vs.0.788).Conclusion PCT and CRP can predict the severity of acute cholangitis in early stage.Nomogram based on PCT and CRP has high predictive efficacy and clinical benefit.

关 键 词：急性胆管炎 降钙素原 C反应蛋白质 列线图 预测 

分 类 号：R65[医药卫生—外科学]