Construction and evaluation of a predictive model for recurrence of intrahepatic bile duct stones after surgery
Objective:To construct and evaluate a predictive model for the recurrence of hepatolithiasis after surgery based on clinical data and serum retinol binding protein 4 (RBP4) and cholecystokinin A (CCK-A). Methods:One hundred and thirty-five patients with intrahepatic duct stone who underwent laparoscopic combined choledochoscopic lithotripsy admitted to our hospital from January 2020 to December 2022 were retrospectively included and divided into a modeling set (n=90) and a validation set (n=45) according to a 2:1 ratio. Patients were divided into relapse group and non-recurrence group according to recurrence status within 1-year follow-up. Univari-ate Logistic regression analysis was performed to analyze the influencing factors of postoperative recurrence of patients. A nomogram was constructed according to the influencing factors,and cali-bration curve,consistency index,receiver operating characteristic curve (ROC) and decision curve were used for internal and external verification. Results:In the modeling set,patients with bilat-eral stone distribution,maximum stone diameter ≥10 mm,bile duct stenosis,multiple stone num-bers,and paracystic diverticulum in the recurrent group had higher serum levels of RBP4 than those in the non-recurrent group at 7 days after surgery,and lower serum levels of CCK-A than those in the non-recurrent group at 7 days after surgery (P<0.05). The factors of recurrence after hepatoli-thiasis surgery were the maximum stone diameter ≥10 mm,bilateral stone distribution,bile duct stenosis,multiple stone numbers,paracystic diverticulum,serum RBP4 level 7 days after surgery,and serum CCK-A level 7 days after surgery (P<0.05). A nomogram was constructed based on the influencing factors,and internal and external validation showed that the prediction model had good predictive ability and clinical net benefit. Conclusion:The influencing factors of recurrence after hepatolithiasis surgery include serum RBP4 levels 7 days after surgery and bilateral stone distribu-tion. The nomogram prediction model constructed based on these factors has high predictive value and clinical benefit.
万方数据
维普
