摘要
目的:探讨胆囊结石伴隐匿性胆总管结石的危险因素,并建立列线图模型.方法:选取2016年1月-2024年2月我院收治的343例接受手术治疗的胆囊结石患者.根据患者是否合并隐匿性胆总管结石,分为单纯性胆囊结石组(n=299)和合并隐匿性胆总管结石组(n=44).通过单因素和二元Logistic回归分析筛选胆囊结石伴隐匿性胆总管结石的危险因素,并建立列线图模型.通过受试者工作曲线(ROC)、校正曲线、临床决策曲线(DCA)和临床影响曲线对模型的区分度、准确度及临床适用性进行验证.结果:合并隐匿性胆总管结石组的胆总管直径、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)、胆囊结石部位涉及颈部和多发性胆囊结石的患者比例高于单纯性胆囊结石组(P＜0.05).患者胆总管直径增加(OR=1.421,95％CI:1.221～1.653)、ALP 升高(OR=1.012,95％CI:1.002～1.022)、GGT 升高(OR=1.080,95％CI:1.058～1.102)及多发性胆囊结石(OR=3.042,95％CI:1.267～7.304)均是胆囊结石伴隐匿性胆总管结石的独立危险因素(P＜0.05)o ROC曲线分析表明,列线图模型预测隐匿性胆总管结石的AUC为0.964(95％CI:0.872～0.983).校正曲线分析表明模型预测概率和实际概率具有高度一致性.DCA和临床影响曲线分析表明,在各阈概率值下,临床净获益大于0,列线图模型预测隐匿性胆总管结石与实际基本符合.结论:胆囊结石患者胆总管直径、胆囊结石数量、ALP和GGT与隐匿性胆总管结石密切相关,基于以上因素构建的列线图模型可为高危患者的识别提供参考依据,具有一定的临床适用性.
Abstract
Objective To explore the risk factors of gallbladder stones with occult common bile duct stones and establish a column chart model.Methods 343 patients with gallstones who underwent surgical treatment in our hospital from January 2016 to February 2024 were selected.According to whether the patient has occult common bile duct stones,they are divided into simple gallbladder stones group(n=299),and occult common bile duct stones group(n=44).Screening the risk factors for gallbladder stones with occult common bile duct stones through univariate and binary logistic regression analysis,and establishing a column chart model.Verify the model's discrimination,accuracy,and clinical applicability through receiver operating characteristic curve(ROC),calibration curve,decision curve analysis(DCA),and clinical impact curve.Results The proportion of patients with choledochal diameter,alkaline phosphatase(ALP),gamma-glutamyltransferase(GGT),gallbladder stone site involving the neck,and multiple gallbladder stones was higher in the combined occult choledochal stone group than in the simple choledochal stone group(P＜0.05).An increase in the diameter of the common bile duct(OR=1.421,95％CI:1.221-1.653),an increase in ALP(OR=1.012,95％CI:1.002-1.022),an increase in GGT(OR=1.080,95％CI:1.058-1.102),and multiple gallstones(OR=3.042,95％CI:1.267-7.304)were independent risk factors for gallbladder stones with occult common bile duct stones(P＜0.05).The ROC curve analysis showed that the column chart model predicted an AUC of 0.964(95％CI:0.872-0.983)for occult common bile duct stones.The calibration curve analysis showed that the predicted probability of the model was highly consistent with the actual probability.The analyses of DC A and clinical impact curve showed that at each threshold probability value,the clinical net benefit was greater than 0,and the column chart model's prediction of occult common bile duct stones was basically consistent with the actual situation.Conclusion The diameter of the common bile duct,the number of gallstones,ALP,and GGT are closely related to occult common bile duct stones in patients with gallbladder stones.A column chart model constructed based on these factors can provide a reference for identifying high-risk patients and has certain clinical applicability.
维普
万方数据