| 摘要: |
| 目的 分析肝硬化患者行内镜逆行胰胆管造影（ERCP）术后并发症的危险因素，建立简单、实用的评分系统。方法 回顾性分析2009年1月至2015年12月223例在第二军医大学长海医院行胆管ERCP同时合并肝硬化患者的临床病理资料。对术后并发症的影响因素，如术前状态、检验指标、术中操作情况等进行单因素分析和logistic回归分析。将独立危险因素中的连续变量转换为分类变量，根据各变量在logistic回归中的β值进行赋值，建立新的评分系统，通过受试者工作特征（ROC）曲线评价其预测并发症的效能。结果 Logistic回归分析发现，总胆红素（TBIL）是术后并发症的独立危险因素（OR=1.003，95%CI：1.001~1.005），白蛋白（ALB）是其保护因素（OR=0.935，95%CI：0.879~0.994）。利用这两项指标建立的评分系统为：TBIL ≤ 31.4 μmol/L为0分，31.5~102.5 μmol/L为1分， ≥ 102.6 μmol/L 为2分；ALB ≥ 31 g/L为0分， ≤ 30 g/L为1分。经过ROC曲线分析发现，新建评分的曲线下面积（AUC）为0.689，与Child-Pugh分级（AUC：0.700）和终末期肝病模型（MELD）评分（AUC：0.692）相当。当以1.5分为界时（即0~1分为低危，2~3分为高危），新建评分系统的敏感度为89.4%，特异度为41.1%，准确率为49.3%，阳性预测值为23.7%，阴性预测值为95.0%。结论 新建的ERCP术后并发症评分系统简便、易用，可以用来区分高危患者。 |
| 关键词: 内镜逆行胰胆管造影 手术后并发症 肝硬化 危险因素 |
| DOI：10.16781/j.0258-879x.2017.05.0543 |
| 投稿时间：2017-03-15修订日期：2017-04-28 |
| 基金项目:国家自然科学基金（81370493，81670435）. |
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| A new scoring system for predicting post-operative complications of ERCP in patients with liver cirrhosis |
| LI Mao1,TANG Jian1,ZHOU Chun-hua1,2,ZHAO Jiu-long1,LI Zhao-shen1,ZOU Duo-wu1* |
(1. Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Department of Gastroenterology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the risk factors of post-operative complications of endoscopic retrograde cholangiopancreatography (ERCP) in patients with liver cirrhosis, and to establish a simple and practical scoring system. Methods We retrospectively analyzed the clinicopathological data of 223 patients with liver cirrhosis who underwent ERCP in Changhai Hospital of Second Military Medical University from Jan. 2009 to Dec. 2015. The univariate analysis and logistic multivariate regression analysis were used to study the effects of pre-operative status, lab parameters and operation performance on post-operative complications. After screening for independent risk factors and transforming the continuous variables into categorical variables, we assigned the scores according to the β value of each independent risk factor, established a new scoring system to predict the occurrence of post-operative omplications, and then drew the receiver operating characteristic (ROC) curve to assess its predicting efficacy for complications. Results Multivariate regression analysis showed that total bilirubin (TBIL) was an independent risk factor for post-operative complications with an OR of 1.003 (95%CI 1.001, 1.005), and albumin (ALB) as a protective factor with an OR of 0.935 (95%CI 0.879, 0.994). The scoring system established according the two factors was as follows:TBIL ≤ 31.4 μmol/L for 0 point, 31.5-102.5 μmol/L for one point, ≥ 102.6 μmol/L for two points; ALB ≥ 31 g/L for 0 point, ≤ 30 g/L for one point. The area under ROC curve (AUC) of the new scoring system was 0.689, which was similar to the Child-Pugh classification (0.700) and the model for end-stage liver disease (MELD) score (0.692) by ROC analysis. All patients were divided into two parts by 1.5 points according to the new scoring system (0-1 point was set as low-risk, and 2-3 points was high-risk). The sensitivity of the new scoring system was 89.4%, specificity was 41.1%, accuracy rate was 49.3%, the positive predictive value was 23.7%, and the negative predictive value was 95.0%. Conclusion The new scoring system for post-ERCP complications is easy-to-use and can be used to identify patients at high-risk. |
| Key words: endoscopic retrograde cholangiopancreatography postoperative complications liver cirrhosis risk factors |
