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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (03) : 239 -243. doi: 10.3877/cma.j.issn.2095-3232.2020.03.009

所属专题： 文献；

临床研究

肝囊型包虫病手术患者胆漏发生危险因素分析及预测模型建立
张永国1, 胥瑾2, 樊海宁3, 祁之俊1, 孔广玺1, 周虎3, 许晓磊3, 王展3,†()   
  1. 1. 810007　西宁，青海省福利慈善医院普通外科
    2. 810001　西宁，青海大学
    3. 810001　西宁，青海大学附属医院肝胆胰外科
  • 收稿日期:2020-02-06 出版日期:2020-06-10
  • 通信作者: 王展
  • 基金资助:
    青海省卫生计生委指导性重点项目(2016-wjzd-04); 青海省包虫病临床医学研究中心项目(2017-SF-L2)

Analysis of risk factors and establishment of prediction model for biliary leakage in cystic echinococcosis patients undergoing surgery

Yongguo Zhang1, Jin Xu2, Haining Fan3, Zhijun Qi1, Guangxi Kong1, Hu Zhou3, Xiaolei Xu3, Zhan Wang3,†()   

  1. 1. General Surgery, Qinghai Welfare Charity Hospital, Xining 810007, China
    2. Qinghai University, Xining 810001, China
    3. Department of Hepatobiliary and Pancreatic Surgery, Qinghai University Affiliated Hospital, Xining 810001, China
  • Received:2020-02-06 Published:2020-06-10
  • Corresponding author: Zhan Wang
  • About author:
    Corresponding author: Wang Zhan, Email:
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引用本文：

张永国, 胥瑾, 樊海宁, 祁之俊, 孔广玺, 周虎, 许晓磊, 王展. 肝囊型包虫病手术患者胆漏发生危险因素分析及预测模型建立[J/OL]. 中华肝脏外科手术学电子杂志, 2020, 09(03): 239-243.

Yongguo Zhang, Jin Xu, Haining Fan, Zhijun Qi, Guangxi Kong, Hu Zhou, Xiaolei Xu, Zhan Wang. Analysis of risk factors and establishment of prediction model for biliary leakage in cystic echinococcosis patients undergoing surgery[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(03): 239-243.

目的

探讨肝囊型包虫病手术患者胆漏发生的危险因素，并建立相应的回归预测模型。

方法

回顾性分析2014年6月至2018年12月于青海省福利慈善医院行手术治疗的183例肝囊型包虫病患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男67例，女116例；年龄12～78岁，中位年龄41岁。采用Logistic回归筛选出胆漏危险因素，森林图显示多因素Logistic回归的各个指标效应大小，建立肝囊型包虫病手术患者胆漏Logistic回归预测模型。通过Hosmer-Lemeshow检验评价预测模型的拟合度，采用受试者工作特征（ROC）曲线评价模型的预测价值。

结果

本组患者胆漏发生率为22.4% （41/183）。多因素Logistic回归结果显示，ALP>135 U/L（OR=10.797，95%CI：4.860～23.927，P<0.05）、囊肿直径>10 cm（OR=3.576，95%CI：1.911～6.268，P<0.05）是肝囊型包虫病手术患者胆漏发生的独立危险因素。将这两个因素纳入Logistic回归方程：Logit（P）=-2.580+2.412XALP+1.215X囊肿直径。概率模型为：P=1/[1+Exp（-2.580+2.412XALP+1.215X囊肿直径）]。ROC曲线下面积为0.792（95%CI：0.719～0.864，P<0.05），敏感度为0.74，特异度为0.70。

结论

ALP、囊肿直径是肝囊型包虫病手术患者胆漏发生的危险因素，根据回归分析建立的预测模型能比较有效地预测肝囊型包虫病手术患者胆漏的发生。

关键词: 棘球蚴病，肝, 胆漏, 危险因素
Objective

To explore the risk factors of bile leakage in patients with cystic echinococcosis undergoing surgery, and to establish a regression prediction model.

Methods

Clinical data of 183 patients with cystic echinococcosis who underwent surgical treatment in Qinghai Welfare Charity Hospital from June 2014 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 67 cases were male and 116 female, aged 12-78 years old with a median age of 41 years old. The risk factors of bile leakage were selected by Logistic regression analysis. The effect of every index in Logistic regression analysis was illustrated in the forest plot. The Logistic regression prediction model for bile leakage of cystic echinococcosis patients undergoing surgery was established. The fitting degree of the prediction model was evaluated by Hosmer-Lemeshow test. The prediction value of this model was assessed by receiver operating characteristic (ROC) curve.

Results

The incidence of bile leakage was 22.4% (41/183). Multivariate Logistic regression analysis demonstrated that ALP>135 U/L (OR=10.797, 95%CI: 4.860-23.927, P<0.05) and cyst diameter>10 cm (OR=3.576, 95%CI: 1.911-6.268, P<0.05) were the independent risk factors for bile leakage in cystic echinococcosis patients undergoing surgery. These two factors were included in the Logistic regression equation: logit (P)=-2.580+2.412XALP+1.215Xcyst diameter. The probability model was: P=1/[1+Exp(-2.580+2.412XALP+1.215Xcyst diameter)]. The area under ROC curve was 0.792 (95%CI: 0.719-0.864, P<0.05), the sensitivity was 0.74 and the specificity was 0.70.

Conclusions

ALP and cyst diameter are the risk factors for bile leakage in cystic echinococcosis patients undergoing surgery. The prediction model established by regression analysis can effectively predict the incidence of bile leakage in patients with cystic echinococcosis undergoing surgery.

Key words: Echinococcosis, hepatic, Biliary fistula, Risk factors
表1 胆漏组和无胆漏组肝囊型包虫病患者一般资料
参数 无胆漏组 胆漏组
性别 ? ?
? 男 55 12
? 女 87 29
年龄（岁，） 35±12 38±14
身高（cm，） 167±7 164±8
体重（kg，） 64±13 59±11
Hb（g/L，） 136±21 133±22
Plt（109/L，） 279±74 244±89
EOS [×109/L，M(Q25，Q75)] 0.35(0.19, 0.54) 0.37(0.22, 0.53)
ALT[U/L，M(Q25，Q75)] 33(23, 54) 37(32, 58)
ALP[U/L，M(Q25，Q75)] 93(62, 125) 203(137, 290)
GGT[U/L，M(Q25，Q75)] 36(26, 57) 45(31, 88)
TB [μmol/L，M(Q25，Q75)] 12.3(8.31, 43.2) 15.1(12.3, 46.6)
ALB（g/L，） 38±4 36±5
囊肿直径[cm，M(Q25，Q75)] 7.5(5.3, 9.7) 9.7(7.7, 12.3)
包虫位置（例） ? ?
? 左半肝 16 2
? 右半肝 84 28
? 左、右半肝 42 11
包虫病灶数目（例） ? ?
? 单个 105 19
? 多个 37 22
表2 不同指标对肝囊型包虫病手术患者胆漏发生的Logistic回归分析
指标 单因素 多因素
OR值 95%CI P值 OR值 95%CI P值
ALP>135 U/L 14.718 6.350～29.021 <0.001 10.797 4.860～23.927 <0.001
GGT>40 U/L 1.835 1.367～6.210 0.037 1.343 0.871～4.575 0.191
囊肿直径>10 cm 5.366 3.031～7.486 <0.001 3.576 1.911～6.268 0.002
图1 肝囊型包虫病手术患者胆漏发生的危险因素森林图
图2 肝囊型包虫病手术患者胆漏发生预测模型的ROC曲线
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