Cao Jun, Peng Chunyan, Ding Xiwei, Shen Yonghua, Wu Han, Zheng Ruhua, Wang Lei, Zou Xiaoping
Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Zhongshan Road 321, Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiang Su Province, China.
BMC Gastroenterol. 2018 Aug 22;18(1):128. doi: 10.1186/s12876-018-0854-3.
The risk factors for post-ERCP cholecystitis (PEC) have not been characterized. Hence, this study aimed to identify the potential risk factors for PEC.
The medical records of 4238 patients undergoing the first ERCP in a single center from January 2012 to December 2016 were analyzed in this study. A multivariate analysis was used to identify the risk factors.
This study included 2672 patients who met the enrollment criteria. Of these, 36 patients (incidence rate of 1.35%) developed PEC within 2 weeks of the procedure. Univariate and multivariate analyses identified the following factors associated with PEC: history of acute pancreatitis [odds ratio (OR) = 2.60; 95% confidence interval (CI): 1.29-5.23], history of chronic cholecystitis (OR = 8.47; 95% CI: 2.54-28.24), gallbladder opacification (OR = 2.79; 95% CI: 1.37-5.70), biliary duct metallic stent placement (OR = 3.66; 95% CI: 1.78-7.54), and high leukocyte count before ERCP (OR = 1.10; 95% CI: 1.04-1.17). The prediction model incorporating these factors demonstrated an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.80-0.91). A prognostic nomogram was developed using the aforementioned variables to estimate the probability of PEC.
The risk factors, including the history of acute pancreatitis, history of chronic cholecystitis, gallbladder opacification, biliary duct metallic stent placement, and high leucocyte counts before ERCP, increased the occurrence of PEC and were positive predictors for PEC. The constructed nomogram was used to estimate the risk of PEC, guiding the implementation of prophylactic measures to prevent PEC in clinical practice.
内镜逆行胰胆管造影术后胆囊炎（PEC）的危险因素尚未明确。因此，本研究旨在确定PEC的潜在危险因素。
本研究分析了2012年1月至2016年12月在单一中心接受首次内镜逆行胰胆管造影术的4238例患者的病历。采用多因素分析来确定危险因素。
本研究纳入了2672例符合纳入标准的患者。其中，36例患者（发病率为1.35%）在术后2周内发生了PEC。单因素和多因素分析确定了以下与PEC相关的因素：急性胰腺炎病史[比值比（OR）=2.60；95%置信区间（CI）：1.29 - 5.23]、慢性胆囊炎病史（OR = 8.47；95% CI：2.54 - 28.24）、胆囊不显影（OR = 2.79；95% CI：1.37 - 5.70）、胆管金属支架置入（OR = 3.66；95% CI：1.78 - 7.54）以及内镜逆行胰胆管造影术前白细胞计数高（OR = 1.10；95% CI：1.04 - 1.17）。纳入这些因素的预测模型显示受试者工作特征曲线下面积为0.85（95% CI，0.80 - 0.91）。使用上述变量开发了一个预后列线图来估计PEC的概率。
包括急性胰腺炎病史、慢性胆囊炎病史、胆囊不显影、胆管金属支架置入以及内镜逆行胰胆管造影术前白细胞计数高在内的危险因素增加了PEC的发生，是PEC的阳性预测因素。构建的列线图用于估计PEC的风险，指导在临床实践中实施预防PEC的预防措施。
