Department of General Surgery, Beijing Friendship Hospital, Capital Medical University and National Clinical Research Center for Digestive Diseases, Beijing 100050, China.
Contrast Media Mol Imaging. 2022 Jun 27;2022:7737610. doi: 10.1155/2022/7737610. eCollection 2022.
To reveal the relationship between a group of preoperative biochemical indicators such as GGT, ALP, ALT, AST, TB, and DB and the occurrence of common bile duct stones in patients with negative results of magnetic resonance cholangiopancreatography, a retrospective diagnostic accuracy clinical test is conducted in this study. In order to reduce the missed diagnosis rate of choledocholithiasis and perform more accurate common bile duct exploration, 466 patients who underwent surgical treatment of cholelithiasis from January 2014 to December 2015 have been analyzed retrospectively. Firstly, the confounding factors are corrected through Binary Logistic regression. Then, the diagnostic efficacy of each indicator is measured by the ROC curve among different types of patients. In all patients, the top three individual indicators with the greatest AUC curve area for predicting common bile duct stones can be observed from the results of MRCP, -glutamyl transpeptidase, and alkaline phosphatase. Besides, the diagnostic efficiency of the comprehensive evaluation is higher than that of all individual indicators. For MRCP-negative patients, the top three largest AUC curve area of the diagnostic efficacy for choledocholithiasis were GGT, ALP, and DB. For patients who have a suspected diagnosis of secondary choledocholithiasis, the diagnostic efficacy of the combination of imaging results, biochemical indexes, common bile duct width, and other abnormal indicators for choledocholithiasis is much higher than that of the single abnormal biochemical indexes for the prediction of choledocholithiasis. For MRCP-negative patients, GGT, ALP, DB, and the width of common bile duct diameter are valuable for the prediction of common bile duct stones, and GGT is the most valuable diagnostic predictor.
为了揭示磁共振胰胆管成像（MRCP）阴性结果患者中一组术前生化指标（如 GGT、ALP、ALT、AST、TB 和 DB）与胆总管结石发生之间的关系，本研究进行了回顾性诊断准确性临床测试。为了降低胆石症漏诊率，进行更准确的胆总管探查，回顾性分析了 2014 年 1 月至 2015 年 12 月接受胆囊结石手术治疗的 466 例患者。首先，通过二元逻辑回归校正混杂因素。然后，通过不同类型患者的 ROC 曲线测量每个指标的诊断效果。在所有患者中，从 MRCP 的结果中可以观察到预测胆总管结石的个体指标中 AUC 曲线面积最大的前三个指标分别为 -谷氨酰转肽酶（GGT）和碱性磷酸酶（ALP）。此外，综合评价的诊断效率高于所有单个指标。对于 MRCP 阴性患者，GGT、ALP 和 DB 是诊断胆总管结石的最大 AUC 曲线面积的前三个最大指标。对于疑似继发性胆总管结石的患者，影像学结果、生化指标、胆总管宽度和其他异常指标联合诊断胆总管结石的诊断效率远高于单一异常生化指标对胆石症的预测。对于 MRCP 阴性患者，GGT、ALP、DB 和胆总管直径宽度对胆总管结石的预测具有价值，GGT 是最有价值的诊断预测指标。
