急性化脓性胆管炎辅助诊断的列线图：病例对照研究。
Nomogram for assistant diagnosing acute suppurative cholangitis: a case-control study.
机构信息
Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, No. 919 Yingtian Street, Jianye District, Nanjing, Jiangsu Province, 210000, China.
Department of General Surgery, Nanling County Hospital, Wuhu, Anhui Province, 242400, China.
出版信息
BMC Gastroenterol. 2024 Sep 20;24(1):322. doi: 10.1186/s12876-024-03379-5.
BACKGROUND
Acute suppurative cholangitis (ASC) lacks sensitive and specific preoperative diagnostic criteria. Some researchers suggest treating ASC as severe cholangitis. This study aimed to explore the relationship between the Tokyo Guidelines 2018 (TG18) grading system for acute cholangitis (AC) and the diagnosis of acute suppurative cholangitis (ASC), searching for independent risk factors of ASC and develop a nomogram to discriminate ASC from acute nonsuppurative cholangitis (ANSC) accurately.
METHODS
After applying the inclusion and exclusion criteria, 401 patients with acute cholangitis (AC) were retrospectively analyzed at Nanjing First Hospital between January 2015 and June 2023. SPSS version 27.0 and R studio software were used to analyze data obtained from medical records. The results were validated in a prospective cohort of 82 AC patients diagnosed at Nanjing First Hospital between July 2023 and February 2024.
RESULTS
Among the 401 patients, 102 had suppurative bile (the ASC group; AC grade I: 40 [39.2%], AC grade II: 27 [26.5%], AC grade III: 35 [34.3%]), whereas 299 did not have (the ANSC group; AC grade I: 157 [52.5%], AC grade II: 92 [30.8%], AC grade III: 50 [16.7%]). The specificity of ASC for diagnosing moderate-to-severe cholangitis is 79.7%. Multivariate logistic regression analysis identified concurrent cholecystitis, CRP, PCT, TBA, and bile duct diameter as independent risk factors for suppurative bile, and all of these factors were included in the nomogram. The calibration curve exhibited consistency between the nomogram and the actual observation, and the area under the curve was 0.875 (95% confidence interval: 0.835-0.915), sensitivity was 86.6%, and specificity was 75.5%.
CONCLUSION
Suppurative bile is a specific indicator for diagnosing moderate-to-severe cholangitis. However, diagnosing ASC with AC grade II and AC grade III has the risk of missed diagnosis as the sensitivity is only 60.8%. To improve the diagnostic rate of ASC, this study identified concurrent cholecystitis, CRP, PCT, TBA, and preoperative bile duct diameter as independent risk factors for ASC, and a nomogram was developed to help physicians recognize patients with ASC.
背景
急性化脓性胆管炎（ASC）缺乏敏感和特异的术前诊断标准。一些研究人员建议将 ASC 视为重症胆管炎进行治疗。本研究旨在探讨 2018 年东京指南（TG18）急性胆管炎（AC）分级系统与 ASC 诊断之间的关系，寻找 ASC 的独立危险因素，并开发一个列线图以准确区分 ASC 与急性非化脓性胆管炎（ANSC）。
方法
在应用纳入和排除标准后，回顾性分析了 2015 年 1 月至 2023 年 6 月期间南京第一医院收治的 401 例急性胆管炎（AC）患者。SPSS 版本 27.0 和 R 工作室软件用于分析从病历中获得的数据。该结果在 2023 年 7 月至 2024 年 2 月期间在南京第一医院诊断的 82 例 AC 前瞻性队列中得到验证。
结果
在 401 例患者中，有 102 例胆汁呈脓性（ASC 组；AC Ⅰ级：40 例[39.2%]，AC Ⅱ级：27 例[26.5%]，AC Ⅲ级：35 例[34.3%]），而 299 例无脓性胆汁（ANSC 组；AC Ⅰ级：157 例[52.5%]，AC Ⅱ级：92 例[30.8%]，AC Ⅲ级：50 例[16.7%]）。ASC 对中重度胆管炎的诊断特异性为 79.7%。多变量逻辑回归分析确定并发胆囊炎、CRP、PCT、TBA 和胆管直径是胆汁脓性的独立危险因素，所有这些因素均纳入列线图。校准曲线显示列线图与实际观察结果之间具有一致性，曲线下面积为 0.875（95%置信区间：0.835-0.915），灵敏度为 86.6%，特异性为 75.5%。
结论
胆汁脓性是诊断中重度胆管炎的特异性指标。然而，诊断 AC Ⅱ级和 AC Ⅲ级的 ASC 存在漏诊风险，因为其灵敏度仅为 60.8%。为了提高 ASC 的诊断率，本研究确定了并发胆囊炎、CRP、PCT、TBA 和术前胆管直径是 ASC 的独立危险因素，并开发了一个列线图以帮助医生识别 ASC 患者。
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