摘要
目的：
分析合并血清胆红素升高的胆囊结石(cholecystolithiasis)患者罹患胆总管结石(common bile duct stones，CBD)的相关危险因素，在此基础上构建预测患病风险的列线图（nomogram）模型并进行验证，实现对患病风险的量化，为可疑合并胆总管结石的胆囊结石患者的诊断提供新的思路。
方法：
回顾性收集2017年6月至2018年12月期间腹部超声(abdominal ultrasound，AUS)诊断为胆囊结石且血清总胆红素（total bilirubin，TB）升高的478例患者临床资料，包括人口统计学因素、临床病理学因素及影像学因素等。以2:1的比例将纳入的患者随机分为训练组和验证组。在训练组中，根据磁共振水成像(magnetic resonance cholangiopancreatography，MRCP)检查是否合并胆总管结石分为两组，采用单因素分析方法筛选罹患胆总管结石的潜在危险因素，并采用多因素logistic回归分析筛选相关独立危险因素。以独立危险因素为基础构建用于预测合并胆红素升高的胆囊结石患者罹患胆总管结石风险的列线图模型。分别在训练组和验证组患者中对列线图的鉴别能力、校准度及临床决策能力进行内、外验证。
结果：
多因素分析获得4个独立危险因素，包括胆囊结石直径＜5mm(Gallstone diameter)(p=0.036)、胆总管内径＞8mm(Common bile duct diameter,CBD) (p=0.002)、直接胆红素升高(direct bilirubin，DB)(p=0.029)、直接胆红素与总胆红素比值＞0.35(Direct bilirubin to total bilirubin ratio)(p=0.001)。以上述因素为基础构建预测合并胆红素升高的胆囊结石患者罹患胆总管结石的列线图模型，区分度分析提示训练组和验证组中计算曲线下面积(area under curve,AUC)分别为0.798和0.7809。校准度分析提示(Hosmer-Lemeshow,H-L)检验p值分别为0.945和0.839。临床决策分析(Decision Curve Analysis，DCA)提示其在0.09-0.73区间具有良好的临床应用价值。
结论：
本研究筛选出合并胆红素升高的胆囊结石患者罹患胆总管结石的危险因
素，并在此基础上构建用于预测患病风险的列线图模型，内外验证均提示其预测效能良好，为此类患者的诊断提供了新的思路。
关键词：胆囊结石；胆总管结石；胆红素；列线图；临床决策分析。
platedABSTRACT
Objective:
To analyze the risk factors associated with the morbidity of common bile duct (CBD)stones in patients with cholecystolithiasis with elevated rum total bilirubin and therefore construct a nomogram to predict the corresponding morbidity risks.The nomogram is further validated and the morbidigy risks are quantified,which provides new insights into the diagnosis of CBD stones in cholecystolithiasis patients with elevated rum bilirubin.
Methods:
Clinical data of478patients diagnod of cholecystolithiasis by abdominal ultrasound together with elevated total bilirubin were retrospectively collected from June2017to December2018,including demographic factors,clinicopathological factors,imaging factors,etc.The admitted patients were randomly divided into a training and a validating group with a ratio of2:1.In the training group,patients were divided into two groups according to morbidity of CBD stones diagnod by magnetic resonance cholangiopancreatography.Univariate analysis was ud to screen the potential morbidity risk factors of CBD stones,and multivariate logistic regression analysis was ud to screen independent risk factors.A nomogram model for predicting the risk of CBD stones in patients with cholecystolithiasis with elevated bilirubin levels was constructed on the basis of independent risk factors.The discrimination,calibration and clinical decision-making ability of the nomogram were verifi
affecteded internally and externally both in the training group and the validating group. Result:
Four independent risk factors were obtained bad on multivariate analysis, including gallstone diameter＜5mm(p=0.036),CBD diameter＞8mm(p=0.002), evelated direct bilirubin(p=0.029),the ratio of direct bilirubin to total bilirubin>0.35 (p=0.001).Bad on the above factors,a nomogram model for predicting CBD stones in cholecystolithiasis patients with elevated bilirubin was established.Discrimination analys showed that the area under curve(AUC)were0.798and0.7809in theaccordion
training group and verification group.Calibration analysis using Hosmer-Lemeshow tests showed that p values were0.945and0.839.Clinical decision analysis showed good clinical application value.
和霍金一起探索宇宙Conclusion:
rockThis study screened out the morbidity risk factors of CBD stones in cholecystolithiasis patients with elevated bilirubin.A nomogram model predicting the morbidity risk was constructed.Both internal and external verification showed good prediction performance,which provided new idea for the diagnosis of the patients.
Key words:cholecystolithiasis;common bile duct stones;bilirubin;nomogram; Decision Curve Analysis.
目录
目录
快手客服电话24小时人工服务热线第1章引言 (1)
第2章病例与方法 (3)
2.1病例资料收集 (3)
2.1.1病例收集 (3)
保镖主题曲下载2.1.2纳入标准 (3)
2.1.3排除标准 (3)
2.2临床指标收集 (3)
2.2.1临床指标 (3)butterfly的复数
2.2.2临床数据指标定义和研究终点 (4)
2.3统计学分析 (4)
第3章结果 (6)
3.1病例纳入情况 (6)
3.2危险因素分析 (8)biceps
3.3列线图模型的构建与验证 (10)
3.4列线图的临床实用性 (14)
第4章讨论 (16)
第5章结论 (19)
致谢 (20)
参考文献 (21)
诚然
攻读学位期间的研究成果 (24)
综述 (25)
