【摘要】：目的分析肝硬化患者行內(nèi)鏡逆行胰膽管造影(ERCP)術(shù)后并發(fā)癥的危險因素,建立簡單、實用的評分系統(tǒng)。方法回顧性分析2009年1月至2015年12月223例在第二軍醫(yī)大學(xué)長海醫(yī)院行膽管ERCP同時合并肝硬化患者的臨床病理資料。對術(shù)后并發(fā)癥的影響因素,如術(shù)前狀態(tài)、檢驗指標(biāo)、術(shù)中操作情況等進(jìn)行單因素分析和logistic回歸分析。將獨立危險因素中的連續(xù)變量轉(zhuǎn)換為分類變量,根據(jù)各變量在logistic回歸中的β值進(jìn)行賦值,建立新的評分系統(tǒng),通過受試者工作特征(ROC)曲線評價其預(yù)測并發(fā)癥的效能。結(jié)果 Logistic回歸分析發(fā)現(xiàn),總膽紅素(TBIL)是術(shù)后并發(fā)癥的獨立危險因素(OR=1.003,95%CI:1.001~1.005),白蛋白(ALB)是其保護(hù)因素(OR=0.935,95%CI:0.879~0.994)。利用這兩項指標(biāo)建立的評分系統(tǒng)為:TBIL≤31.4μmol/L為0分,31.5~102.5μmol/L為1分,≥102.6μmol/L為2分;ALB≥31 g/L為0分,≤30 g/L為1分。經(jīng)過ROC曲線分析發(fā)現(xiàn),新建評分的曲線下面積(AUC)為0.689,與ChildPugh分級(AUC:0.700)和終末期肝病模型(MELD)評分(AUC:0.692)相當(dāng)。當(dāng)以1.5分為界時(即0~1分為低危,2~3分為高危),新建評分系統(tǒng)的敏感度為89.4%,特異度為41.1%,準(zhǔn)確率為49.3%,陽性預(yù)測值為23.7%,陰性預(yù)測值為95.0%。結(jié)論新建的ERCP術(shù)后并發(fā)癥評分系統(tǒng)簡便、易用,可以用來區(qū)分高�；颊摺�
[Abstract]:Objective to analyze the risk factors of complications after endoscopic retrograde cholangiopancreatography (ERCP) in patients with liver cirrhosis and to establish a simple and practical scoring system. Methods from January 2009 to December 2015, the clinical and pathological data of 223 patients who underwent bile duct ERCP combined with liver cirrhosis in Changhai Hospital, second military Medical University were retrospectively analyzed. Single factor analysis and logistic regression analysis were used to analyze the factors affecting postoperative complications, such as preoperative condition, test indexes, and intraoperative operation. The continuous variables in independent risk factors were converted into classified variables. According to the 尾 values of each variable in logistic regression, a new scoring system was established. The effectiveness of predicting complications was evaluated by using the (ROC) curve of receiver operating characteristics. Results Logistic regression analysis showed that total bilirubin (TBIL) was an independent risk factor for postoperative complications (OR=1.003,95%CI:1.001~1.005) and albumin (ALB) was a protective factor (OR=0.935,95%CI:0.879~0.994). The score system based on these two indexes was 0 for TBIL 31.4 渭 mol / L, 1 for 31.5 ~ 102.5 渭 mol / L, 2 for 鈮，

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