Risk factors for common bile duct calculi recurrence and application value of its prediction model after endoscopic retrograde cholangiopancreatography / 中华消化外科杂志

ABSTRACT

Objective:To investigate the risk factors for common bile duct calculi recurrence and application value of its prediction model after endoscopic retrograde cholangiopancreato-graphy (ERCP) .Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 506 patients with common bile duct calculi who were admitted to the First Hospital of Lanzhou University from January 2015 to December 2017 for ERCP routine treatment were collected. There were 251 males and 255 females, aged (59±15)years. Patients received ERCP for common bile duct calculi. Observation indicators (1) clinicopathological data of patients with common bile duct calculi; (2) risk factors for common bile duct calculi recurrence after ERCP; (3) establishment of prediction model for common bile duct calculi recurrence after ERCP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analysis were conducted using the COX proportional hazard model. The prediction model for the recurrence of common bile duct stones after ERCP was established according to the coefficient of regression equation. The receiver operating characteristic curve(ROC) was drawed for efficiency evaluation with area under curve (AUC). Results:(1) Clinicopathological data of patients with common bile duct calculi 104 of 506 patients with common bile duct calculi had recurrence and 402 had no recurrence. There were significant differences in the age, hyperlipidemia, common bile duct diameter, distal bile duct stricture, the number of calculi, gallbladder status, history of biliary tract surgery, endoscopic spinecterotomy, postoperative drainage mode between patients with and without recurrence ( Z=?2.844, χ2=6.243, Z=?2.897, χ2=11.631, 4.617, 16.589, 18.679, 2.070, 50.274, P<0.05). (2) Risk factors for common bile duct calculi recurrence after ERCP Results of univariate analysis showed that age, time of first attack, hyperlipidemia, common bile duct diameter, distal bile duct stricture, the number of calculi, the maximum calculi diameter, gallbladder status, history of biliary tract surgery and postoperative biliary drainage mode were related factors for common bile duct calculi recurrence after ERCP ( hazard ratio=1.656, 2.179, 1.712, 1.657, 2.497, 1.509, 1.971, 2.635, 3.649,95% confidence interval as 1.113?2.463, 1.135?4.184, 1.122?2.644, 1.030?2.663, 1.501?4.154, 1.025?2.220, 1.122?3.464, 1.645?4.221, 1.575?8.456, P<0.05). Results of multivariate analysis showed that time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent were independent risk factors for common bile duct calculi recurrence after ERCP ( hazard ratio=2.332, 1.676, 2.088, 2.566, 3.712, 95% confidence interval as 1.089?4.998, 1.060?2.649, 1.189?3.668, 1.456?4.521, 1.296?10.635, P<0.05). (3) Establishment of prediction model for common bile duct calculi recurrence after ERCP based on multivariate analysis, indicators including time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent were included into the coefficient of regression equation, and the prediction model for common bile duct calculi recurrence after ERCP was established ln[(λ(t))/(λ 0(t))]=0.847×time of first attack+0.516×hyperlipidemia+0.736×distal bile duct stricture+0.942×history of biliary tract surgery+1.312×cholangiopancreatic stent. The perfor-mance evaluation showed that the AUC of ROC of prediction model was 0.757 (95% confidence interval as 0.713?0.811, P<0.05), and the optimal cut-off value was 1.41, the sensitivity and specificity were 69.2% and 72.9% respectively. Conclusions:The time of first attack <30 days, hyperlipidemia, distal bile duct stricture, history of biliary tract surgery and postoperative biliary drainage mode as cholangiopancreatic stent are independent risk factors for common bile duct calculi recurrence after ERCP. Patients with evaluation score >1.41 in prediction model were at high risk for common bile duct calculi recurrence after ERCP.