老年胆总管结石ERCP术后高淀粉酶血症危险因素及预测模型

Risk Factors and Predictive Model for Post-ERCP Hyperamylasemia in Elderly Choledocholithiasis Patients

摘要: 目的：探讨老年胆总管结石内镜逆行胰胆管造影术(ERCP)治疗术后发生高淀粉酶血症的主要危险因素并构建相关预测模型。方法：收取2021年1月至2023年2月青岛市市立医院收治经ERCP取石术治疗的老年胆总管结石患者共227例，根据术后血淀粉酶结果分为高淀粉酶血症组与正常组，通过x2检验及logistic回归分析分析其危险因素，构建并检验预测模型。结果：logistic回归分析结果显示超高龄，内镜下乳头柱状气囊扩张术(EPBD)等为高淀粉酶血症的危险因素(P < 0.05, OR > 1)，内镜下鼻胆管引流术(ENBD)等为保护因素(P < 0.05, OR < 1)。列线图预测模型受试者工作特征曲线下面积为0.829，模型对ERCP术后高淀粉酶血症具有良好的预测能力。结论：ERCP取石术后危险因素分析为临床预防、减少术后高淀粉血症的发生有着重要意义。列线图风险预测模型预测效能良好，为老年性胆总管结石ERCP取石术后高淀粉酶血症预测提供了依据。

Abstract: Objective: To investigate the primary clinical risk factors of hyperamylasemia after endoscopic ret-rograde cholangiopancreatography (ERCP) in elderly patients with choledocholithiasis and to con-struct a related prediction model. Methods: A total of 227 elderly patients with choledocholithiasis treated by ERCP in Qingdao Municipal Hospital from January 2021 to February 2023 were enrolled. Based on postoperative amylase levels, patients were divided into the hyperamylasemia group and the normal group. The risk factors were analyzed by χ2 test and logistic regression analysis, and the prediction model was constructed and tested. Results: Logistic regression analysis revealed that advanced age, endoscopic papillary balloon dilation (EPBD), and other factors were associated with hyperamylasemia (P < 0.05, OR > 1), while endoscopic nasobiliary drainage (ENBD) and other fac-tors were protective (P < 0.05, OR < 1). The receiver operating characteristic curve for the predic-tive model had an area under the curve of 0.829, indicating its good predictive capability for post-ERCP hyperamylasemia. Conclusion: Analyzing the risk factors for post-ERCP hyperamylasemia is crucial for clinical prevention and reduction of this complication. The predictive model based on logistic regression demonstrates good predictive performance and provides a foundation for pre-dicting hyperamylasemia in elderly patients with common bile duct stones following ERCP stone removal procedures.