彩超初诊为胆囊结石患者行磁共振胰胆管造影的必要性及指征分析

目的探讨临床上彩超初诊为胆囊结石患者行磁共振胰胆管造影(MRCP)的必要性及指征。方法采用回顾性病例对照研究方法,收集了2013年1月-2017年12月徐州医科大学附属医院收治的1431例以胆囊结石首诊入院患者的临床病例资料。入院时,腹部彩超均只发现胆囊结石,未发现其他病变。最终经过手术治疗后,诊断为单纯胆囊结石患者为对照组,合并有胆总管结石患者为实验组。通过logistic回归分析,建立"胆囊结石合并胆总管结石"的相关预测模型,并最终绘制预测模型及各个指标的受试者工作特征曲线(ROC曲线),计算曲线下面积。结果经过logistic分析筛选的4项指标为:胆总管扩张(χ1)、胆囊增大(χ^2)、DBil(χ3)、GGT(χ4),建立的logistic回归模型为:Logit(P)=-4.153+3.592χ1+1.720χ^2+1.798χ3+1.519χ4。模型对于彩超漏诊胆总管结石的敏感度为53.4%,特异度为99.6%,准确度为92.5%,ROC曲线下面积为0.904。优于其他任意单一指标。结论彩超初诊为单纯胆囊结石患者无常规行MRCP的必要性。但是胆囊增大,胆总管增宽> 0.8 cm,DBil> 7μmol/L,GGT> 40 U/L是胆囊结石合并胆总管结石的独立危险因素。本研究建立的回归模型有较高的敏感度及特异度,可以为临床医生的决策提供一定的参考价值。

Necessity of magnetic resonance cholangiopancreatography in patients with initial diagnosis of gallstones on color Doppler ultrasound and an analysis of related indications

Objective To investigate the necessity and indication of magnetic resonance cholangiopancreatography(MRCP) in patients with gallstones diagnosed by color Doppler ultrasound.Methods A retrospective case-control study was conducted.The clinical data of 1431 patients who were admitted to The Affiliated Hospital of Xuzhou Medical University from January 2013 to December 2017 with the initial diagnosis of gallstones were collected.On admission,abdominal ultrasound found gallstones alone,without other lesions.The patients who were diagnosed with gallstones alone after surgical treatment were enrolled as control group,and those who were diagnosed with gallstones and common bile duct stones were enrolled as experimental group.A logistic regression analysis was performed to establish a predictive model for gallstones with common bile duct stones.The receiver operating characteristic(ROC) curve was plotted for the predictive model and each index,and the area under the ROC curve was calculated.Results Four indices were finally screened out by the logistic regression analysis,i.e.,bile duct dilation(χ1),gallbladder enlargement(χ^2),direct bilirubin(DBIL)(χ3),and gamma-glutamyl transpeptidase(GGT)(χ4),and the logistic regression model was Logi(P)=-4.153 + 3.592χ1+ 1.720χ^2+ 1.798χ3+ 1.519χ4.In the diagnosis of common bile duct stones missed by color Doppler ultrasound,this model had a sensitivity of 53.4%,a specificity of 99.6%,an accuracy of92.5%,and an area under the ROC curve of 0.904,which was significantly better than each index alone.Conclusion MRCP is not necessary for patients diagnosed with simple gallstones by color Doppler ultrasound.However,enlarged gallbladder,a diameter of common bile duct of > 0.8 cm,DBil > 7 μmol/L,and GGT > 40 U/L are independent risk factors for gallstones with common bile duct stones.The logistic regression model established in this study has high sensitivity and specificity and can provide a reference for to decision-making among clinicians.