Diagnosis of Chronic Pancreatitis Incorporating Endosonographic Features, Demographics, and Behavioral Risk.
Diagnosis of Chronic Pancreatitis Incorporating Endosonographic Features, Demographics, and Behavioral Risk.
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DOI：
10.1097/mpa.0000000000000768
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发表时间：
2017-03
期刊：
影响因子：
2.9
通讯作者：
Conwell DL
中科院分区：
文献类型：
--
作者：
Lee LS;Tabak YP;Kadiyala V;Sun X;Suleiman S;Johannes RS;Banks PA;Conwell DL
慢性胰腺炎的诊断仍然具有挑战性。内镜超声（EUS）用于评价胰腺疾病。胰腺功能检查异常被认为是慢性胰腺炎的“非组织学”金标准。我们通过丰富EUS结果与患者人口统计学和胰腺炎行为风险特征，推导出异常内镜PFT（ePFT）的预测模型。从胰腺疾病评估患者中收集人口统计学、行为风险特征、EUS结果和碳酸氢盐峰值结果。异常ePFT定义为峰值碳酸氢盐<75 mEq/L。我们拟合逻辑回归模型，并将其转换为风险评分系统。使用1，000次bootstrap模拟验证了风险评分。共纳入176例患者; 61%为女性，中位年龄48岁（四分位距38，57）。ePFT异常率为39.2%（69/176）。四个变量制定的风险评分：酒精或吸烟状态，数量的实质异常，数量的导管异常，和钙化。异常ePFT发生在10.7%的评分为4分或更低，而92.0%的评分为20分或更高。模型c统计量为0.78（95%CI：0.71，0.85）。EUS胰管和实质异常的数量、钙化的存在和吸烟/饮酒状态可预测ePFT异常。这个简单的模型对ePFT结果有很好的区分度。
Diagnosing chronic pancreatitis remains challenging. Endoscopic ultrasound (EUS) is utilized to evaluate pancreatic disease. Abnormal pancreas function test is considered the “non-histologic” gold standard for chronic pancreatitis. We derived a prediction model for abnormal endoscopic PFT (ePFT) by enriching EUS findings with patient demographic and pancreatitis behavioral risk characteristics. Demographics, behavioral risk characteristics, EUS findings, and peak bicarbonate results were collected from patients evaluated for pancreatic disease. Abnormal ePFT was defined as peak bicarbonate <75 mEq/L. We fit a logistic regression model and converted it to a risk score system. The risk score was validated using 1,000 bootstrap simulations. A total of 176 patients were included; 61% were female with median age 48 (interquartile range 38, 57). Abnormal ePFT rate was 39.2% (69/176). Four variables formulated the risk score: alcohol or smoking status, number of parenchymal abnormalities, number of ductal abnormalities, and calcifications. Abnormal ePFT occurred in 10.7% with scores 4 or less versus 92.0% scoring 20 or greater. The model c-statistic was 0.78 (95% CI: 0.71, 0.85). Number of EUS pancreatic duct and parenchymal abnormalities, presence of calcification, and smoking/alcohol status were predictive of abnormal ePFT. This simple model has good discrimination for ePFT results.