Risk Factors and Nomogram for Common Bile Duct Stricture in Chronic Pancreatitis A Cohort of 2153 Patients
Risk Factors and Nomogram for Common Bile Duct Stricture in Chronic Pancreatitis A Cohort of 2153 Patients
复制标题
慢性胰腺炎胆总管狭窄的危险因素和列线图：2,153 名患者的队列
DOI：
10.1097/mcg.0000000000000930
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发表时间：
2019-03-01
影响因子：
2.9
通讯作者：
Hu, Liang-Hao
中科院分区：
文献类型：
--
作者：
Hao, Lu;Bi, Ya-Wei;Hu, Liang-Hao
目的：探讨慢性胰腺炎（CP）患者胆总管（CBD）狭窄的危险因素，并绘制其诺模图。背景资料：胆总管狭窄是CP的常见并发症，临床表现多样，从无症状到明显的黄疸和胆管炎。研究：入组了2000年1月至2013年12月在长海医院（中国上海）住院的CP患者。计算了发病和诊断CP后CBD狭窄的累积率。患者以2：1的比例随机分配到培训和验证队列。在训练队列的基础上，通过考克斯比例风险回归模型识别CBD狭窄和症状性CBD狭窄的危险因素，并绘制列线图。分别为内部验证队列。结果：共有2153例患者，中位随访时间为7.0年。在340例（15.8%）患者中检测到CBD狭窄，其中159例有症状。男性、CP发病年龄、吸烟、体重指数和主胰管形态是CBD狭窄发展的危险因素。CP发病时的年龄、体重指数和疼痛类型是有症状的CBD狭窄发展的危险因素。这两个列线图实现了良好的一致性指数拟合良好的校准曲线。结论：诺模图实现了CP患者症状性CBD狭窄发展的个体化预测。这可能有助于症状性CBD狭窄的早期诊断和干预，并降低严重不良事件的发生率。
Goals: To identify the risk factors and develop nomograms for common bile duct (CBD) stricture in chronic pancreatitis (CP) patients. Background: CBD stricture is a common complication in CP and has a variable clinical presentation ranging from asymptomatic to overt jaundice and cholangitis. Study: Patients with CP admitted to Changhai Hospital (Shanghai, China) from January 2000 to December 2013 were enrolled. Cumulative rates of CBD stricture after onset and diagnosis of CP were calculated. Patients were randomly assigned, in a 2: 1 ratio, to the training and validation cohort. On the basis of the training cohort, risk factors for CBD stricture and symptomatic CBD stricture were identified through Cox proportional hazards regression model, and nomograms was developed, respectively. Internal validation cohort, respectively. Results: With a total of 2153 patients, the median duration of follow-up was 7.0 years. CBD strictures were detected in 340 (15.8%) patients, whereas 159 of them were symptomatic. Male gender, age at onset of CP, smoking, body mass index, and morphology of main pancreatic duct were identified risk factors for CBD stricture development. Age at onset of CP, body mass index, and type of pain were identified risk factors for symptomatic CBD stricture development. Both nomograms achieved good concordance indexes with well-fitted calibration curves. Conclusions: The nomogram achieved an individualized prediction of symptomatic CBD stricture development in CP patients. It may help the early diagnosis and intervention of symptomatic CBD stricture and reduce the rates of severe adverse events.