胆囊胆固醇息肉与胆囊腺瘤的术前预测因素研究

doi:10.16139/j.1007-9610.2021.02.011

摘要/Abstract

摘要：

目的：分析与胆囊胆固醇息肉（gallbladder cholesterol polyp, GCP）和胆囊腺瘤（gallbladder adenoma, GA）相关的因素,建立预测模型,术前区分两者。方法：研究2015年1月至2019年12月间,在首都医科大学宣武医院和北京大学第一医院两个中心,超声检查胆囊息肉（gallbladder polyp, GBP）直径≥10 mm、行胆囊切除术的病人。依据病理诊断结果分为GCP组和GA组。通过单因素和多因素分析研究GCP与GA相关因素,用Logistic回归方程,建立预测模型,评估诊断效果。结果：共384例GBP病人,男女比例1∶1.49,年龄（50.32±14.15）岁。GCP组250例（65.1%）,GA组134例（34.9%）。单因素分析显示,计量资料中年龄、血糖、低密度脂蛋白、白蛋白和总胆汁酸在两组差异具有统计学意义（P<0.05）,计数资料中年龄≥50岁、低密度脂蛋白≥3.1 mmol/L、总胆汁酸≥10.0 μmol/L差异具有统计学意义（P<0.05）。多因素分析可得出年龄、低密度脂蛋白以及总胆汁酸具有统计学意义。建立预测回归方程,以P≥0.601诊断GCP,灵敏度74.8%。回归方程经过ROC曲线拟合,曲线下面积为0.662。结论：用年龄、低密度脂蛋白和总胆汁酸因素建立的方程,可较好地术前预测GBP病人GCP与GA。

关键词: 胆囊息肉, 胆囊胆固醇息肉, 胆囊腺瘤, 预测模型

Abstract:

Objective To analyze the factors related to gallbladder cholesterol polyp (GCP) and gallbladder adenoma (GA) and establish predictive model for distinction between GCP and GA before surgery. Methods Patients with gallbladder polyps diameter≥10 mm diagnosed by ultrasonography in Xuanwu Hospital Capital Medical University and the First Hospital of Peking University from January 2015 to December 2019 were studied. There were GCP group and GA group based pathological diagnosis. Univariate and multivariate analyses were used to study the factors related to GCP and GA. Logistic linear regression was used to establish a predictive model and to evaluate the diagnostic effect. Results A total of 384 patients with gallbladder polyp were in this study with male to female ratio of 1:1.49 and age of (50.32±14.15) years. There were 250 patients (65.1%) in GCP group and 134 patients (34.9%) in GA group. Univariate analysis showed that five factors in quantitative data including age, blood glucose, low density lipoprotein, albumin, and total bile acid and three factors in count data including age 50 years or older, low density lipoprotein ≥3.1 mmol/L and total bile acid ≥10.0 μmol/L had significant difference statistically between two groups (P<0.05). Three factors were gotten as age, low density lipoprotein and total bile acid with significant difference statistically in multivariate analysis. The sensitivity of predictive regression equation were 74.8%, when P≥0.601 was used to diagnose cholesterol polyps. The regression equation was fitted by ROC curve and the area under curve was 0.662. Conclusions The equation on the factors of age, low density lipoprotein and total bile acid could be used to predict cholesterol polyps and adenomas preoperatively for patients with gallbladder polyps.

Key words: Gallbladder polyp, Gallbladder cholesterol polyp, Gallbladder adenoma, Predictive model

中图分类号:

王佳琪, 马右维, 肖双涛, 黄雨达, 于志浩, 李征, 郑亚民. 胆囊胆固醇息肉与胆囊腺瘤的术前预测因素研究[J]. 外科理论与实践, 2021, 26(02): 144-148.

WANG Jiaqi, MA Youwei, XIAO Shuangtao, HUANG Yuda, YU Zhihao, LI Zheng, ZHENG Yamin. Analysis of predictive factors for gallbladder cholesterol polyp and gallbladder adenoma before surgery[J]. Journal of Surgery Concepts & Practice, 2021, 26(02): 144-148.

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参考文献 18

[1]	Mellnick VM, Menias CO, Sandrasegaran K, et al. Polypoid lesions of the gallbladder: disease spectrum with pathologic correlation[J]. Radiographics, 2015, 35(2):387-399. doi: 10.1148/rg.352140095 pmid: 25763724
[2]	姚贵宾, 刘力玮, 白雪松, 等. 胆囊息肉的超声观察随访及其危险因素[J]. 中华肝胆外科杂志, 2020, 26(8):606-610.
[3]	郑亚民, 姚贵宾, 王悦华, 等. 胆囊息肉癌变风险分析和临床处理的研究进展[J]. 医学研究杂志, 2018, 47(8):1-3.
[4]	李非, 郑亚民, 王喆. 胆囊息肉的规范化诊断和治疗[J]. 中国实用外科杂志, 2015, 35(9):1003-1004,1007.
[5]	刘力玮, 姚贵宾, 白雪松, 等. 胆囊息肉形成相关风险因素的研究进展[J]. 医学研究杂志, 2020, 49(2):13-15,19.
[6]	陈善鹏, 王智翔, 张小弟, 等. 胆囊息肉样病变的流行病学及危险因素[J]. 临床肝胆病杂志, 2019, 35(2):441-443.
[7]	Taskin OC, Bellolio E, Dursun N, et al. Non-neoplastic polyps of the gallbladder: a clinicpathologic analysis of 447 cases[J]. Am J Surg Pathol, 2020, 44(4):467-476. doi: 10.1097/PAS.0000000000001405 pmid: 31725469
[8]	Corwin MT, Siewert B, Sheiman RG, et al. Incidentally detected gallbladder polyps: is follow-up necessary?--long-term clinical and US analysis of 346 patients[J]. Radiology, 2011, 258(1):277-282.
[9]	Yamin Z, Xuesong B, Zhen Z, et al. Correlation of dyslipidemias and gallbladder polyps - a large retrospective study among Chinese population[J]. Asian J Surg, 2020, 43(1):181-185.
[10]	Yao G, Bai X, Yang C, et al. Analysis of risk factors for gallbladder polyp formation - a retrospective study based on serial ultrasounds[J]. Eur J Gastroenterol Hepatol, 2020, 32(9):1154-1159.
[11]	Yamin Z, Xuesong B, Guibin Y, et al. Risk factors of gallbladder polyps formation in East Asian population: a meta-analysis and systematic review[J]. Asian J Surg, 2020, 43(1):52-59.
[12]	Choi YS, Do JH, Seo SW, et al. Prevalence and risk factors of gallbladder polypoid lesions in a healthy population[J]. Yonsei Med J, 2016, 57(6):1370-1375.
[13]	Lim SH, Kim D, Kang JH, et al. Hepatic fat, not visceral fat, is associated with gallbladder polyps: a study of 2 643 healthy subjects[J]. J Gastroenterol Hepatol, 2015, 30(4):767-774.
[14]	Zhao MF, Huang P, Ge CL, et al. Conjugated bile acids in gallbladderbile and serum as potential biomarkers for cholesterol polyps and adenomatous polyps[J]. Int J Biol Markers, 2016, 31(1):e73-e79.
[15]	黄鹏, 赵梅芬, 孟凡斌, 等. 胆囊息肉样变患者血清中八种结合胆汁酸含量的分析[J]. 中华医学杂志, 2014, 94(40):3154-3158.
[16]	Waluga M, Zorniak M, Fichna J, et al. Pharmacological and dietary factors in prevention of colorectal cancer[J]. J Physiol Pharmacol, 2018, 69(3).doi: 10.26402/jpp.2018.3.02. Epub 2018 Aug 22. doi: 10.26402/jpp.2018.3.02. Epub 2018 Aug 22 URL
[17]	Elmasry M, Lindop D, Dunne DFJ, et al. The risk of malignancy in ultrasound detected gallbladder polyps: a systematic review[J]. Int J Surg, 2016, 33(Pt A):28-35.
[18]	Kozuka S, Tsubone N, Yasui A, et al. Relation of adenoma to carcinoma in the gallbladder[J]. Cancer, 1982, 50(10):2226-2234. pmid: 7127263

项目	GCP组（n=250）	GA组（n=134）	t值	P值
年龄（岁）	48.18±13.22	54.31±14.99	-4.125	<0.001^a)
BMI	24.67±3.56	24.33±4.11	0.770	0.442
收缩压（mm Hg）	128.50±15.42	127.98±19.79	0.227	0.821
舒张压（mm Hg）	76.78±11.32	76.64±10.40	0.098	0.922
血糖（mmol/L）	5.37±1.27	5.82±1.62	-2.999	0.003^a)
总胆固醇（mmol/L）	4.54±1.05	4.51±0.99	0.238	0.812
三酰甘油（mmol/L）	1.36±1.02	2.30±9.94	-1.080	0.282
LDL（mmol/L）	2.91±0.98	2.71±0.86	2.023	0.044^a)
HDL（mmol/L）	1.34±0.80	1.23±0.45	1.517	0.130
LDL/HDL	2.36±0.89	2.52±1.42	-1.185	0.238
白细胞（×10⁹/L）	6.76±3.05	6.28±2.41	1.561	0.119
ALT（U/L）	25.99±22.53	34.92±71.60	-1.407	0.162
AST（U/L）	26.76±20.11	29.82±39.02	-0.849	0.397
白蛋白（g/L）	42.49±5.92	44.57±7.98	-2.890	0.004^a)
总胆红素（mmol/L）	13.64±5.74	19.14±39.89	-1.529	0.114
TBA（μmol/L）	2.68±2.56	8.88±30.10	-2.368	0.019^a)

项目	分界值	GCP组（n=250）	GA组（n=134）	总计（n=384）	χ²值	P值
年龄	≥50岁	122(48.8)	91(67.9)	213(55.5)	12.899	<0.001^a)
性别	女	151(60.4)	79(59.0)	230(59.9)	0.076	0.783
BMI	≥28.0	56(22.4)	27(20.1)	83(21.6)	0.261	0.610
收缩压	≥140 mm Hg	89(35.6)	39(29.1)	128(33.3)	1.656	0.198
舒张压	≥90 mm Hg	41(16.4)	18(13.4)	59(15.4)	0.591	0.442
血糖	≥6.1 mmol/L	40(16.0)	32(23.9)	72(18.8)	3.566	0.059
总胆固醇	≥5.7 mmol/L	34(13.6)	22(16.4)	56(14.6)	0.556	0.456
三酰甘油	≥2.25 mmol/L	27(10.8)	14(10.4)	41(10.7)	0.011	0.915
LDL	≥3.1 mmol/L	110(44.0)	44(32.8)	154(40.1)	4.527	0.033^a)
HDL	≤0.9 mmol/L	27(10.8)	23(17.2)	50(13.0)	3.120	0.077
白细胞	≥10.0×10⁹/L	20(8.0)	10(7.5)	30(7.8)	0.035	0.852
ALT	≥40.0 U/L	44(17.6)	23(17.2)	67(17.4)	0.012	0.915
AST	≥40.0 U/L	27(10.8)	16(11.9)	43(11.2)	0.114	0.736
白蛋白	≥48.0 g/L	35(14.0)	26(19.4)	61(15.9)	1.906	0.167
总胆红素	≥23.34 mmol/L	17(6.8)	10(7.5)	27(7.0)	0.059	0.809
TBA	≥10.0 μmol/L	6(2.4)	14(10.4)	20(5.2)	11.444	0.001^a)

项目	分界值	回归系数	标准误	OR值	95%CI	P值
年龄	≥50岁	-0.857	0.231	0.425	(0.270~0.668)	<0.001
LDL	≥3.1 mmol/L	0.580	0.233	1.750	(1.108~2.766)	0.016
TBA	≥10.0 μmol/L	-1.486	0.510	0.226	(0.083~0.615)	0.004
常数		0.993	0.193	2.699		<0.001