胆道恶性肿瘤胆道支架植入术后并发胆囊炎的高危因素及IL-6、PCT对其诊断的预测价值

摘要/Abstract

摘要： 目的分析探讨胆道恶性肿瘤胆道支架植入术后并发胆囊炎的高危因素、炎症标志物特点及白细胞介素-6(IL-6)、降钙素原 (PCT)对其诊断的预测价值。方法回顾分析2021年1月—2023年12月间因胆道恶性肿瘤并发胆道梗阻在空军军医大学第一附属医院行经皮胆道支架植入术的205例(其中包含术后并发胆囊炎22例)患者的临床资料。根据患者术前及术后1周转氨酶、胆红素,合并胆道结石或有胆道结石病史、肿瘤及支架位于胆总管下段、术中胆道支架植入后胆囊是否显影等因素分析其术后发生胆囊炎的高危因素。并比较两组CRP、PCT、IL-6、TNF-α差异,分析IL-6、PCT对其诊断的预测价值。结果术后1周并发胆囊炎组血清总胆红素水平为(235.99±145.22)μmol/L,高于对照组[(185.28±131.41)μmol/L], 并发胆囊炎组合并胆道结石或有胆道结石病史率为22.73%,高于对照组的9.84%、肿瘤或支架位于胆总管下段患者并发胆囊炎率为68.18%,高于对照组的19.67%,变量行logistic分析显示,肿瘤及支架位于胆总管下段是影响胆道支架植入术后胆囊炎发生的主要因素(OR=1.176,P=0.016)。ROC曲线结果显示,以14.58 pg/mL为截断值,IL-6预测胆道支架植入术后并发胆囊炎的灵敏度为68.2％,特异度为70.0％;以4.21 ng/mL为截断值, PCT预测胆道支架植入术后并发胆囊炎的灵敏度为50.0％,特异度为96.7％;两者联合预测胆道支架植入术后并发胆囊炎的灵敏度为67.7％,特异度为90.4％。结论肿瘤及支架位于胆总管下段是影响胆道支架植入术后胆囊炎发生的主要因素。IL-6、PCT对其诊断的预测具有价值,两者联合能更好预测胆道支架植入术后胆囊炎的发生。

关键词: 胆道恶性肿瘤, 胆道支架植入术, 胆囊炎, 白细胞介素-6, 降钙素原

Abstract: Objective To analyze the high-risk factors, characteristics of inflammatory markers, and predictive value of IL-6 and PCT in diagnosing cholecystitis after biliary stent implantation in patients with malignant biliary tract tumors. Methods A retrospective analysis was conducted on the clinical data of 205 patients (including 22 cases of postoperative cholecystitis) who underwent percutaneous biliary stent implantation for malignant obstructive jaundice in our hospital from January 2021 to December 2023. High-risk factors for postoperative cholecystitis were analyzed based on factors such as transaminase and bilirubin levels before and one week after surgery, presence of biliary stones or a history of biliary stones, tumor and stent placement in the lower segment of the common bile duct, and visualization of the gallbladder after intraoperative biliary stent implantation. Compare the differences in CRP, PCT, IL-6, and TNF - α between the two groups, and analyze the predictive value of IL-6 and PCT for their diagnosis. Results One week after surgery, the total bilirubin value in the group with concurrent cholecystitis (235.99 ± 145.22) μmol/L was higher than that in the control group (185.28 ± 131.41) μmol/L. The incidence of concurrent cholecystitis combined with biliary stones or a history of biliary stones was 22.73% higher than that in the control group (9.84%). The incidence of concurrent cholecystitis in patients with tumors or stents located in the lower part of the common bile duct was 68.18% higher than that in the control group (19.67%). Logistic analysis of variables showed that tumors and stents located in the lower part of the common bile duct were the main factors affecting the occurrence of cholecystitis after biliary stent implantation (OR=1.176, P=0.016). The ROC curve results showed that at 14.58 pg The sensitivity and specificity of IL-6 in predicting postoperative cholecystitis after biliary stent implantation were 68.2% and 70.0%, with/mL as the cutoff value; With a cut-off value of 4.21ng/mL, the sensitivity and specificity of PCT in predicting postoperative cholecystitis after biliary stent implantation are 50.0% and 96.7%, respectively; The sensitivity and specificity of the combined prediction of cholecystitis after biliary stent implantation are 67.7% and 90.4%, respectively. Conclusion Tumors and stents located in the lower segment of the common bile duct are the main factors affecting the occurrence of cholecystitis after biliary stent implantation. IL-6 and PCT are valuable in predicting its diagnosis, and their combination can better predict the occurrence of cholecystitis after biliary stent implantation.

Key words: Malignant tumors of the biliary tract, Biliary stent implantation, Cholecystitis, Interlukin-6, Procalcitonin

杨小斌, 蒋金泉. 胆道恶性肿瘤胆道支架植入术后并发胆囊炎的高危因素及IL-6、PCT对其诊断的预测价值[J]. 肝脏, 2025, 30(2): 245-248.

YANG Xiao-bin, JIANG Jin-quan. Analysis of the effect of chemical cholecystectomy on cholecystitis after biliary stent implantation[J]. Chinese Hepatolgy, 2025, 30(2): 245-248.

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