胆囊息肉恶变的危险因素分析

陈少华; 王成方; 李会星; 史宪杰

doi:10.3760/cma.j.issn.1673-9752.2019.02.008

摘要: 目的:探讨影响胆囊息肉恶变的危险因素。
方法:采用回顾性病例对照研究方法。收集中国人民解放军总医院2011年1月至2016年10月收治的604例胆囊息肉患者的临床病理资料；男255例，女349例；平均年龄为47岁，年龄范围为19～88岁。604例患者中良性胆囊息肉565例，恶性胆囊息肉39例。观察指标：(1)影响胆囊息肉恶变的危险因素分析。(2)胆囊息肉直径对胆囊息肉恶变的预测能力。正态分布的计量资料以Mean±SD表示，偏态分布的计量资料以M(范围)表示，单因素分析采用t检验或秩和检验。计算资料以绝对数表示，单因素分析均采用χ²检验或Fisher确切概率法。结合临床应用将单因素分析中P<0.05的指标纳入多因素分析，多因素分析采用Logistic回归模型。绘制受试者工作特征(ROC)曲线，计算约登指数，分析胆囊息肉直径对胆囊息肉恶变的预测能力。
结果:(1)影响胆囊息肉恶变的危险因素分析。单因素分析结果显示：患者的年龄、胆囊息肉直径、胆囊息肉数目、慢性胆囊炎、癌胚抗原是影响胆囊息肉恶变的相关因素(t=-5.50，Z=-9.65， χ²=15.92，312.65，Z=-1.78，P<0.05)。多因素分析结果显示：患者的年龄、胆囊息肉直径、胆囊息肉数目是影响胆囊息肉恶变的独立因素(优势比=1.088，45.190，9.655，95%可信区间为0.974～1.159，4.312～121.139，0.890～117.551，P<0.05)。(2)胆囊息肉直径对胆囊息肉恶变的预测能力。胆囊息肉直径为10 mm时，约登指数=0.761，预测胆囊息肉恶变的灵敏度为94.9%，特异度为81.2%。胆囊息肉直径为12 mm时，约登指数=0.803，预测胆囊息肉恶变的灵敏度为89.7%，特异度为90.6%。胆囊息肉直径为13 mm时，约登指数=0.772，预测胆囊息肉恶变的灵敏度为84.6%，特异度为92.6%。
结论:年龄、胆囊息肉直径、胆囊息肉数目是影响胆囊息肉恶变的独立因素。患者年龄>50岁，直径>12 mm的单发胆囊息肉，息肉恶变的可能性高，应给予积极手术治疗。

Abstract: Objective:To investigate the risk factors of malignancy from gallbladder polyps (GBPs).
Methods:The retrospective case-control study was conducted. The clinicopathological data of 604 patients with GBPs who were admitted to the Chinese PLA General Hospital between January 2011 and October 2016 were collected. There were 255 males and 349 females, aged from 19 to 88 years, with an average age of 47 years. There were 565 of 604 patients with benign GBPs and 39 with malignant GBPs. Observation indicators: (1) risk factors analysis of malignancy from GBPs; (2) the predictive ability of polyp diameter for malignancy from GBPs. Measurement data with normal distribution were expressed as Mean±SD, measurement data with skewed distribution were described as M (range), and the univariate analysis was done using the t test or rank-sum test. Count data were described by the absolute amount, and the univariate analysis was done using the chi-square test or Fisher exact probability. The indicators with P<0.05 in the univariate analysis based on clinical application were used in the Logistic regression models for multivariate analysis. The receiver operating characteristic (ROC) curve was drawn. The Youden index was calculated to analyze the predictive ability of polyp diameter for malignancy from GBPs.
Results:(1) Risk factors analysis of malignancy from GBPs: results of univariate analysis showed that age, polyp diameter, polyp number, chronic cholecystitis and carcinoembryonic antigen (CEA) level were related factors affecting malignancy from GBPs (t=-5.50, Z=-9.65, χ²=15.92, 312.65, Z=-1.78, P<0.05). The results of multivariate analysis showed that age, polyp diameter and polyp number were independent factors affecting malignancy from GBPs (odds ratio=1.088, 45.190, 9.655, 95% confidence interval: 0.974-1.159, 4.312-121.139, 0.890-117.551, P<0.05). (2) The predictive ability of polyp diameter for malignancy from GBPs. The sensitivity and specificity predicting malignancy from GBPs were 94.9% and 81.2% in patients with polyp diameter=10 mm and Youden index=0.761, 89.7% and 90.6% in patients with polyp diameter=12 mm and Youden index=0.803, 84.6% and 92.6% in patients with polyp diameter=13 mm and Youden index=0.772, respectively.
Conclusions:The age, polyp diameter and polyp number are the independant factors affecting malignancy from GBPs. The malignancy possibility from GBPs is higher in patients with the age > 50 years, polyp diameter >12 mm, solitary polyp, and should undergo surgical therapy actively.

胆囊息肉恶变的危险因素分析

Risk factors analysis of malignancy from gallbladder polyps