基于决策树模型的内镜逆行胰胆管造影术后胆总管结石复发的研究OACSTPCD

Objective The decision tree model was utilized to investigate the risk factors and recurrence probability of calculus of common bile duct following endoscopic retrograde cholangiopancreatography(ERCP).Methods Clinical data of 500 patients who underwent ERCP with calculus of common bile duct from January 2016 to December 2020 were retrospectively analyzed.Decision tree and Logistic regression models were separately established,and the receiver operator characteristic curve(ROC curve)were established,area under the curve(AUC),sensitivity,and specificity were used to evaluate the predictive performance of both models.Independent risk factors of recurrence for calculus of common bile duct after ERCP were identified,and the models were utilized to predict the risk of recurrence in patients.Results The decision tree analysis revealed that the history of choledocholithotomy(P = 0.000),common bile duct diameter＞1.60 cm(P = 0.000),and history of cholecystectomy(P = 0.004)were significant risk factors for calculus of common bile duct recurrence after ERCP.Furthermore,Logistic regression analysis identified independent risk factors for calculus of common bile duct recurrence after ERCP,including the history of cholecystectomy(P = 0.003),history of choledocholithotomy(P = 0.000),common bile duct diameter＞1.60 cm(P = 0.000),number of stones≥2(P = 0.001),and biliary stent(P = 0.038),albumin level≥40.5 g/L(P = 0.026)as a protective factor.Compared to the Logistic regression model(93.3%),the decision tree model had an overall accuracy of 92.2%,an AUC of 0.890(95%CI:0.839～0.940)and 0.926(95%CI:0.887～0.964),sensitivity of 87.0%and 85.3%,and specificity of 81.0%and 89.2%.Conclusion The history of choledocholithotomy,common bile duct diameter＞1.60 cm,and cholecystectomy significantly contribute to the risk of stone recurrence.The decision tree model offers a simple and user-friendly approach that enhances the prediction accuracy of stone patients'recurrence risk.It can serve as a valuable tool for screening and targeted prevention strategies aimed at high-risk groups susceptible to calculus of common bile duct recurrence after ERCP.