实用临床医药杂志2025，Vol.29Issue(23)：1-8,8.DOI:10.7619/jcmp.20252937
急性胆源性胰腺炎患者内镜逆行胰胆管造影术后胰腺真菌感染的早期病原学证据及预测模型构建
Early etiological evidence and predictive model construction of pancreatic fungal infection after endoscopic retrograde cholangiopancreatography in acute biliary pancreatitis
摘要
Abstract
Objective To explore the fungal species distribution features in pancreatic infections in patients with acute biliary pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP)and analyze the predisposing factors.Methods A total of 31 patients with pancreatic fungal infection after ERCP for acute biliary pancreatitis admitted to the First Affiliated Hospital of Air Force Medical University of Chinese People's Liberation Army were selected as infection group,and another 155 patients without infection after ERCP for acute biliary pancreatitis during the same period were selected as non-infection group.Clinical data of patients in both groups were collected.A multivariate Logistic regression model was used to analyze the influencing factors of pancreatic fungal infection after ERCP for acute biliary pancreatitis patients.The generalized estimating equation(GEE)model was used to validate the results of the multivariate Logistic regression analysis.The receiver operating character-istic(ROC)curve was used to evaluate the predictive value.The chi-square automatic interaction detector(CHAID)algorithm was applied to construct a decision tree model based on the influencing factors,and a risk score table for pancreatic fungal infection was established.Risk stratification(low-risk and high-risk groups)was performed according to the cut-off value,and the incidence of pancreatic fungal infection after ERCP was compared.Results In the infection group,the time from admission to the diagnosis of pancreatic infection was 11(8,14)days.A total of 38 fungal strains were isolated,with Candida albicans being the most frequently detected strain.Among the 186 patients,one pancreatic juice specimen and one bile specimen were collected for culture after the operation.The time from the diagnosis of pancreatic infection to a positive pancreatic juice speci-men culture was 5(3,6)days,and the time from the diagnosis of pancreatic infection to a positive bile specimen culture was 6(4,7)days.The proportions of positive cultures in pancreatic juice and bile specimens in the infection group were higher than those in the non-infection group,with statistically significant differences(P＜0.05).A high proportion of positive pancreatic juice speci-men cultures(OR=10.413,95％CI,2.059 to 52.667),a high proportion of positive bile speci-men cultures(OR=7.468,95％CI,1.603 to 34.789),diabetes(OR=4.567,95％CI,1.090 to 19.131),prolonged operation time(OR=1.052,95％CI,1.012 to 1.093),inadequate postoperative bile drainage(OR=4.951,95％CI,1.304 to 18.802),and high preoperative total bilirubin(TBil)(OR=1.221,95％CI,1.100 to 1.354)were independent influencing factors for pancreatic fungal infection after ERCP for acute biliary pancreatitis patients(P＜0.05).High pre-operative albumin(OR=0.860,95％CI,0.773 to0.958)was an independent protective factor for pancreatic fungal infection after ERCP for acute biliary pancreatitis patients(P＜0.05).The ROC curve showed that the diagnostic efficacy,sensitivity,and specificity of combined detection were higher than those of single detection.The decision tree model selected three risk factors(results of pancreatic juice and bile specimens and inadequate postoperative bile drainage)as the nodes of the model.Among them,the culture result of the pancreatic juice specimen was the most important pre-dictive factor,and the classification accuracy rate of the model was 83.3％.The incidence of pan-creatic fungal infection in high-risk patients was higher than that in low-risk patients,with a statisti-cally significant difference(P＜0.05).Conclusion Candida albicans is the main fungus detected in pancreatic infections after ERCP for acute biliary pancreatitis.A high proportion of positive pan-creatic juice specimen cultures,a high proportion of positive bile specimen cultures,diabetes,pro-longed operation time,inadequate postoperative bile drainage,and high preoperative TBil are inde-pendent risk factors for pancreatic fungal infection after ERCP for acute biliary pancreatitis patients,while high preoperative albumin is an independent protective factor.关键词
胰腺炎/胆源性/内镜逆行胰胆管造影/真菌感染/念珠菌属/危险因素/预测模型/早期诊断Key words
pancreatitis/biliary type/endoscopic retrograde cholangiopancreatography/fun-gal infection/candida/risk factors/predictive model/early diagnosis分类
医药卫生引用本文复制引用
康瑞,康晓宁,史奕,张田,王海英..急性胆源性胰腺炎患者内镜逆行胰胆管造影术后胰腺真菌感染的早期病原学证据及预测模型构建[J].实用临床医药杂志,2025,29(23):1-8,8.基金项目
国家自然科学基金项目(8237160985) （8237160985）
