| Objective:Hope that through study the WBC,serum CA19-9,liver meritorious service is related index of common bile duct calculi in patients with obstructive jaundice early prediction value of acute cholangitis,whether for common bile duct stones in patients with obstructive jaundice to make predictions early acute cholangitis,early and timely give relevant clinical interventions,relieve biliary obstruction,improve clinical curative effect,improve prognosis,to provide opportunities for some patients next surgery,to reduce morbidity and mortality.Methods : Collected in January 2016-June 2019 obstructive jaundice due to common bile duct calculi in yanan university hospital liver surgery and 306 patients with digestive diseases,all into the group of patients admitted to hospital 24 hours perfecting routine blood,hepatic function,blood coagulation series,for liver tumor markers,and related laboratory tests,according to the hospital to perfect the related check after acute cholangitis,divided into AC group 123 examples,OJ group 183 cases(control group).The AC group was diagnosed according to the 2018 Tokyo guidelines for acute cholangitis.According to the measured for the first time after admission the WBC,CA19-9,PA,TBi L,DBi L,GGT and ALP,AST,ALT,statistical analysis with statistical significance of the indicators to build the subjects operating characteristic curve(ROC curve),according to the ROC curve to calculate the diagnostic accuracy of the highest clinical value and the corresponding sensitivity and specific degrees,to assess the indexes of acute cholangitis forecasting value.All data were statistically processed by SPSS20.0 statistical software.Result:1.Comparison of basic data between OJ group and AC group: a total of 306 patients were collected,including 143 males(46.7%)and 163 females(53.3%),aged16-91 years,with an average age of 58.26±3.256 years.There were 123 cases in AC group(experimental group),including 60 males and 63 females,with an average age of61.56±15.185 years.There were 183 cases in OJ group(control group),83 males and 100 females,with an average age of(58.08±15.543)years.There was no significant difference in age and gender between the two groups(P>.05,as shown in table 1).2.By comparing the biochemical data and WBC of patients in AC group and OJ group,the differences in serum CA19-9,TBi L,DBi L,AST,ALT,ALP,GGT,PA and WBC in the two groups were statistically significant(P < 0.05)(see table 2).3.Multi-factor analysis of acute cholangitis in patients with obstructive choledocholitis found that: compared with OJ group,AC group showed that gender,age,WBC,TBIL,DBIL,ALT,AST and ALP were not independent risk factors for acute cholangitis in patients with obstructive choledocholitis(P>,0.05).Serum CA19-9,PA and GGT were independent risk factors for acute cholangitis in patients with obstructive jaundice of choledocholithiasis(OR)of 1.001,0.999 and 1.001,respectively(see table3).4.ROC curve analysis of serum CA19-9,PA and GGT showed that serum CA19-9and GGT were positively correlated with acute cholangitis in patients with obstructive jaundice of choledocholithiasis,and the higher the value,the greater the possibility of acute cholangitis(figure 1).PA was negatively correlated with acute cholangitis in patients with obstructive jaundice of choledocholithiasis,and the smaller the value,the greater the likelihood of acute cholangitis(figure 2).The areas under the serum CA19-9,PA and GGT curves were 0.787,0.736 and 0.655,respectively,and the highest critical values of the corresponding diagnostic criteria were 48.52KU/L,159.5mg/L and224.0U/L,respectively.The sensitivity was 79.7%,80.5% and 79.7%,and the specificity was 78.7%,56.8% and 44.8%,respectively(see table 4).Conclusions : 1.Elevated serum CA19-9,GGTand decreased PA have early predictive value for the occurrence of acute cholangitis in patients with obstructive jaundice of choledocholithiasis,but the specificity for the diagnosis of reduced GGT is low.2.Serum CA19-9 and PA may also be non-specific inflammatory markers of acute cholangitis in obstructive jaundice of common bile duct stones. |
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