| BackgroundCholelithiasis is a disease in which cholesterol or pigment in bile condenses and precipitates stones in the gallbladder or bile duct.Most patients with cholelithiasis are asymptomatic,but there are still some patients with acute and chronic inflammation manifested as biliary colic and other symptoms,and it can cause a variety of complications,such as acute pancreatitis,biliary perforation,liver injury,and biliary malignant tumor.These complications can increase medical costs,and sometimes even cause life-threatening of patients.Due to the differences in environment and dietary habits,the reported prevalence rates of cholelithiasis in different regions of China were between 2.4%and 22.9%According to the location of stones,cholelithiasis can be divided into gallbladder stones,bile duct stones,or gallbladder stones combined with bile duct stones.80%-90%of gallbladder stones are usually cholesterol stones or mixed stones.Bile duct stones are mostly pigment stones,and gallbladder stones combined with bile duct stones are mostly developed from gallbladder stones.The pathogenesis of different locations of stones is different.The corresponding clinical laboratory examination indicators changes are also different.The related factors of cholelithiasis include age,gender,hypertension,diabetes,bilirubin,transpeptidase,hemoglobin,etc.Most of the patients are asymptomatic cholelithiasis patients,which only show the rise of some clinical laboratory examination indicators.They are often found in the presence of symptoms,physical examination,or other diseases.Therefore,it is particularly important for the early recognition of cholelithiasis.Abdominal ultrasound is easy to examine and has no radiation hazard,so it is often used as the first choice for the examination of biliary stones.However,due to the size and location of the stones,the gas in the intestinal tract,the ultrasound of small stones,or some common bile duct stones may not be able to find.The accuracy of CT and MRI in the diagnosis of cholelithiasis was higher,but the medical cost was more expensive.The examinees have a longer time to accept the examination,and the requirements for the examinees’cooperation are higher.So the limitations of them are larger.The operation of serological examination is simple,and the price is relatively low.If we can find the relevant indicators of cholelithiasis in biochemical indicators and blood routine indicators,and combine with the basic information of patients,we can construct the discrimination model of cholelithiasis.It is helpful to the screening of cholelithiasis and guides the people to check and diagnose as soon as possible.ObjectivesA case-control study in groups was designed,using LASSO regression combined with logistic regression to screen and analyze the related factors of cholelithiasis,and to understand the differences of clinical laboratory indicators between different types of cholelithiasis.In order to discriminate whether an individual had gallbladder stones,bile duct stones,or gallbladder stones combined with bile duct stones,the multinomial logistic regression and random forest algorithm were used to construct the discriminant model of cholelithiasis,and the two models were evaluated and compared to select the optimal model.MethodsThis study was based on the electronic medical records of cholelithiasis patients and the physical examination population in the Third Hospital of Shandong Province from November 1,2019 to October 31,2020.According to the inclusion and exclusion criteria,the patients who were diagnosed as cholelithiasis according to the discharge diagnosis were selected as the case group,and people without cholelithiasis diagnosis who did the physical examination over the same period were selected as the control group.The electronic medical record system was used to retrieve the electronic medical record and collect the information of participants.The basic information(age,gender),comorbidity(hypertension,diabetes,hepatitis B,kidney stones),biochemical indicators,and blood routine indicators of participants were extractedR 4.0.4 software was used for data processing and statistical analysis.Based on the hospital case-control study in groups,the χ2 test,t test,Mann-Whitney U test,and other methods were used to compare and analyze the differences between patients with cholelithiasis and the physical examination population.The variables were screened by the LASSO regression,and the related factors of cholelithiasis were analyzed by multinomial logistic regression.The differences of basic information and clinical laboratory examination indicators of patients with cholelithiasis at different sites were compared by analysis of variance,Kruskal-Wallis H test,and Nemenyi test.The discriminant factors of cholelithiasis were screened by LASSO regression.The discriminant models of cholelithiasis were constructed based on the multinomial logistic regression and random forest algorithm,and the two models were evaluated and comparedResultsIn this case-control study,there were 1167 patients in the cholelithiasis group and 1344 in the physical examination group.Among the cholelithiasis group,545 patients had gallbladder stones,135 patients had bile duct stones,and 487 patients had gallbladder stones combined with bile duct stones.Twenty-three variables were selected after LASSO regression analysis,and the continuous variables were grouped.By stepwise multinomial logistic regression analysis,we included 16 factors of cholelithiasis,such as age,hypertension,creatinine,and total protein.Compared with the group of 18-44 years old,the age of 45-64 years old and the age of 65 years old and above were positively correlated with gallbladder stones,bile duct stones,and gallbladder stones with bile duct stones.Hypertension was only positively correlated with gallbladder stones(OR=2.61,95%CI:1.67-4.07),while kidney stone was positively correlated with gallbladder stones(OR=5.90,95%CI:1.55-22.54)and bile duct stones(OR=7.55,95%CI:1.32-43.25).Compared with the normal indicators group,the high levels of direct bilirubin,glutamyl transpeptidase,and alanine aminotransferase were related to three types of cholelithiasis.The low levels of total protein,albumin,lymphocyte count,hemoglobin,and mean platelet volume were all related to three types of cholelithiasis.However,the high level of red blood cell distribution width was only related to bile duct stones(OR=0.07,95%CI:0.01-0.75),and the low level of plateletcrit was only related to gallbladder stones(OR=0.22,95%CI:0.09-0.57).The correlation between neutrophil count and the three types of cholelithiasis was not statistically significant.Comparing two kinds of discriminant models of cholelithiasis,the AUC value of the multinomial logistic regression in the test set was 0.793,the accuracy was 0.748,the macro average precision rate was 0.593,the macro average recall rate was 0.538,and the macro average F1 score was 0.529.The AUC value of the random forest model in the test set was 0.755,the accuracy was 0.728,the macro average precision rate was 0.492,the macro average recall rate was 0.501,and the macro average F1 score was 0.489.In contrast,the multinomial logistic regression model was relatively better.Conclusions1.This study shows that age is a risk factor of cholelithiasis,hypertension is positively correlated with gallbladder stones,kidney stone is positively correlated with gallbladder stones,and bile duct stones2.Compared with the normal indicator group,the high levels of direct bilirubin,glutamyl transpeptidase,and alanine aminotransferase are associated with three types of cholelithiasis.The low levels of total protein,albumin,lymphocyte count,and hemoglobin,and mean platelet volume are also associated with three types of cholelithiasis.However,the high level of red blood cell distribution width is only related to bile duct stones,and the low level of plateletcrit is only related to gallbladder stones.3.From the results of comparison between the multinomial logistic regression model and random forest model of cholelithiasis,the multinomial logistic regression has a better comprehensive discriminant effect.It has a certain reference value for the prevention and screening of cholelithiasis. |
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