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Objective:To investigate the risk factor analysis and model prediction of bleeding after endoscopic retrograde cholangiopancreatography in patients with malignant obstructive jaundice (MOJ).Methods:A retrospective analysis was performed on 302 patients with MOJ treated with ERCP who were treated in the No. 363 Hospital Affiliated to Southwest Medical University from January 2015 to June 2021. The general clinical data of the patients were collected, and the biochemical indicators of the pancreatic and bile ducts were detected. The patients were followed up after discharge, and the patients were divided into a bleeding group ( n=47) and a control group ( n=255) according to whether the follow-up patients were bleeding after ERCP. Compared the general and clinical data of the two groups of patients, including age, gender, platelet count, presence of bile duct stones, acute cholangitis, acute pancreatitis, number of stones, intraoperative bleeding, pancreatic cancer, cholangiocarcinoma, large stone diameter, stone incarceration, duodenal papillary diverticulum, and pre-surgical incision. The measurement data that obey the normal distribution were represented by the mean±standard deviation ( ± s), and the two independent sample t test was used for the comparison between groups; the data that do not conform to the normal distribution were represented by M ( Q1, Q3), and the comparison between groups was used Mann-Whitney U test. The comparison of enumeration data between groups adopted chi-square test. Logistic multivariate regression was used to analyze the independent risk factors of postoperative bleeding after ERCP, and a nomogram prediction model was established and verified according to the independent risk factors of postoperative bleeding. Results:The two groups of patients were compared in age, gender, platelet count, bile duct stones, acute cholangitis, acute pancreatitis, the number of stones, intraoperative bleeding and other aspects, the difference was not statistically significant ( P>0.05). The percentages of pancreatic cancer, cholangiocarcinoma, large stone diameter, stone incarceration, duodenal papillary diverticulum, and surgical pre-incision in the bleeding group were 12.77%, 17.02%, 19.15%, 51.06%, 59.57%, and 14.89%, respectively. , the percentages of the control group were 3.92%, 5.10%, 9.02%, 19.22%, 17.65%, and 5.88%, and the difference was statistically significant between the two groups ( P<0.05). Taking postoperative bleeding as the dependent variable, and using the indicators with statistical differences in univariate analysis as independent variables, multivariate Logistic regression analysis showed that the patient had pancreatic cancer ( OR=1.838, 95% CI: 1.524-4.613, P=0.041), cholangiocarcinoma ( OR=2.548, 95% CI: 1.870-5.116, P=0.015), stone incarceration ( OR=3.078, 95% CI: 2.374-6.012, P<0.001), duodenum Intestinal papillary diverticula ( OR=1.140, 95% CI: 1.045-1.628, P<0.001), surgical pre-incision ( OR=1.640, 95% CI: 1.321-1.928, P<0.001) were associated with postoperative bleeding in MOJ patients after ERCP independent risk factors. The predictive ability of duodenal papillary diverticulum was the highest; the predictive ability of stone incarceration and cholangiocarcinoma was the second, and there was no significant difference between them; the predictive ability of pancreatic cancer, stone diameter, and pre-incision on bleeding after ERCP in MOJ patients smaller. Pancreatic cancer, cholangiocarcinoma, large stone diameter, stone incarceration, duodenal papillary diverticulum, and pre-incision scores were 42, 63, 28, 65, 76, and 34 points respectively, and the total score was 308 points corresponding to the nomogram model. The predictive power of the nomogram was 61.6%, and overall, the nomogram had good predictive performance. Harrell concordance index analysis and ROC curve were used to evaluate the model discrimination, the C-index calculation result was 0.826 (95% CI: 0.771-0.847), the ROC curve AUC was 0.843 (95% CI: 0.801-0.884), and the ROC prediction The value and the calculation result of C-index are relatively close. The model discrimination is applied in this study and has a certain prediction effect. The nomogram model in the Calibration curve predicted the probability of postoperative bleeding after ERCP in MOJ patients with high consistency with the actual probability. Conclusion:ERCP is safe and feasible for most patients with MOJ, but for patients with pancreatic cancer, bile duct cancer, large stone diameter, stone incarceration, and duodenal papillary diverticulum, it should be performed with caution, and preoperative incision should be avoided, to reduce the risk of postoperative bleeding. In addition, the nomogram model has a strong predictive ability in predicting bleeding after ERCP in patients with MOJ, which is worthy of reference in clinical research.
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Objective To investigate the changes of serum carcinoembryonic antigen (CEA),lactate dehydrogenase (LDH),β2-microglobulin (β2-MG) levels in non-Hodgkin's lymphoma (NHL) patients and their clinical significance.Methods From February 2015 to February 2018,54 patients with NHL who were hospitalized in Shiyan People's Hospital were selected as the observation group.All patients underwent two cycles of chemotherapy combined with radiation therapy.Another 54 healthy subjects were selected as the control group.To observe the changes of serum LDH,β2-MG,CEA levels in the control group,and compare the changes of serum LDH,β2-MG,CEA levels before and after treatment with different clinical stages,different conditions,and different effects in NHL.Results The levels of serum LDH,β2-MG,and CEA in the observation group were higher than those in the control group (P ＜ 0.05);the levels of serum LDH,β2-MG,and CEA in patients with NHL in stage Ⅲ to Ⅳ were higher than those in stage Ⅰ to Ⅱ (P ＜0.05);the levels of serum LDH,β2-MG,and CEA in patients with NHL in the middle-high-risk and high-risk groups were higher than those in the middle-risk and low-risk groups (P ＜ 0.05);after treatment,the levels of serum LDH,β2-MG,and CEA in stable disease (SD) and progression disease (PD) patients were not significantly different from those before treatment (P ＞ 0.05).While after treatment,the levels of serum LDH,β2-MG and CEA in complete relief (CR) and partial remission (PR) patients were lower than those before treatment (P ＜ 0.05),and were lower than those in SD and PD patients.Conclusions The level of serum LDH,β2-MG and CEA in patients with NHL increased,and the combined detection of the level changes is of great clinical value in the determination of clinical stage,malignant degree,clinical efficacy and prognosis of NHL patients.
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Objective@#To investigate the changes of serum carcinoembryonic antigen (CEA), lactate dehydrogenase (LDH), β2-microglobulin (β2-MG) levels in non-Hodgkin's lymphoma (NHL) patients and their clinical significance.@*Methods@#From February 2015 to February 2018, 54 patients with NHL who were hospitalized in Shiyan People's Hospital were selected as the observation group. All patients underwent two cycles of chemotherapy combined with radiation therapy. Another 54 healthy subjects were selected as the control group. To observe the changes of serum LDH, β2-MG, CEA levels in the control group, and compare the changes of serum LDH, β2-MG, CEA levels before and after treatment with different clinical stages, different conditions, and different effects in NHL.@*Results@#The levels of serum LDH, β2-MG, and CEA in the observation group were higher than those in the control group (P<0.05); the levels of serum LDH, β2-MG, and CEA in patients with NHL in stage Ⅲ to Ⅳ were higher than those in stage Ⅰ to Ⅱ (P<0.05); the levels of serum LDH, β2-MG, and CEA in patients with NHL in the middle-high-risk and high-risk groups were higher than those in the middle-risk and low-risk groups (P<0.05); after treatment, the levels of serum LDH, β2-MG, and CEA in stable disease (SD) and progression disease (PD) patients were not significantly different from those before treatment (P>0.05). While after treatment, the levels of serum LDH, β2-MG and CEA in complete relief (CR) and partial remission (PR) patients were lower than those before treatment (P<0.05), and were lower than those in SD and PD patients.@*Conclusions@#The level of serum LDH, β2-MG and CEA in patients with NHL increased, and the combined detection of the level changes is of great clinical value in the determination of clinical stage, malignant degree, clinical efficacy and prognosis of NHL patients.