超声联合炎症、营养指标预测胆囊息肉良恶性的价值

摘要

探讨超声联合炎症、营养指标对胆囊息肉良恶性的预测价值。回顾性分析837例胆囊息肉患者，其中良性594例，恶性243例。收集患者临床资料、实验室指标及超声特征。采用单因素和多因素Logistic回归分析筛选胆囊息肉恶变的独立影响因素，绘制受试者工作特征（ROC）曲线并比较各预测指标的效能。单因素分析显示，年龄、息肉直径、息肉数量、息肉形态、血清白蛋白（ALB）、脂肪肝、中性粒细胞与淋巴细胞比值（NLR）及系统炎症反应指数（SIRI）均与息肉恶变显著相关（P＜0.05）。多因素Logistic回归分析结果提示，年龄（OR=1.043，95%CI:1.021~1.066，P＜0.001）、息肉直径（OR=1.244，95%CI：1.163~1.331，P＜0.001）、息肉数量（OR=1.514，95%CI：1.018~2.253，P=0.041）、息肉形态（OR=2.441，95%CI：1.678~3.551，P＜0.001）、ALB（OR=0.880，95%CI：0.835~0.928，P＜0.001）、脂肪肝（OR=2.065，95%CI：1.384~3.081，P＜0.001）、NLR（OR=1.072，95%CI：1.010～1.135，P＜0.001）以及SIRI（OR=1.155，95%CI：1.022～1.305，P＜0.001）均为胆囊息肉恶变的独立影响因素。ROC曲线分析显示，各单项指标中息肉直径的鉴别效能最高，AUC为0.846；进一步将息肉直径、脂肪肝、息肉数量及息肉形态联合评估后，AUC为0.877；在此基础上进一步联合年龄、ALB、NLR及SIRI后，AUC提高至0.944。联合模型较单项指标具有更高的鉴别效能，综合超声表现、炎症及营养相关指标后预测价值最佳。

关键词

胆囊息肉 / 危险因素 / 超声 / 中性粒细胞与淋巴细胞比值 / 系统炎症反应指数

参考文献

[1] Cocco G , Basilico R , Delli Pizzi A , et al. Gallbladder polyps ultrasound: what the sonographer needs to know[J]. J Ultrasound, 2021, 24(2): 131-142. DOI: 10.1007/s40477—021—00563—1.

[2] Kalbi D P , Bapatla A , Chaudhary A J , et al. Surveillance of Gallbladder Polyps: A Literature Review[J]. Cureus, 2021, 13(7): e16113. DOI: 10.7759/cureus.16113.

[3] Foley K G , Lahaye M J , Thoeni R F , et al. Management and follow—up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE[J]. Eur Radiol, 2022, 32(5): 3358-3368. DOI: 10.1007/s00330—021—08384—w.

[4] Szpakowski J L , Tucker L Y . Outcomes of gallbladder polyps and their Association with gallbladder cancer in a 20—year cohort[J]. JAMA Netw Open, 2020, 3(5): e205143. DOI: 10.1001/jamanetworkopen.2020.5143.

[5] Zhou Q , Su S , You W , et al. Systemic inflammation response index as a prognostic marker in cancer patients: a systematic review and meta—analysis of 38 cohorts[J]. Dose—Response, 2021, 19(4)： 1-14. DOI: 10.1177/15593258211064744.

[6] 朱连华， 韩鹏， 姜波， 等 . 微血流成像能准确鉴别和诊断胆囊息肉样病变[J]. 南方医科大学学报， 2022， 42（6）： 922-928. DOI: 10.12122/j.issn.1673—4254.2022.06.17.

[7] Wiles R , Thoeni R F , Barbu S T , et al. Management and follow—up of gallbladder polyps : Joint guidelines between the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery — European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE)[J]. Eur Radiol, 2017, 27(9): 3856-3866. DOI: 10.1007/s00330—017—4742—y.

[8] Knight J , Kamaya A , Fetzer D , et al. Management of incidentally detected gallbladder polyps: a review of clinical scenarios using the 2022 SRU gallbladder polyp consensus guidelines[J]. Abdom Radiol, 2024, 49(9): 3158-3165. DOI: 10.1007/s00261—024—04197—9.

[9] Foley K G , Riddell Z , Coles B , et al. Risk of developing gallbladder cancer in patients with gallbladder polyps detected on transabdominal ultrasound: a systematic review and meta—analysis[J]. Br J Radiol, 2022, 95(1137): 20220152. DOI: 10.1259/bjr.20220152.

[10] Heitz L , Kratzer W , Gräter T , et al. Gallbladder polyps — a follow—up study after 11 years[J]. BMC Gastroenterol, 2019, 19(1): 42. DOI: 10.1186/s12876—019—0959—3.

[11] Sogabe M , Okahisa T , Kagawa M , et al. Metabolic dysfunction—associated steatotic liver disease and gallbladder polyp development: an observational study[J]. Sci Rep—UK, 2024, 14(1): 22446. DOI: 10.1038/s41598—024—73429—1.

[12] Zhang J , Wu Y , Feng Y , et al. The value of CT findings combined with inflammatory indicators for preoperative differentiation of benign and malignant gallbladder polypoid lesions[J]. World J Surg Oncol, 2023, 21(1): 51-59. DOI: 10.1186/s12957—023—02941—x.

[13] Kucuk S , Mızrak S . Diagnostic value of inflammatory factors in patients with gallbladder cancer, dysplasia, and cholecystitis[J]. Cancer Control, 2021, 28: 1-11. DOI: 10.1177/10732748211033746.