| Background and Objective:As one of the common diseases of digestive system,acute cholangitis is a systemic inflammatory disease caused by biliary tract infection.At present,studies have shown that the main causes are choledocholithiasis,benign and malignant biliary stricture and other factors such as duodenal diverticulum,postoperative stent and so on.Choledocholithiasis is the most common cause of acute cholangitis.When stones cause biliary obstruction,the increase of biliary pressure makes bacteria retrograde into the blood circulation,leading to the occurrence of acute cholangitis.If it is not treated in time,its condition will deteriorate rapidly and be life-threatening.In recent years,with the standardization of antibiotic treatment and the progress of biliary drainage technology,the mortality rate of severe cholangitis is significantly lower than before,but the mortality rate is still as high as 5%.According to the severity of acute cholangitis,reasonable antibiotic treatment and endoscopic drainage are the key measures to improve the survival rate of patients,so the early and accurate evaluation of the severity of acute cholangitis plays a key guiding role in the implementation of clinical diagnosis and treatment plan.In recent years,more and more studies have shown that factors related to metabolic disorders may have a certain clinical value in evaluating the prognosis of sepsis.Metabolic syndrome is a group of clinical syndrome caused by various metabolic abnormalities,including obesity,hypertension,insulin resistance,hypertriglyceridemia and other factors.In recent years,studies have shown that some metabolic factors may be related to the formation of choledocholithiasis,but whether they are related to the pathogenesis of acute cholangitis and whether they can be used as an index to evaluate the severity of choledocholithiasis with acute cholangitis,it is still unknown.In this study,the correlation between metabolic factors and the incidence of choledocholithiasis with acute cholangitis was analyzed,and the clinical characteristics of choledocholithiasis with acute cholangitis with different severity were compared.to explore the value of metabolic factors in early prediction of the severity of choledocholithiasis with acute cholangitis,in order to find more clinical indicators and guide treatment to a certain extent.Methods:The clinical data of inpatients in Hospital from January 2020 to December 2021 were collected.A total of 363 patients with choledocholithiasis with acute cholangitis were diagnosed.2515 healthy people who came to the hospital for physical examination in the same period were set as the control group.The difference of the proportion of metabolic syndrome between the experimental group and the control group was analyzed.The experimental group was divided into mild group,moderate group and severe group according to the guidelines for diagnosis and treatment of acute biliary tract infection(2021 version).The clinical characteristics of each group were analyzed.Results:1.There was no significant difference in gender composition between the experimental group and the control group.2.A comparative analysis was made between the experimental group and the control group complicated with metabolic syndrome: the results of univariate analysis showed that the proportion,age and BMI of metabolic syndrome in the experimental group were higher than those in the control group(P <0.05).Multivariate analysis of age,BMI and metabolic syndrome showed that there was still significant difference in the proportion of metabolic syndrome and BMI between the two groups,but there was no statistical difference in age.3.According to the guidelines,patients with acute cholangitis were divided into mild,moderate and severe groups,and the correlation between metabolic syndrome and the severity of acute cholangitis was compared.There was significant difference in the proportion of metabolic syndrome among the three groups(P<0.05),and there was no significant difference between mild group and moderate group(P>0.05),but there was significant difference between severe group and mild group and moderate group(P<0.05).4.Because there was no significant difference in the proportion of metabolic syndrome between mild group and moderate group,mild and moderate groups were combined into non-severe group,and compared with severe group again,the proportion of metabolic syndrome was significantly different between non-severe group and severe group(P<0.05).The difference was statistically significant(P<0.05).The characteristics of clinical data of non-severe group and severe group were analyzed.The results of univariate analysis showed that: Two groups of data on age,neutrophils ratio value,neutrophils and lymphocytes,platelets,calcitonin,total bilirubin,direct bilirubin,triglycerides,high-density lipoprotein cholesterol(hdl-c),apolipoprotein-A1,fasting blood sugar that there were significant differences on eleven indicators,and the difference has statistical significance(P<0.05),the rest of the indicators and no obvious difference.Eleven indicators with statistical differences in the results of single-factor analysis were jointly constructed to carry out multi-factor analysis by logistics regression equation,and the results were as follows: Age,neutrophils and lymphocytes ratio,platelets,calcitonin,high-density lipoprotein cholesterol(hdl-c),apolipoprotein-A1,fasting blood glucose in multi-factor analysis differences are statistically significant(P<0.05),but the neutrophils value,total bilirubin,direct bilirubin,triglycerides,no statistically significant difference in the multiple factors analysis.Age,neutrophil to lymphocyte ratio,procalcitonin and fasting blood glucose were positively correlated with the severity of choledocholithiasis with acute cholangitis,while platelets,high density lipoprotein and apolipoprotein-A1 were negatively correlated.The ROC curves of the above seven indexes were drawn,in which the area under the curve(AUC)of procalcitonin was 0.833,the sensitivity was 82.6%,and the specificity was 73.0%(95%CI 0.775-0.891,P <0.001);the AUC of NLR was 0.826,the sensitivity was 78.3%,and the specificity was 75.2%(95%CI0.761-0.890,P < 0.001).The AUC of age is 0.804,the sensitivity is 76.1%,the specificity is 71.8%(95%CI0.726-0.881,P < 0.001),and the fasting blood glucose AUC is 0.806,the sensitivity is 73.9%,the specificity is 70.0%(95%CI 0.736-0.877,P < 0.001).Platelet AUC was 0.759,sensitivity was 77.0%,specificity was 67.4%(95%CI 0.695-0.824(P < 0.001),AUC was 0.755,sensitivity was 69.6%,specificity was 71.7(95%CI 0.690-0.820,P < 0.001).The AUC of apolipoprotein A1 was 0.749,the sensitivity was75.6%,and the specificity was 67.4%(95%CI 0.672-0.826 P < 0.001).Conclusion:1.The risk of choledocholithiasis with acute cholangitis is increased in patients with metabolic abnormality.2.Age,PCT,fasting blood glucose and NLR were positively correlated with the severity of choledocholithiasis with acute cholangitis,while platelets,high-density lipoprotein and apolipoprotein A1 were negatively correlated with the severity of choledocholithiasis with acute cholangitis. |
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