| BackgroundCholelithiasis is a common digestive tract disease with a high prevalence worldwide.It has become an urgent problem of digestive tract disease in all countries.The prevalence of cholelithiasis in Chinese mainland is between 6%and 12%,and that in Taiwan is 5.0%.In recent years,with the improvement of Chinese people’s living standards,the accelerated pace of work and lack of exercise and other reasons,the incidence of cholelithiasis is increasing year by year.According to the Financial Burden of Cholelithiasis Survey,cholelithiasis brings an economic burden of more than $4 billion to the United States every year.In China,the per capita medical expenses of cholelithiasis patients are increasing rapidly.In 2006,the hospitalization cost of each patient with cholelithiasis have reached 10000 yuan,and this growth trend will not change in the short term.Cholelithiasis can be divided into gallstones,intrahepatic bile duct stones and extrahepatic bile duct stones according to the site of stones.Accurate preoperative diagnosis of patients with different types of cholelithiasis is of vital importance both to help doctors make correct treatment plans and to relieve unnecessary pain for patients.Common ultrasonography is the first choice for diagnosis of cholelithiasis because of its simple operation and low cost.Ultrasonography has a very high accuracy rate in the diagnosis of gallstone,up to 96%,but it has a poor effect in the examination of bile duct stones,with a sensitivity of only 30%～64.3%,which is easy to cause missed diagnosis.Some studies suggest that when using ultrasonography to diagnose choledocholithiasis,the results of ultrasonic report can be combined with serum liver function indexes to improve the accuracy of diagnosis.The causes of cholelithiasis are complex,including not only individual factors,family history,behavioral factors,dietary factors and other common influencing factors,but also blood biochemical indicators such as inflammatory factors,immunoglobulin,bilirubin,liver enzymes,etc.,which are also related to cholelithiasis.Objectives(1)To describe the clinical characteristics of inpatients with cholelithiasis and find out the key problems in the diagnosis and treatment of cholelithiasis at present.(2)To construct a screening model suitable for the classification of cholelithiasis in the real world based on the basic information of patients and the results of laboratory examination,so as to provide a simple and rapid auxiliary screening tool for clinicians.(3)To preliminarily explore the risk factors of blood biochemical indicators of cholelithiasis,so as to provide evidence for the prevention and early intervention of cholelithiasis.MethodsIn this study,the inpatients in the Third Hospital of Shandong Province were selected as the research object.A total of 1036 patients with cholelithiasis hospitalized between November 2019 and October 2020 were included as the case group.A total of 1645 patients without cholelithiasis who were hospitalized at the same time as the case group were selected as the control group from the Department of Respiratory Medicine,Department of Cardiovascular Medicine and Department of Gastroenterology.The basic information and clinical information of patients were collected from the medical record information system.The basic information mainly included gender,age,household registration,occupation,marital status,etc.,and the clinical information mainly included the medical record information of inpatients,laboratory examination,medical expenses,etc.SPSS24.0 and R were used for data analysis and graph drawing.The main analytical methods include:The main analytical methods include:t test was used to compare the measurement data conforming to normal distribution and homogeneity of variance between the two groups,variance analysis was used to compare the measurement data conforming to normal distribution and homogeneity of variance between multiple groups.Mann-Whitney U test was used to compare the position of the measurement data incompatible with normal distribution and homogeneity of variance between the two groups.Kruskal-Wallis test was used to compare the positions of measurement data that did not conform to normal distribution and homogeneity of variance.χ2 test was used to compare the enumeration data between groups.Lasso-Logistic regression analysis was used to construct the discriminant model of cholelithiasis.Adjusted odds ratios and 95%confidence intervals of cholelithiasis were calculated by Logistic regression model.Two-sided P values<0.05 were considered statistically significant.Results1.Among the 1036 cholelithiasis inpatients,there were 508 males(49.03%)and 528 females(51.97%),the male to female ratio was 1:1.04.The average age of inpatients with cholelithiasis was 61.99±16.47 years old,and the age group of 60-79 years old accounted for the highest proportion(45.17%).There was no statistical difference in gender composition among different age groups(χ2=5.142,P=0.162).The majority of the occupations of cholelithiasis inpatients were farmers,retirees,and unemployed.2.Among the 1036 cholelithiasis inpatients,427 patients(41.22%)had gallstones,609 patients(58.79%)had bile duct stones,and 932 patients(89.96%)had undergone minimally invasive surgery.The median length of hospitalization for cholelithiasis inpatients was 7 days,quartiles were 5 and 10 days,and the number of patients with 4-6 days of hospitalization was the largest,with 345 patients(33.31%).The median total hospitalization cost of cholelithiasis inpatients was 22070.97 yuan,quartile was 17666.69 yuan and 29050.91 yuan,and the number of patients with total hospitalization cost ranging from 20000 to 29999 yuan was the largest,with 408 cases(39.38%).3.In the study of constructing the discriminant model of cholelithiasis classification,9 blood biochemical indicators screened out by Lasso regression were used to calculate the scores of blood biochemical indicators,and the Logistic discriminant model was constructed by using stepwise regression method to screen out the four variables with discriminant value,namely the scores of blood biochemical indicators,age,household registration and occupation.The AUC and its 95%confidence interval were 0.861(0.835,0.888)on the training set,and the AUC and its 95%confidence interval were 0.846(0.793,0.898)on the validation set.4.In the case control study of cholelithiasis,compared with the normal range of blood biochemical indexes,decreased lymphocyte(OR=1.81,95%CI:1.36-2.41),increased direct bilirubin(OR=2.65,95%CI:1.78-3.94),increased alkaline phosphatase(OR=4.82,95%CI:3.12-7.45),increased transpeptidase(OR=3.30,95%CI:2.52-4.33),and increased alanine aminotransferase(OR=2.00,95%CI:1.42-2.82)were associated with an increased risk of cholelithiasis,increased lymphocyte(OR=0.32,95%CI:0.15-0.68)and decreased globulin(OR=0.42,95%CI:0.21-0.86)were associated with a reduced risk of cholelithiasis.Conclusions1.Most of the inpatients with cholelithiasis are elderly patients.No matter in general or by age group,there is no significant difference between men and women in cholelithiasis.Most cholelithiasis patients have bile duct stones in the classification of cholelithiasis.There are more patients with bile duct stones than cholecystolithiasis,and most patients with cholelithiasis are treated with minimally invasive surgery.2.Logistic model based on conventional variables and blood biochemical index scores to distinguish the classification of cholelithiasis has a good effect,and can be used as a supplementary method for cholelithiasis diagnosis.3.In hospitalized patients,decreased lymphocyte,increased direct bilirubin,increased alkaline phosphatase,increased transpeptidase,and increased alanine aminotransferase are associated with an increased risk of cholelithiasis,increased lymphocyte and decreased globulin are associated with a reduced risk of cholelithiasis. |
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