【摘要】 目的：探讨胆道恶性肿瘤转移的危险因素，并分析相关临床指标对胆道恶性肿瘤转移的预测价值。方法：回顾性分析2015年1月至2021年12月在延边大学附属医院住院治疗的276例胆道恶性肿瘤患者的临床资料，按肿瘤有无转移分为转移组与非转移组。收集患者的各项临床指标，进行单因素及多因素Logistic回归分析，总结胆道恶性肿瘤转移的危险因素，并绘制受试者工作特征曲线（ROC曲线），分析相关临床指标对胆道恶性肿瘤转移的预测价值。结果：单因素分析结果显示，转移组与非转移组的白细胞计数（WBC）、中性粒细胞计数（NEUT）、癌胚抗原（CEA）、糖类抗原19-9(CA19-9)、凝血酶原时间（PT）、血小板/淋巴细胞比值（PLR）、中性粒细胞/淋巴细胞比值（NLR）、淋巴细胞绝对值（LYM）、谷草转氨酶（AST）、谷丙转氨酶（ALT）、碱性磷酸酶（ALP）、总胆红素（TBIL）、直接胆红素（DBIL）、总胆汁酸（TBA）差异均有统计学意义（P <0.05）。多因素Logistic回归分析结果显示，CA19-9、PLR是胆道恶性肿瘤转移的独立危险因素（OR> 1,P <0.05）;ALP、TBA是胆道恶性肿瘤转移的独立保护因素（OR <1,P <0.05）。CA19-9是胆道恶性肿瘤肝内转移的独立危险因素，LYM、TBA是其独立保护因素；CA19-9、NLR是胆道恶性肿瘤肝外转移的独立危险因素。ALP、TBA、CA19-9、PLR单独检测及四项联合检测的ROC曲线下面积（AUC）分别为0.604、0.635、0.646、0.647、0.791。结论：CA19-9、PLR是胆道恶性肿瘤转移的独立危险因素，而ALP、TBA是其独立保护因素。CA19-9、TBA、PLR、ALP联合检测对胆道恶性肿瘤转移具有一定的预测价值，其中CA19-9、LYM、TBA对预测胆道恶性肿瘤肝内转移具有一定价值，CA19-9、NLR对预测胆道恶性肿瘤肝外转移具有一定价值。更多还原

【Abstract】 Objective: To investigate the risk factors of metastasis of biliary tract malignant tumors, and analyze the predictive value of related clinical indexes in biliary malignant tumor metastasis. Method: A retrospective analysis was conducted on the clinical data of 276 patients with biliary tract malignant tumor who were hospitalized in the Affiliated Hospital of Yanbian University from January 2015 to December 2021. The patients were divided into metastatic group and non-metastatic group according to whether the tumor had metastases. Various clinical indicators of patients were collected, univariate and multivariate logistic regression analysis was performed to summarize the risk factors for metastasis of biliary tract malignant tumor, and receiver operating characteristic curve(ROC curve) was plotted to analyze the predictive value of relevant clinical indicators for biliary tract malignant tumor metastasis. Result: The results of univariate analysis showed that there were statistically significant differences in Leukocyte count(WBC), neutrophil count(NEUT), carcinoembryonic antigen(CEA), carbohydrate antigen 19-9(CA19-9), prothrombin time(PT), platelet/lymphocyte ratio(PLR), neutrophil/lymphocyte ratio(NLR), absolute lymphocyte value(LYM), aspartate transaminase(AST), alanine transaminase(ALT), alkaline phosphatase(ALP), total bilirubin(TBIL), direct bilirubin(DBIL) and total bile acid(TBA) between metastatic group and non-metastatic group(P<0.05). Multivariate Logistic regression analysis showed that CA19-9 and PLR were independent risk factors for biliary tract malignant tumor metastasis(OR>1, P<0.05), and ALP and TBA were independent protective factors for biliary tract malignant tumor metastasis(OR<1, P<0.05). CA19-9 was an independent risk factor for intrahepatic metastasis of biliary tract malignant tumor, while LYM and TBA were independent protective factors. CA19-9 and NLR were independent risk factors for extrahepatic metastasis of biliary tract malignant tumor. The areas under the ROC curve(AUC)of ALP, TBA, CA19-9 and PLR alone and combined detection were 0.604, 0.635, 0.646, 0.647, and 0.791, respectively. Conclusion: CA19-9 and PLR are independent risk factors for biliary tract malignant tumor metastasis, while ALP and TBA are independent protective factors. The combined detection of CA19-9, TBA, PLR and ALP has certain predictive value for the metastasis of biliary tract malignant tumors, among which CA19-9, LYM and TBA have certain value in predicting intrahepatic metastasis of biliary tract malignant tumors, and CA19-9 and NLR have a certain value in predicting extrahepatic metastasis of biliary tract malignant tumors.更多还原