血清再生胰岛衍生蛋白3α与降钙素原对胆总管结石患者内镜逆行胰胆管造影术后胰腺炎的预测价值

doi:10.3877/cma.j.issn.2095-2015.2026.01.012

中华消化病与影像杂志(电子版) ›› 2026, Vol. 16 ›› Issue (01) : 67 -72. doi: 10.3877/cma.j.issn.2095-2015.2026.01.012

论著

血清再生胰岛衍生蛋白3α与降钙素原对胆总管结石患者内镜逆行胰胆管造影术后胰腺炎的预测价值

王小娟¹, 王一菲¹, 冯莉², 周发明², 杨玉华¹, 叶艳华¹, 许云涛¹^,^†(

)

¹610000　成都，四川省中医药科学院中医研究所（四川省第二中医医院）普外科
²610000　成都，四川省中医药科学院中医研究所（四川省第二中医医院）消化内科

收稿日期:2025-09-14 出版日期:2026-02-01
通信作者: 许云涛

Predictive value of serum regenerated islet derived protein 3α and procalcitonin for post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with common bile duct stones

Xiaojuan Wang¹, Yifei Wang¹, Li Feng², Faming Zhou², Yuhua Yang¹, Yanhua Ye¹, Yuntao Xu¹^,^†()

¹Department of General Surgery, Institute of Traditional Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences (Sichuan Second Hospital of Traditional Chinese Medicine), Chengdu 610000, China
²Department of Gastroenterology, Institute of Traditional Chinese Medicine, Sichuan Academy of Chinese Medicine Sciences (Sichuan Second Hospital of Traditional Chinese Medicine), Chengdu 610000, China

Received:2025-09-14 Published:2026-02-01
Corresponding author: Yuntao Xu

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引用本文：

王小娟, 王一菲, 冯莉, 周发明, 杨玉华, 叶艳华, 许云涛. 血清再生胰岛衍生蛋白3α与降钙素原对胆总管结石患者内镜逆行胰胆管造影术后胰腺炎的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(01): 67-72.

Xiaojuan Wang, Yifei Wang, Li Feng, Faming Zhou, Yuhua Yang, Yanhua Ye, Yuntao Xu. Predictive value of serum regenerated islet derived protein 3α and procalcitonin for post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with common bile duct stones[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(01): 67-72.

目的

探讨血清再生胰岛衍生蛋白3α（Reg3α）、降钙素原（PCT）及临床因素检测，对胆总管结石患者内镜逆行胰胆管造影（ERCP）术后胰腺炎（PEP）的预测价值。

方法

回顾性选取2022年1月至2025年1月于四川省第二中医医院接受ERCP治疗的200例胆总管结石患者为研究对象，根据术后是否发生PEP分为PEP组（32例）和非PEP组（168例）。比较两组患者的临床资料和血清Reg3α和PCT水平差异，Spearman分析血清Reg3α和PCT水平与PEP发生的相关性。多因素Logistic回归筛选PEP的独立危险因素。绘制受试者工作特征曲线（ROC）评估各指标单独及联合预测价值。

结果

PEP组与非PEP组患者既往胰腺炎病史、血清淀粉酶（AMY）、血清脂肪酶（LPS）、胆总管结石大小及手术操作时间均差异显著（P<0.05），PEP组患者血清Reg3α和PCT水平均高于非PEP组（P<0.001）。Spearman分析显示，血清Reg3α和PCT水平均与PEP发生呈正相关（r=0.426，P<0.001；r=0.361，P<0.001）。二元Logistic回归显示，AMY、胆总管结石大小、血清Reg3α、血清PCT及既往胰腺炎病史是胆总管结石患者ERCP术后PEP的独立危险因素（P<0.05）。ROC分析显示，血清Reg3α、PCT等各单一指标预测PEP的AUC为0.604~0.872，而联合预测模型的AUC显著提高至0.987（灵敏度0.938，特异度0.946）。DeLong检验显示，联合预测效能显著优于任何单一指标（P<0.05）。

结论

术前血清Reg3α与PCT及临床因素联合检测对胆总管结石患者ERCP后PEP有较高临床预测价值，其联合预测效能显著优于单一指标检测，有助于早期识别PEP高风险患者。

关键词: 胆总管结石, 胰腺炎, 内镜逆行胰胆管造影, 再生胰岛衍生蛋白3α, 降钙素原, 预测价值

Objective

To explore the predictive value of combined detection of serum regenerated islet derived protein 3α (Reg3α), procalcitonin (PCT), and clinical factors for postoperative pancreatitis (PEP) in patients with common bile duct stones after endoscopic retrograde cholangiopancreatography (ERCP).

Methods

A total of 200 patients with common bile duct stones who received ERCP treatment in Sichuan Second Hospital of Traditional Chinese Medicine from January 2022 to January 2025 were selected retrospectively as the research subjects. They were divided into the PEP group (32 cases) and the non-PEP group (168 cases) according to whether PEP occurred after the operation. The clinical data and the levels of serum Reg3α and PCT between the two groups were compared. Spearman was used to analyze the correlation between serum Reg3α and PCT levels and PEP. Multivariate Logistic regression was used to screen for independent risk factors of PEP. The receiver operating characteristic (ROC) curve was drawn to evaluate the individual and combined predictive value of each index.

Results

There were statistically significant differences in the history of previous pancreatitis, serum amylase level (AMY), serum lipase (LPS), size of common bile duct stones and operation time between the PEP group and the non-PEP group (P<0.05). The levels of serum Reg3α and PCT in the PEP group were both higher than those in the non-PEP group (P<0.001). Spearman showed that both serum Reg3α and PCT levels were positively correlated with the occurrence of PEP (r=0.426, P<0.001; r=0.361, P<0.001). Binary Logistic regression showed that AMY, the size of common bile duct stones, serum Reg3α, serum PCT and previous history of pancreatitis were independent risk factors for PEP after ERCP in patients with common bile duct stones (P<0.05). ROC showed that the AUC of serum Reg3α, PCT and other single indicators for predicting PEP was 0.604-0.872, while the AUC of the combined prediction model was significantly increased to 0.987 (with a sensitivity of 0.938 and a specificity of 0.946). Moreover, the DeLong test showed that the combined predictive efficacy was significantly superior to any single indicator (P<0.05).

Conclusion

The combined detection of preoperative serum Reg3α, PCT and clinical factors has a high clinical predictive value for PEP in patients with common bile duct stones after ERCP, and its combined predictive efficiency is significantly better than that of single index detection, which is helpful for early identification of patients with high risk of PEP.

Key words: Common bile duct stones, Pancreatitis, Endoscopic retrograde cholangiopancreatography, Regenerated islet derived protein 3α, Procalcitonin, Predictive value

表1 两组患者临床基线资料对比

临床资料		PEP组(n=32)	非PEP组(n=168)	χ²/t值	P值
性别[例(%)]	男	18(56.25)	92(54.76)	0.024	0.877
	女	14(43.75)	76(45.24)
年龄(岁,±s)		58.31±6.42	57.86±6.61	0.359	0.720
体重指数(kg/m²,±s)		22.47±1.36	22.80±1.26	-1.348	0.179
吸烟史[例(%)]	有	14(43.75)	68(40.48)	0.119	0.730
	无	18(56.25)	100(59.52)
饮酒史[例(%)]	有	12(37.50)	52(30.95)	0.530	0.467
	无	20(62.50)	116(69.05)
糖尿病史[例(%)]	有	8(25.00)	30(17.86)	0.891	0.345
	无	24(75.00)	138(82.14)
高血压病史[例(%)]	有	12(37.50)	60(35.71)	0.037	0.847
	无	20(62.50)	108(64.29)
高脂血症史[例(%)]	有	8(25.00)	36(21.43)	0.200	0.655
	无	24(75.00)	132(78.57)
胰腺炎病史[例(%)]	有	8(25.00)	7(4.17)	16.817	<0.001
	无	24(75.00)	161(95.83)
淀粉酶(U/L,±s)		121.46±23.63	92.46±18.61	7.716	<0.001
脂肪酶(U/L,±s)		155.75±27.50	142.46±25.66	2.655	0.009
总胆红素(μmol/L,±s)		28.46±8.36	27.74±7.81	0.476	0.635
丙氨酸转氨酶(U/L,±s)		45.64±11.27	44.44±10.62	0.582	0.561
天冬氨酸转氨酶(U/L,±s)		40.18±10.60	39.52±9.91	0.342	0.733
碱性磷酸酶(U/L,±s)		125.77±22.32	124.38±22.64	0.318	0.751
γ-谷氨酰转移酶(U/L)		105.67±20.32	104.37±19.49	0.345	0.731
白细胞计数(×10⁹/L,±s)		7.81±1.95	7.47±1.84	0.966	0.335
C反应蛋白(mg/L,±s)		8.53±3.29	7.89±2.89	1.131	0.259
胆总管结石大小(mm,±s)		12.20±2.21	9.11±1.85	8.387	<0.001
胆总管结石数量(±s)		2.19±0.64	2.05±0.73	1.008	0.315
手术操作时间(min,±s)		42.68±7.63	38.48±7.27	2.975	0.003

表1 两组患者临床基线资料对比

临床资料		PEP组(n=32)	非PEP组(n=168)	χ²/t值	P值
性别[例(%)]	男	18(56.25)	92(54.76)	0.024	0.877
	女	14(43.75)	76(45.24)
年龄(岁,±s)		58.31±6.42	57.86±6.61	0.359	0.720
体重指数(kg/m²,±s)		22.47±1.36	22.80±1.26	-1.348	0.179
吸烟史[例(%)]	有	14(43.75)	68(40.48)	0.119	0.730
	无	18(56.25)	100(59.52)
饮酒史[例(%)]	有	12(37.50)	52(30.95)	0.530	0.467
	无	20(62.50)	116(69.05)
糖尿病史[例(%)]	有	8(25.00)	30(17.86)	0.891	0.345
	无	24(75.00)	138(82.14)
高血压病史[例(%)]	有	12(37.50)	60(35.71)	0.037	0.847
	无	20(62.50)	108(64.29)
高脂血症史[例(%)]	有	8(25.00)	36(21.43)	0.200	0.655
	无	24(75.00)	132(78.57)
胰腺炎病史[例(%)]	有	8(25.00)	7(4.17)	16.817	<0.001
	无	24(75.00)	161(95.83)
淀粉酶(U/L,±s)		121.46±23.63	92.46±18.61	7.716	<0.001
脂肪酶(U/L,±s)		155.75±27.50	142.46±25.66	2.655	0.009
总胆红素(μmol/L,±s)		28.46±8.36	27.74±7.81	0.476	0.635
丙氨酸转氨酶(U/L,±s)		45.64±11.27	44.44±10.62	0.582	0.561
天冬氨酸转氨酶(U/L,±s)		40.18±10.60	39.52±9.91	0.342	0.733
碱性磷酸酶(U/L,±s)		125.77±22.32	124.38±22.64	0.318	0.751
γ-谷氨酰转移酶(U/L)		105.67±20.32	104.37±19.49	0.345	0.731
白细胞计数(×10⁹/L,±s)		7.81±1.95	7.47±1.84	0.966	0.335
C反应蛋白(mg/L,±s)		8.53±3.29	7.89±2.89	1.131	0.259
胆总管结石大小(mm,±s)		12.20±2.21	9.11±1.85	8.387	<0.001
胆总管结石数量(±s)		2.19±0.64	2.05±0.73	1.008	0.315
手术操作时间(min,±s)		42.68±7.63	38.48±7.27	2.975	0.003

表2 两组患者血清Reg3α和PCT水平比较（

±s）

组别	例数	Reg3α(ng/mL)	PCT(ng/mL)
PEP组	32	13.61±2.88	1.78±0.54
非PEP组	168	10.23±2.06	1.23±0.41
t值		6.336	5.436
P值		<0.001	<0.001

表2 两组患者血清Reg3α和PCT水平比较（

±s）

组别	例数	Reg3α(ng/mL)	PCT(ng/mL)
PEP组	32	13.61±2.88	1.78±0.54
非PEP组	168	10.23±2.06	1.23±0.41
t值		6.336	5.436
P值		<0.001	<0.001

表3 血清Reg3α和PCT水平与胆总管结石患者ERCP术后胰腺炎的相关性分析

变量	系数	组别	血清Reg3α	血清PCT
组别	r	1	0.426	0.361
	P	-	<0.001	<0.001
血清Reg3α	r	0.426	1	0.168
	P	<0.001	-	0.017
血清PCT	r	0.361	0.168	1
	P	<0.001	0.017	-

表3 血清Reg3α和PCT水平与胆总管结石患者ERCP术后胰腺炎的相关性分析

变量	系数	组别	血清Reg3α	血清PCT
组别	r	1	0.426	0.361
	P	-	<0.001	<0.001
血清Reg3α	r	0.426	1	0.168
	P	<0.001	-	0.017
血清PCT	r	0.361	0.168	1
	P	<0.001	0.017	-

表4 Logistic回归分析胆总管结石患者ERCP术后胰腺炎的独立危险因素

变量	β	SE	Wald χ²	P	OR(95% CI)
血清淀粉酶	0.061	0.026	5.435	0.020	1.063(1.010~1.118)
血清脂肪酶	0.030	0.020	2.336	0.126	1.031(0.992~1.071)
胆总管结石大小	0.934	0.313	8.904	0.003	2.543(1.378~4.696)
手术操作时间	0.113	0.067	2.833	0.092	1.120(0.982~1.278)
血清Reg3α	0.758	0.281	7.255	0.007	2.134(1.229~3.703)
血清降钙素原	3.949	1.277	9.557	0.002	51.880(4.243~634.328)
既往胰腺炎病史	6.196	1.695	13.353	<0.001	490.573(17.681~13 611.602)

表4 Logistic回归分析胆总管结石患者ERCP术后胰腺炎的独立危险因素

变量	β	SE	Wald χ²	P	OR(95% CI)
血清淀粉酶	0.061	0.026	5.435	0.020	1.063(1.010~1.118)
血清脂肪酶	0.030	0.020	2.336	0.126	1.031(0.992~1.071)
胆总管结石大小	0.934	0.313	8.904	0.003	2.543(1.378~4.696)
手术操作时间	0.113	0.067	2.833	0.092	1.120(0.982~1.278)
血清Reg3α	0.758	0.281	7.255	0.007	2.134(1.229~3.703)
血清降钙素原	3.949	1.277	9.557	0.002	51.880(4.243~634.328)
既往胰腺炎病史	6.196	1.695	13.353	<0.001	490.573(17.681~13 611.602)

图1 血清Reg3α和PCT检测及各独立因素对胆总管结石患者ERCP术后胰腺炎的预测效能的ROC曲线注：Reg3α再生胰岛衍生蛋白3α；PCT降钙素原；ERCP内镜逆行胰胆管造影

表5 血清Reg3α和降钙素原检测及各独立因素对胆总管结石患者ERCP术后胰腺炎的预测效能

检验变量	AUC	SE	P	95% CI	临界值	约登指数	灵敏度	特异度
血清淀粉酶	0.830	0.046	<0.001	0.738~0.921	109.56	0.614	0.781	0.833
胆总管结石大小	0.872	0.042	<0.001	0.791~0.954	11.22	0.688	0.813	0.875
血清Reg3α	0.835	0.043	<0.001	0.752~0.919	12.63	0.581	0.688	0.893
血清降钙素原	0.784	0.051	<0.001	0.685~0.884	1.725	0.518	0.625	0.893
既往胰腺炎病史	0.604	0.06	0.062	0.487~0.722	0.500	0.208	0.250	0.958
联合预测	0.987	0.007	<0.001	0.972~1.000	0.214	0.884	0.938	0.946

表5 血清Reg3α和降钙素原检测及各独立因素对胆总管结石患者ERCP术后胰腺炎的预测效能

检验变量	AUC	SE	P	95% CI	临界值	约登指数	灵敏度	特异度
血清淀粉酶	0.830	0.046	<0.001	0.738~0.921	109.56	0.614	0.781	0.833
胆总管结石大小	0.872	0.042	<0.001	0.791~0.954	11.22	0.688	0.813	0.875
血清Reg3α	0.835	0.043	<0.001	0.752~0.919	12.63	0.581	0.688	0.893
血清降钙素原	0.784	0.051	<0.001	0.685~0.884	1.725	0.518	0.625	0.893
既往胰腺炎病史	0.604	0.06	0.062	0.487~0.722	0.500	0.208	0.250	0.958
联合预测	0.987	0.007	<0.001	0.972~1.000	0.214	0.884	0.938	0.946

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Predictive value of serum regenerated islet derived protein 3α and procalcitonin for post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with common bile duct stones

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Predictive value of serum regenerated islet derived protein 3α and procalcitonin for post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with common bile duct stones