急性肠系膜血管缺血性疾病发生肠坏死的预测因素分析  

Predictive Factors of Intestinal Necrosis in Acute Mesenteric Ischemic

作　　者：徐亮[1] 吴鹏波[1] 谭诗云[1] XU Liang;WU Pengbo;TAN Shiyun(Department of Gastroenterology,Renmin Hospital of Wuhan University,Hubei 430060,China)

机构地区：[1]武汉大学人民医院消化内科,430060

出　　处：《医学研究杂志》2023年第5期119-123,共5页Journal of Medical Research

摘　　要：目的探讨急性肠系膜血管缺血性疾病(acute mesenteric ischemia,AMI)发生肠坏死的预测因素,为临床诊治提供参考依据。方法回顾性分析2013年1月~2021年12月武汉大学人民医院收治的75例AMI患者的临床资料,根据开腹手术确诊为肠坏死组28例和非肠坏死组47例。通过单因素和多因素Logistic回归分析确定AMI发生肠坏死的预测因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线评价各因素的预测价值。结果单因素分析显示,两组腹膜刺激征、白细胞计数、丙氨酸氨基转移酶(glutamyl aminotransferase,ALT)、天冬氨酸氨基转移酶(aspartate aminotransferase,AST)、血尿素氮、凝血酶原时间(prothrombin time,PT)、D-二聚体、腹腔游离液体、肠壁积气比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,白细胞计数升高、血尿素氮水平升高、腹腔游离液体及肠壁积气是AMI发生肠坏死的独立预测因素。上述指标及四者联合ROC曲线下面积分别为0.767(95%CI:0.656~0.857)、0.728(95%CI:0.613~0.825)、0.715(95%CI:0.600~0.814)、0.729(95%CI:0.614~0.825)、0.922(95%CI:0.837~0.972),四者联合预测肠坏死的敏感度为92.9%,特异性为83.0%。结论白细胞计数升高、血尿素氮水平升高、腹腔游离液体和肠壁积气是AMI患者发生肠坏死的独立预测因素,四者联合对发生肠坏死具有较高的诊断预测价值。Objective To explore the predictive factors for intestinal necrosis in acute mesenteric ischemic(AMI)and provide reference for clinical diagnosis and treatment.Methods The clinical data of 75 patients with AMI admitted to Renmin Hospital of Wuhan University from January 2013 to December 2021 were retrospectively analyzed.According to laparotomy,patients were divided into intestinal necrosis group(n=28)and non-intestinal necrosis group(n=47).Univariate analysis and multivariate Logistic regression analysis were used to determine predictive factors of intestinal necrosis in AMI.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of these factors.Results Univariate analysis showed that peritonitis irritation sign,white blood cell count,glutamyl aminotransferase(ALT),aspartate aminotransferase(AST),blood urea nitrogen level,prothrombin time(PT),D-dimer,free peritoneal fluid and pneumatosis intestinalis were risk factors of intestinal necrosis(all P<0.05).Multivariate Logistic regression analysis showed that white blood cell count,elevated blood urea nitrogen,free peritoneal fluid,pneumatosis intestinalis were the independent predictive factors of intestinal necrosis in AMI.The area under the ROC curve of the above indexes and the combination of the four were 0.767(95%CI:0.656-0.857),0.728(95%CI:0.613-0.825),0.715(95%CI:0.600-0.814),0.729(95%CI:0.614-0.825),0.922(95%CI:0.837-0.972),respectively.The combination of the four factors has a sensitivity of 92.9%and a specificity of 83.0%in predicting intestinal necrosis.Conclusion Increased white blood cell count,elevated blood urea nitrogen level,free peritoneal fluid and pneumatosis intestinalis are independent predictors of intestinal necrosis in patients with AMI,and the four alone or combined have certain diagnostic value for intestinal necrosis.The combination of the four has a high diagnostic and predictive value for the occurrence of intestinal necrosis.

关 键 词：急性肠系膜血管缺血性疾病 肠坏死 预测因素 

分 类 号：R572.3[医药卫生—消化系统]