重症急性胰腺炎后期发生胃瘫的影响及其风险预测模型构建  

Impact of gastroparesis in the late phase of severe acute pancreatitis and development of a risk prediction model

作　　者：张孟哲 张正乐 李汉军 朱忠超 荣愈平[1] 杨强[1] 熊星铖[1] 陶京 Zhang Mengzhe;Zhang Zhengle;Li Hanjun;Zhu Zhongchao;Rong Yuping;Yang Qiang;Xiomg Xingcheng;Tao Jing(Department of Pancreatic Surgery,Renmin Hostipal of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院胰腺外科,湖北武汉430060

出　　处：《腹部外科》2025年第2期134-141,共8页Journal of Abdominal Surgery

摘　　要：目的探讨重症急性胰腺炎(severe acute pancreatitis,SAP)后期胃瘫的发生风险及SAP的预后,开发一种在SAP早期即可预测后期胃瘫发生风险的列线图模型。方法回顾性分析2019年10月至2023年12月武汉大学人民医院胰腺外科收治的240例SAP病人的临床资料,根据SAP发病2周后是否发生胃瘫分为胃瘫组和非胃瘫组,并进行组间比较。将240例SAP病人按8∶2比例随机分为训练集192例和验证集48例,对训练集变量进行相关性分析,采用Lasso回归和多元logistic回归筛选出胃瘫风险预测因子,构建列线图模型并进行验证和分析。结果240例病人SAP后期胃瘫发生率为29.6%(71/240),胃瘫组较非胃瘫组住院费用增加、住院时间延长、长期ICU住院率显著延长、60 d全因死亡率增加、手术次数及开腹手术率均增加。基于训练集数据筛选出7项独立预测因子,营养风险筛查2002评分、肠内营养开始距SAP发病时间、入院72 h平均血糖、C反应蛋白和白细胞计数、胰腺胰周坏死或炎症渗出面积和部位,并构建列线图模型。列线图模型在训练集和验证集中均展现了良好的区分度、真实性和临床应用价值。结论SAP后期胃瘫发生率较高且影响预后,该研究建立的SAP病人后期胃瘫风险预测模型有助于早期识别高风险病人,为临床采取针对性干预措施提供重要参考,有望改善病人预后。Objective To investigate the risk of gastroparesis and prognosis of late-phase gastroparesis in severe acute pancreatitis(SAP),and to constructa nomogram to early predict its risk,thus reducing the incidence of gastroparesis.Methods A retrospective analysis was conducted on the clinical data of 240 SAP patients who were admitted to the Department of Pancreatic Surgery,Renmin Hospital of Wuhan University,from October 2019 to December 2023.Based on the occurrence of gastroparesis at 2 weeks of SAP,they were divided into the gastroparesis group and non-gastroparesis group,and clinical data were compared between groups.A total of 240 SAP patients were randomly divided into the training set(192 cases)and validation set(48 cases)at a ratio of 8∶2.Correlation analysis was conducted on the variables in the training set,and Lasso regression and multivariate logistic regression was used to identify risk predictors for gastroparesis.A nomogram was constructed,validated,and analyzed.Results The incidence of gastroparesis in the late phase of SAP was 29.6%(71/240).Compared with the non-gastroparesis group,patients with gastroparesis demonstrated significantly increased hospitalization costs,prolonged hospital stays,higher rates of extended ICU admission,elevated 60-day all-cause mortality,and greater frequencies of both overall surgical interventions and laparotomy procedures.Through analysis of the training cohort,seven independent predictive factors were identified:Nutritional Risk Screening 2002(NRS2002)score,time interval from SAP onset to enteral nutrition initiation,mean 72-hour blood glucose(Glu)levels,C-reactive protein concentration,leukocyte count,as well as the extent and anatomical distribution of pancreatic/peripancreatic necrosis or inflammatory exudation.These parameters were incorporated into a nomogram,which exhibited excellent discriminative ability,calibration,and clinical utility in both training and validation datasets.Conclusion The validated nomogram provides clinicians with a practical tool for early

关 键 词：胃瘫 重症急性胰腺炎 列线图 预测模型 

分 类 号：R657.5[医药卫生—外科学]