急性肠系膜动静脉血管闭塞临床特征差异的研究

Investigation of different clinical features between acute mesenteric artery occlusion and acute mesenteric venous occlusion

目的探讨急性肠系膜动静脉血管闭塞临床特征的差异。方法回顾性总结2005—06～2011—05收治的69例急性肠系膜动静脉血管闭塞患者，根据CT血管造影（CTA）或手术所见将患者分为肠系膜动脉闭塞组和肠系膜静脉闭塞组。总结其临床特征，并分别记录两组肠坏死例数、发病至就诊的间隔时间及入院后即刻测定的静脉血白细胞计数（WBC）、中性粒细胞比例（N％）、D-二聚体（D—dimer）数值。结果①急性肠系膜血管闭塞（AMVO）患者初次就诊时均有腹痛表现，其中超过70％表现为上腹部或脐周疼痛；急性肠系膜动脉闭塞组呕吐发生率明显高于急性肠系膜静脉闭塞组（r=6．683，P=0．010）；长期吸烟在诱发AMVO中具有重要意义；②急性肠系膜动脉闭塞组就诊时发生的肠坏死率显著高于急性肠系膜静脉闭塞组（χ2=10．177，P〈0．01）；③急性肠系膜动脉闭塞组发病至就诊的间隔时间明显低于急性肠系膜静脉闭塞组[（47．1±39．0）hvs（154．6±62．6）h，P〈0．01]；N％、WBC均数水平高于急性肠系膜静脉闭塞组，其中N％比较差异有显著统计学意义（0．89±0．08vs0．73±0．19，P〈0．01），而两组WBC水平比较差异无统计学意义（P〉0．05）。两组D—dimer水平均明显高于正常值高限，但急性肠系膜动脉闭塞组明显低于急性肠系膜静脉闭塞组[（2．4±3．0）μg／mLvs（10．8±7．2）μg／mL，P〈0．01]。以D—dimer水平3．0μg／mL为截值鉴别急性肠系膜动脉闭塞和静脉闭塞有较高的敏感性（82．0％）和特异性（78．9％）。结论急性肠系膜动静脉血管闭塞临床特征及辅助检查间存在差异，检测D—dimer有助于急性肠系膜动脉与静脉闭塞间的鉴别。

Objective To study different clinical features between acute mesenteric artery occlusion and acute mesenteric venous occlusion. Methods The clinical data of 69 cases with acute mesenteric vascular occlusion （AMVO） from June 2005 to May 2011 were retrospectively reviewed. The 69 cases were divided into mesenteric artery occlusion group and mesenteric venous occlusion group according to CT angiography or the findings of operations. Their clinical features were summarized. The counts of bowel necrosis, the interval from onset to treatment, the serum WBC, N% and the levels of D - dimer of the two groups were recorded. Results （1）Abdominal pain was the same symptom in all the patients with AMVO when they received medical treatment for the first time. Over 70% patients displayed upper abdominal pain or umbilicus - round pain. The incidence rate of vomiting was much higher in mesenteric artery occlusion group than in mesenteric venous occlusion group （χ2 = 6. 683, P 〈 0.05）. Long -term smoking was very of significance in the AMVO; （2）The incidence rate of bowel necrosis was much higher in mesenteric artery occlusion group than in mesenteric venous occlusion group （χ2 = 10. 177 ,P 〈 0.01 ） ; （3）The interval from onset to treatment was much shorter in mesenteric artery occlusion group than in mesenteric venous occlusion group [ （47.1±39.0） h vs （ 154.6±62.6） h, P 〈0.01 ）. The mean of WBC and N% were higher in mesenteric artery occlusion group than in mesenteric venous occlusion group,but there was statistical significance only in the mean of N% （0.89±0.08 vs 0.73±0.19 ,P 〈 0.01 ）. The levels of D - dimer of the two groups were all obviously higher than normal levels, but the level of mesenteric artery occlusion group was much lower than that of mesenteric venous occlusion group [ （2.4±3.0） μg/mL vs （ 10.8±7.2） μg/mL, P 〈 0. 01 ]. The sensibility was 82.0% and the specificity was 78.9% in the identification of acute mesenteric artery occlusion and acute mesenteric venous occlusion according as the level of D - dimer was 3.0 μg/mL. Conclusion There are differences in clinical features and auxiliary examinations between acute mesenteric artery occlusion and acute mesenteric venous occlusion, and the test of D - dimer is helpful to identify acute mesenteric artery occlusion and acute mesenteric venous occlusion.