穿透型克罗恩病病人术后并发症发生的风险和保护性因素

Risk and protective factors for postoperative complications in penetrating Crohn's disease

目的：探讨穿透型克罗恩病（CD）术后并发症发生的风险和保护性因素,以期改进术前管理。方法：回顾我科收治的154例接受肠切除吻合手术的穿透型CD病人的临床资料,采用Logistic回归模型分析术后并发症发生的风险和保护性因素。结果：手术后有20例（12.9%）病人出现并发症。多变量分析显示,术前C反应蛋白（CRP,P=0.028,A值：1.687,95%CI：1.059~2.687）是术后并发症发生的风险性因素,且CRP的分界值为26.5 mg/L（P=0.000）,敏感性为85.0%,特异性为93.3%。术前营养支持（P=0.021,A值：0.001,95%CI：0.000~0.341）和骨骼肌含量（SMM,P=0.027,A值：0.172,95%CI：0.036~0.815）是术后并发症发生的保护性因素,且SMM的分界值为17.4 kg（P=0.000）,敏感性为95.0%,特异性为80.6%。结论：术前应尽可能降低CD的炎性活动,并进行营养支持,以改善病人的营养状况。SMM可作为预测参数,从而改进术前管理、降低术后并发症的发生率。

Objective： The study was to explore the risk and protective factors for postoperative complications in penetrating Crohn＇s disease（ CD）. Methods： 154 patients with penetrating CD were collected and analyzed. Results： Postoperative complications occurred in 20 /154（ 12. 9%）. In the multivariate analysis,preoperative C-reactive protein（ CRP,P = 0. 028,A： 1. 687,95% CI： 1. 059 ~2. 687） was a significantly independent risk factor for postoperative complications,and the cut-off value of CRP was 26. 5mg / L（ P = 0. 000,sensitivity 85. 0%,specificity 93. 3%）. Preoperative nutrition support（ P = 0. 021,A： 0. 001,95% CI： 0. 000 ~ 0. 341） and skeletal muscle mass（ SMM,P = 0. 027,A：0. 172,95% CI： 0. 036 ~ 0. 815） were significantly independent protective factors for postoperative complications,and the cut-off value of SMM was 17. 4 kg（ P = 0. 000,sensitivity 95. 0%,specificity80. 6%）. Conclusion： The inflammatory activity should be controlled and the nutritional support must be provided before operation in indicated penetrating CD patients. SMM may be an appropriate predictor.