相关血液与血生化指标对缺血性结肠炎诊断及结局预判价值的研究

Study on the value of related blood and blood biochemical indicators in the diagnosis and outcome prediction of ischemic colitis

目的分析临床相关血液与血生化指标对缺血性结肠炎(IC)的诊断及结局预测价值。方法收集2013年1月—2018年3月武汉大学人民医院、武汉大学中南医院收治的IC患者115例的临床资料并进行分析;同期于医院因腹痛或便血就诊94例患者,均完成肠镜检查,并诊断为非IC患者作为对照组。比较2组入院48 h内血生化指标,采用受试者工作特征(ROC)曲线评价各项指标对IC的诊断效能及预后价值。结果 IC组患者高血压、冠心病、脑梗死、房颤、腹部手术史比例较对照组显著增高(χ~2/P=16.756/0.000、7.133/0.011、5.711/0.024、4.905/0.041、9.263/0.003);2组纤维蛋白原(Fib)、D-二聚体(D-D)、血小板(PLT)、白细胞(WBC)、血红蛋白(Hb)、凝血酶原时间(PT)、血钾(K)、白蛋白(Alb)、总胆固醇(TC)等比较差异均有统计学意义(t/P=5.753/0.000、1.986/0.045、2.253/0.025、7.189/0.000、5.271/0.000、1.988/0.049、6.969/0.000、9.045/0.000、3.582/0.000); Fib+DD+血K联合诊断IC的准确性最高(AUC=0.903,95%CI=0.861～0.946,P=0.000)。另Hb对IC结局的预测效能最大(AUC=0.695,95%CI=0.551～0.840,P=0.019)。结论若患者首诊以腹痛或便血就诊,血生化联合检测可提高IC的诊断效能,纤维蛋白原+D-二聚体+血钾联合检测能达到较好的准确性,血红蛋白可能具有早期预测IC结局的效能,患者既往病史也有助于IC的诊断及鉴别诊断。

Objective To analyze the value of clinically relevant blood and blood biochemical indicators in the diagnosis and outcome of ischemic colitis(IC).Methods The clinical data of 115 patients with IC admitted to Wuhan University People's Hospital and Zhongnan Hospital of Wuhan University from January 2013 to March 2018 were collected and analyzed.In the same period,94 patients with abdominal pain or blood in the hospital were treated with colonoscopy.A non-IC patient was diagnosed as a control group.The blood biochemical parameters of the two groups were compared within 48 hours after admission.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy and prognostic value of each index for IC.Results The proportion of patients with hypertension,coronary heart disease,cerebral infarction,atrial fibrillation,and abdominal surgery in the IC group was significantly higher than that in the control group(χ^2/P=16.756/0.000,χ^2/P=7.133/0.011,χ^2/P=5.711/0.024,χ2/P=4.905/0.041,χ^2/P=9.263/0.003);2 groups of fibrinogen(Fib),D-dimer(DD),platelet(PLT),white blood cells(WBC),hemoglobin(Hb),thrombin The differences in the original time(PT),serum potassium(K),albumin(Alb),total cholesterol(TC)were statistically significant(t/P=5.753/0.000,t/P=1.986/0.045,t/P=2.253/0.025,t/P=7.189/0.000,t/P=5.271/0.000,t/P=1.988/0.049,t/P=6.969/0.000,t/P=9.045/0.000,t/P=3.582/0.000);Fib+DD+blood K combined diagnostic IC had the highest accuracy(AUC=0.903,95%CI=0.861-0.946,P=0.000).In addition,Hb had the highest predictive power for IC outcome(AUC=0.695,95%CI=0.551~0.840,P=0.019).Conclusion If patients first visit with abdominal pain or stool blood,combined blood biochemical test can improve the diagnostic efficiency of IC.The combined detection of fibrinogen+D dimer+blood potassium can achieve better accuracy.Hemoglobin may have the effect of early predicting IC outcomes.The patient's past medical history is also helpful to the diagnosis and differential diagnosis of IC.