急性肠系膜上静脉血栓形成继发透壁性肠坏死的相关因素分析

Relative factors of transmural intestinal necrosis in acute superior mesenteric vein thrombosis

目的探讨急性肠系膜上静脉血栓形成(ASMVT)阶梯式治疗过程中继发透壁性肠坏死(TIN)的相关因素。方法回顾性分析2009年1月至2017年6月南京大学医学院附属金陵医院(东部战区总医院)普通外科收治的89例ASMVT患者的临床资料,男性52例,女性37例,年龄(45.9±12.6)岁(范围:20~69岁)。根据术后病理学结果及随访情况分为TIN组31例及非TIN组58例(其中肠狭窄18例)。ASMVT继发TIN的相关因素的单因素分析采用t检验、U检验、χ^2检验,多因素分析采用二元Logistic回归。采用受试者工作特征(ROC)曲线和曲线下面积评价各因素预测TIN的价值和截点值。结果单因素分析结果显示,两组吸烟史、高血压、腹膜炎刺激征,白细胞计数、血红蛋白、国际标准化比值、血清白蛋白,以及肠系膜上静脉分支血栓形成、腹腔游离积液、肠壁增强减弱、肠壁积气差异有统计学意义(P值均<0.05)。多因素分析结果显示,白细胞计数升高(OR=1.093,95%CI:1.010~1.182,P=0.027)、肠系膜上静脉分支血栓形成(OR=11.519,95%CI:1.906~69.615,P=0.008)及肠壁积气(OR=11.140,95%CI:2.360~52.585,P=0.002)是ASMVT患者发生TIN的相关因素。上述指标及预测模型ROC曲线下面积分别为0.759(95%CI:0.647~0.871)、0.745(95%CI:0.641~0.848)、0.737(95%CI:0.621~0.854)、0.909(95%CI:0.847~0.971)。ROC曲线显示,白细胞计数的截点值是18.1×10^9/L。结论白细胞水平升高、肠系膜上静脉分支血栓形成和肠壁积气是ASMVT继发TIN的独立相关因素。

Objective To examine the relative factors of transmural intestinal necrosis(TIN)during multidisciplinary stepwise management facilitating the decision making in patients with acute superior mesenteric vein thrombosis(ASMVT).Methods Clinical data of patients with ASMVT admitted to Department of General Surgery,Jinling Hospital from January 2009 to June 2017 were reviewed retrospectively.There were 52 males and 37 females,aging(45.9±12.6)years(range:20 to 69 years).According to the postoperative pathological results and follow-up,the patients were divided into TIN group(n=31)and non-TIN group(n=58,including 18 cases of intestinal stricture).The related factors were compared between ASMVT patients with TIN and patients without TIN by univariate analysis using t test,U test and χ^2 test accordingly,and factors with statistically significance were subsequently submitted to binary Logistic regression analysis.The predictive value and cut-off point of factors were evaluated by receiver operator characteristic(ROC)curve and area under the curve.Results In univariate analysis,smoking,hypertension,peritonitis,white blood cell count,haemoglobin,international normalized ratio,blood albumin,thrombosis of superior mesenteric branches vein,free intraperitoneal fluid,decrease of bowel wall enhancement and pneumatosis intestinalis were TIN risk factors(all P<0.05).According to the binary Logistic regression analysis,white blood cell count(OR=1.093,95%CI:1.010 to 1.182,P=0.027),thrombosis of the superior mesenteric branches vein(OR=11.519,95%CI:1.906 to 69.615,P=0.008),pneumatosis intestinalis(OR=11.140,95%CI:2.360 to 52.585,P=0.002)were independent relative factors of TIN in patients with AMI,and the area under the ROC curve of the above factors and predictive model was 0.759(95%CI:0.647 to 0.871),0.745(95%CI:0.641 to 0.848),0.737(95%CI:0.621 to 0.854),0.909(95%CI:0.847 to 0.971),respectively.The cutoff value of white blood cell count was 18.1×10^9/L.Conclusion White blood cell levels,superior mesenteric vein branch thrombosis and pneumatosis intestinalis are independent predictors of TIN in ASMVT.