腹股沟嵌顿疝患者肠坏死的预测和危险因素分析

Predictors and risk factors for intestinal necrosis in patients with incarcerated inguinal hernia

目的研究腹股沟嵌顿疝患者肠坏死的危险因素及预测因子的诊断价值。方法回顾性分析2017年1月至2021年6月复旦大学附属金山医院107例嵌顿疝急诊手术患者。肠坏死病例为观察组(n=24),无肠坏死为对照组(n=83)。利用受试者工作特征曲线(receiver operating characteristic curve,ROC)确定连续变量的截断值,评估肠坏死预测因子的诊断价值。单因素和多因素分析嵌顿疝患者肠坏死的危险因素。结果满足入组标准107例患者,肠坏死24例(22.4%),单因素分析显示肠坏死与女性(P=0.028)、高龄(P=0.004)、股疝(P=0.013)、嵌顿时间(P=0.023)、白细胞计数(P=0.002)、中性粒细胞计数(P<0.001)、淋巴细胞计数(P=0.016)、中性粒细胞/淋巴细胞数(P<0.001)、C反应蛋白(P=0.031)、血浆纤维蛋白(P=0.018)、D-二聚体(P<0.001)、肠梗阻(P<0.001)、腹膜炎体征(P=0.002)相关。多因素回归分析显示:中性粒细胞数>7×10^(9)/L(OR=6.188,95%CI:1.350~41.326,P=0.023)和D-二聚体>0.3 mg/L(OR=24.961,95%CI:3.328~186.659,P=0.002)为嵌顿疝患者肠坏死的危险因素。联合中性粒细胞计数(>7×10^(9)/L)和D-二聚体(>0.3 mg/L)预测肠坏死的ROC曲线AUC面积为0.894,诊断肠坏死的敏感度为95.8%,特异度为91.6%,阳性预测值76.7%,阴性预测值98.7%。结论中性粒细胞和D-二聚体升高可能与嵌顿疝患者的肠坏死风险相关,有助于术前预测诊断肠管坏死。

Objective To explore the risk factors of intestinal necrosis in patients with incarcerated inguinal hernia and the diagnostic value of predictors.Methods A total of 107 patients with incarcerated hernia underwent emergency surgery in Jinshan Hospital,Fudan University from Jan 2017 to Jun 2021 were analyzed retrospectively.Cases of intestinal necrosis were the observation group(n=24)and no intestinal necrosis was the control group(n=83).The cutoff value of continuous variables was determined by receiver operating characteristic curve(ROC)to evaluate the diagnostic value of intestinal necrosis predictors.Univariate and multivariate analysis were applied to analyze the potential risk factors for intestinal necrosis in incarcerated hernia.Results Among 107 patients who met the inclusion criteria,24(22.4%)underwent intestinal resection for intestinal necrosis.Univariate analysis showed that intestinal necrosis was associated with female(P=0.028),elderly(P=0.004),femoral hernia(P=0.013),incarceration time(P=0.023),leukocyte count(P=0.002),neutrophil count(P<0.001),lymphocyte count(P=0.016),neutrophil/lymphocyte count(P<0.001),C-reactive protein(P=0.031),plasma fibrin(P=0.018),increased D-Dimer(P<0.001),intestinal obstruction(P<0.001)and peritonitis signs(P=0.002).Multivariate regression analysis showed that the number of neutrophils>7×10^(9)/L(OR=6.188,95%CI:1.350-41.326,P=0.023)and D-dimer>0.3 mg/L(OR=24.961,95%CI:3.328-186.659,P=0.002)were the risk factors of intestinal necrosis in incarcerated hernia.The AUC area of ROC curve predicted by neutrophil count(>7×10^(9)/L)and D-dimer(>0.3 mg/L)was 0.894.The sensitivity,specificity,positive predictive value and negative predictive value for the diagnosis of intestinal necrosis were 95.8%,91.6%,76.7%and 98.7%,respectively.Conclusion Elevated neutrophils and D-dimers may be associated with the risk of intestinal necrosis in patients with incarcerated hernia,which can help predict and diagnose intestinal necrosis before surgery.