基于围手术期指标的临床列线图预测回肠储袋肛管吻合术后储袋炎研究

Prediction of pouchitis after ileal pouch-anal anastomosis based on clinical nomogram of perioperative factors

目的分析行回肠储袋肛管吻合术(IPAA)的溃疡性结肠炎(UC)病人术后发生储袋炎的危险因素并建立列线图模型。方法回顾性分析2014年1月至2021年1月南京大学医学院附属金陵医院普通外科收治的行IPAA的142例UC病人的临床资料。分析筛选影响术后储袋炎发生的潜在因素,并使用R4.0.2软件构建列线图模型。结果随访时间为27(13.8~44.3)个月,共40例(28.2%)病人发生储袋炎。多因素分析发现,术前抗肿瘤坏死因子α(TNF-α)治疗(OR=4.118,P=0.003)、嗜酸性粒细胞百分比>1.45%(OR=3.665,P=0.003)以及降钙素原>0.0635μg/L(OR=2.845,P=0.011)是UC病人IPAA术后发生储袋炎的独立危险因素。基于上述3个危险因素构建的列线图模型,C指数为0.747(95%CI 0.656-0.893)。校准曲线证实模型预测储袋炎发生风险与实际风险一致性较好。结论基于术前抗TNF-α治疗、嗜酸性粒细胞百分比、降钙素原建立的列线图模型能够有效识别IPAA术后可能发生储袋炎的病人,具有临床应用价值。

Objective To identify risk factors of postoperative pouchitis in ulcerative colitis(UC)patients undergoing ileal pouch-anal anastomosis(IPAA)and to establish a nomogram model in predicting postoperative pouchitis.Methods The clinical data of 142 patients with UC after IPAA admitted to the Department of General Surgery,Jinling Hospital Affiliated to the Medical School of Nanjing University from January 2014 to January 2021 were retrospectively analyzed.SPSS22.0 software was used to conduct a statistical analysis of the risk factors of postoperative pouchitis.The potential factors influencing the occurrence of postoperative pouchitis were screened by univariate and multivariate analysis,and the nomogram was constructed using R4.0.2.Results The follow-up time was 27(13.8-44.3)months.A total of 40 patients(28.2%)developed pouchitis.Multivariate analysis found that preoperative anti-TNF-αtherapy(OR=4.118,P=0.003),eosinophils percentage>1.45%(OR=3.665,P=0.003),and procalcitonin>0.0635μg/L(OR=2.845,P=0.011)were independent risk factors for pouchitis in UC patients after IPAA.In the nomogram model constructed based on the above three risk factors,the C index was 0.747(95%CI 0.656-0.893).The calibration curve confirmed that the risk of pouchitis predicted by the model was consistent with the actual risk.Conclusion The nomogram model based on preoperative anti-TNF-αtherapy,eosinophils percentage and procalcitonin,can effectively identify patients who may develop pouchitis after IPAA,which has certain clinical promotion and reference value.