老年机械性肠梗阻患者不良预后的危险因素及预测效能分析

Risk factors for poor prognosis in elderly patients with mechanical intestinal obstruction and predictive efficacy analysis

目的筛选导致老年机械性肠梗阻患者不良预后的危险因素,评价不同危险因素预测患者不良预后的效能。方法回顾性分析2021年2月—2023年2月新疆医科大学第一附属医院胃肠(肿瘤)外科收治老年机械性肠梗阻患者98例,根据患者治疗预后分为预后良好组(n=76)和预后不良组(n=22)。比较2组患者临床资料、症状与体征、炎性相关指标及治疗相关特征的差异;分析老年机械性肠梗阻患者临床资料、症状与体征、炎性相关指标及治疗相关特征与不良预后的相关性;多因素Logistic回归分析筛选老年机械性肠梗阻患者不良预后的危险因素并通过受试者工作特征曲线(ROC)评价其预测效能。结果预后不良组患者平均BMI、PG-SGA分级及糖尿病患病率与预后良好组患者比较差异有统计学意义[t(χ^(2))/P=2.486/0.015、8.164/0.017、4.382/0.036];预后不良组患者发生肠鸣音消失比例、腹痛进行性加重比例与预后良好组患者比较差异有统计学意义(χ^(2)/P=4.025/0.045、4.248/0.039);预后不良组患者平均CRP、PCT、IL-6、NLR水平均显著高于预后良好组患者(t/P=2.653/0.009、2.478/0.015、2.391/0.019、2.636/0.010);预后不良组患者平均手术时长、应用糖皮质激素比例及平均住院时间与预后良好组患者比较差异有统计学意义[t(χ^(2))/P=2.373/0.020、5.002/0.025、2.366/0.020];Spearman相关性分析表明,老年机械性肠梗阻患者PG-SGA分级、糖尿病患病、血清CRP、PCT、IL-6、NLR水平与预后不良呈正相关性(r/P=0.202/0.040、0.211/0.037、0.213/0.036、0.229/0.023、0.211/0.037、0.207/0.039),平均BMI水平与预后不良呈负相关性(r/P=-0.242/0.016);多因素Logistic回归分析表明,老年机械性肠梗阻患者BMI升高为预后不良保护因素[OR(95%CI)=0.377(0.196~0.724)],PG-SGA分级、血清PCT、IL-6及NLR水平增高均是预后不良的危险因素[OR(95%CI)=9.893(5.087~16.043)、2.835(1.742~10.840)、1.415(1.044~1.919)、2.990(1.905~9.884)];BMI、PCT、IL-6及NLR水平预测老年机械性肠梗阻患者不良预后的AUC分别为0.668、0.659、0.646、0.630,四者各自单独预测效能的差异无统计学意义(Z=1.321,P=0.357)。结论老年机械性肠梗阻患者BMI及血清PCT、IL-6、NLR水平变化对于预测不良预后具有重要价值,提示营养状况及炎性反应水平与老年机械性肠梗阻患者治疗效果相关,应在临床中密切监测上述指标变化以评估患者预后。

Objective To screen the risk factors leading to poor prognosis of elderly patients with mechanical intestinal obstruction,and to evaluate the efficacy of different risk factors in predicting the poor prognosis of patients.Methods Retrospectively analyzed 98 cases of elderly patients with mechanical intestinal obstruction admitted to the Department of Gastrointestinal(Oncology)Surgery of the First Affiliated Hospital of Xinjiang Medical University from February 2021 to February 2023,which were divided into a good prognosis group(n=76)and a poor prognosis group(n=76)according to the prognosis of the patients.poor prognosis group(n=22).We compared the differences in clinical data,symptoms and signs,inflammation-related indexes,and treatment-related characteristics between the 2 groups;analyzed the correlation between clinical data,symptoms and signs,inflammation-related indexes,and treatment-related characteristics of elderly patients with mechanical intestinal obstruction and poor prognosis;and screened the risk factors for poor prognosis of elderly patients with mechanical intestinal obstruction by multifactorial logistic regression and evaluated their predictive efficacy by the subjects'work characterization curve(ROC).ROC)to evaluate their predictive efficacy.Results The mean BMI,PG-SGA grade and prevalence of diabetes mellitus in the poor prognosis group were statistically different from those in the good prognosis group(t/χ^(2)/P=2.486/0.015,8.164/0.017,4.382/0.036);statistically significant differences in the proportion of patients in the poor prognosis group who experienced loss of bowel sounds and progressive exacerbation of abdominal pain compared with patients in the good prognosis group(χ^(2)/P=4.025/0.045,4.248/0.039);prognostication The mean CRP,PCT,IL-6,and NLR levels of patients in the poor prognosis group were significantly higher than those of patients in the good prognosis group(t/P=2.653/0.009,2.478/0.015,2.391/0.019,2.636/0.010);the difference between the average length of surgery,the proportion of glucocorticoid application and the average length of hospitalization of the patients in the poor prognosis group compared with the patients in the good prognosis group was statistically significant(t/χ^(2)/P=2.373/0.020,5.002/0.025,2.366/0.020);Spearman's correlation analysis showed that PG-SGA classification,prevalence of diabetes mellitus,serum CRP,PCT,IL-6,and NLR levels in elderly patients with mechanical intestinal obstruction were significantly and positively correlated with poor prognosis(r/P=0.202/0.040,0.211/0.037,0.213/0.036,0.229/0.023,0.211/0.037,0.207/0.039),and the mean BMI level was significantly negatively correlated with poor prognosis(r=-0.242/0.016);multifactorial logistic regression analysis showed that lower BMI,higher PG-SGA grading,serum PCT,IL-6 and IL-2 levels in elderly patients with painful mechanical intestinal obstruction were all risk factors for poor prognosis[OR(95%CI)=0.377(0.196-0.724),9.893(5.087-16.043),2.835(1.742-10.840),1.415(1.044-1.919),2.990(1.905-9.884)];BMI,PCT,IL-6 and NLR levels predicted adverse prognosis in elderly patients with mechanical intestinal obstruction with AUCs of 0.668,0.659,0.646,and 0.630,respectively,and the differences in the predictive efficacy of each of the four individually were not statistically significant when compared by DeLong's method(Z=1.321,P=0.357).Conclusion Changes in BMI and serum PCT,IL-6 and NLR levels in elderly patients with mechanical intestinal obstruction are of great value in predicting poor prognosis,suggesting that nutritional status and inflammatory response level are related to the treatment effect of mechanical intestinal obstruction in elderly patients,and that changes in the above indexes should be closely monitored in clinical practice to assess the prognosis of the patients.