糖尿病及肥胖对肛周脓肿患者单纯切开引流术后复发或并发肛瘘风险的影响

Influence of diabetes and obesity on the risk of recurrence or anal fistula in patients with perianal abscess after simple incision and drainage

目的探究糖尿病及肥胖对肛周脓肿患者单纯切开引流术后复发或并发肛瘘的交互影响。方法回顾性选取2021年6月至2023年6月首都医科大学附属北京潞河医院收治的163例接受单纯切开引流术治疗的肛周脓肿患者临床资料,统计患者术后6个月复发或并发肛瘘情况,多因素Logistic回归模型分析术后复发或并发肛瘘的影响因素,相乘和相加模型分析糖尿病及肥胖对术后复发或并发肛瘘风险的交互作用。结果单纯切开引流术后6个月,肛周脓肿患者复发或并发肛瘘的发生率为28.22%(46/163)。单因素分析结果显示,性别、肥胖、糖尿病与肛周脓肿患者复发或并发肛瘘有关(P<0.05)。多因素Logistic回归分析结果显示,肥胖(OR=2.447、95%CI:1.320~4.538)、糖尿病(OR=2.162、95%CI:1.187~3.938)是患者术后复发或并发肛瘘的独立危险因素(P<0.05)。交互作用分析显示,调整混杂因素后,糖尿病、肥胖对术后复发或并发肛瘘的发生风险存在相加交互作用,交互作用超额相对危险度(RERI)、归因百分比(AP)、交互作用指数(S)分别为1.829(95%CI:0.605~3.007)、0.405(95%CI:0.143~0.597)、2.098(95%CI:1.201~3.172);二者无相乘交互作用(P>0.05)。结论糖尿病、肥胖是肛周脓肿患者单纯切开引流术后复发或并发肛瘘的独立危险因素,二者对术后复发或并发肛瘘的发生风险可能存在协同作用。

Objective To explore the interaction effect of diabetes and obesity on recurrence or anal fistula in patients with perianal abscess after simple incision and drainage.Methods The clinical data of 163 patients with perianal abscess who underwent simple incision and drainage from Jun.2021 to Jun.2023 were analyzed retrospectively.The incidence of recurrence or anal fistula in 6 months after surgery was calculated.Multivariate Logistic regression model was used to analyze the influencing factors of postoperative recurrence or anal fistula.The multiplicative and additive models were used to analyze the interaction effect of diabetes and obesity on the risk of postoperative recurrence or anal fistula.Results In 6 months after simple incision and drainage,the incidence of recurrence or anal fistula was 28.22%(46/163).Univariate analysis results showed that gender,obesity,and diabetes were related to recurrence of perianal abscess or incidence of anal fistula(P<0.05).Multivariate Logistic regression analysis results showed that obesity(OR=2.447,95%CI:1.320-4.538)and diabetes(OR=2.162,95%CI:1.187-3.938)were independent risk factors for postoperative recurrence or anal fistula(P<0.05).Interaction effect analysis found that after adjusting for confounding factors,diabetes and obesity had additive interaction effect on the risk of postoperative recurrence or anal fistula.The relative excess risk due to interaction(RERI),attribution percentage(AP),and interaction effect index(S)were 1.829(95%CI:0.605-3.007),0.405(95%CI:0.143-0.597),and 2.098(95%CI:1.201-3.172),respectively.There was no multiplicative interaction effect between the two(P>0.05).Conclusions Diabetes and obesity are independent risk factors for recurrence or anal fistula in patients with perianal abscess after simple incision and drainage.The two may have synergistic effect on the risk of postoperative recurrence or anal fistula.