中国实用外科杂志2025，Vol.45Issue(4)：443-449,7.DOI:10.19538/j.cjps.issn1005-2208.2025.04.11
急性闭塞性肠系膜缺血临床特征分析及肠坏死风险预测模型构建
Analysis on clinical characteristics of acute occlusive mesenteric ischemia and development of a risk prediction model for intestinal necrosis
摘要
Abstract
Objective To analyze the factors influencing clinical outcomes in patients with acute occlusive mesenteric ischemia(AOMI)and to develop and validate a clinical prediction model for intestinal necrosis.Methods A retrospective analysis was conducted on clinical data from 236 AOMI patients admitted to West China Hospital of Sichuan University between January 2020 and December 2023,including 108 cases of acute arterial mesenteric ischemia(AAMI)and 128 cases of mesenteric venous thrombosis(MVT).The clinical characteristics of AOMI cases were analyzed,and logistic regression was used to identify risk factors for poor outcomes.Further,patients with confirmed intestinal necrosis status were selected to compare clinical features,construct a prediction model,and perform internal validation.Results Multivariate analysis revealed that organic heart disease(OR=5.030,95％CI 1.675-15.123),portal hypertension(OR=16.557,95％CI 1.094-249.326),WBC count ≥10×109/L(OR=9.670,95％CI 2.193-42.668),platelet count＜100×109/L(OR=9.122,95％CI 2.235-37.262),total bilirubin ≥17.1 μmol/L(OR=3.175,95％CI 1.148-8.786),and AAMI(OR=38.862,95％CI 2.005-752.530)were independent risk factors for poor outcomes(all P＜0.05).The intestinal necrosis prediction model integrated imaging features and laboratory indicators,including intestinal cavity effusion(OR=3.466,95％CI 1.468-8.175),mesenteric swelling(OR=2.373,95％CI 1.008-5.582),intestinal wall swelling(OR=1.742,95％CI 0.738-4.093),white blood cell count(OR=2.509,95％CI 0.950-6.587),D-dimer(OR=2.165,95％CI 0.952-4.976),albumin(OR=0.449,95％CI 0.163-1.248),and lymphocyte percentage(OR=0.883,95％CI 0.335-2.308).The training set demonstrated an AUC of 0.808(95％CI 0.742-0.891,sensitivity 0.742,specificity 0.781),while the validation set showed an AUC of 0.793(95％CI 0.664-0.913,sensitivity 0.668,specificity 0.734),with calibration curves indicating good consistency between groups.Conclusion The prediction model for intestinal necrosis,constructed based on multidimensional clinical data including imaging features and laboratory indicators,exhibits high accuracy and clinical utility.It provides a quantitative foundation for early intervention,personalized treatment,and optimization of emergency protocols in AOMI patients.关键词
急性闭塞性肠系膜缺血/肠坏死/临床特征/影响因素/预测模型Key words
acute occlusive mesenteric ischemia/intestinal necrosis/clinical features/influencing factors/prediction model分类
医药卫生引用本文复制引用
撖毓敏,姜笑梅,张贵祥,黄理宾,冯丽,黄斌,张蜀,刘聪,杨烈..急性闭塞性肠系膜缺血临床特征分析及肠坏死风险预测模型构建[J].中国实用外科杂志,2025,45(4):443-449,7.基金项目
国家重点研发计划项目(No.2024YFB3311700) National Key Research and Development Program of China(No.2024YFB3311700) （No.2024YFB3311700）
