内脏动脉狭窄和腹部不适：临床病史在检测胃肠道缺血方面价值有限。
Splanchnic artery stenosis and abdominal complaints: clinical history is of limited value in detection of gastrointestinal ischemia.
机构信息
Department of Gastroenterology, University Medical Centre Groningen, Hanzeplein 1, Postbox 30001, 9700 RB, Groningen, The Netherlands.
出版信息
World J Surg. 2012 Apr;36(4):793-9. doi: 10.1007/s00268-012-1485-4.
BACKGROUND
Splanchnic artery stenosis is common and mostly asymptomatic and may lead to gastrointestinal ischemia (chronic splanchnic syndrome, CSS). This study was designed to assess risk factors for CSS in the medical history of patients with splanchnic artery stenosis and whether these risk factors can be used to identify patients with high and low risk of CSS.
METHODS
All patients referred for suspected CSS underwent a standardized workup, including a medical history with questionnaire, duplex ultrasound, gastrointestinal tonometry, and angiography. Definitive diagnosis and treatment advice was made in a multidisciplinary team. Patients with confirmed CSS were compared with no-CSS patients.
RESULTS
A total of 270 patients (102 M, 168 F; mean age, 53 years) with splanchnic artery stenosis were analyzed, of whom 109 (40%) had CSS and 161 no CSS. CSS-patients more often reported postprandial pain (87% vs. 72%, p = 0.007), weight loss (85% vs. 70%, p = 0.006), adapted eating pattern (90% vs. 79%, p = 0.005) and diarrhea (35% vs. 22%, p = 0.023). If none of these risk factors were present, the probability of CSS was 13%; if all were present, the probability was 60%. Adapted eating pattern (odds ratio (OR) 3.1; 95% confidence interval (CI) 1.08-8.88) and diarrhea (OR 2.6; 95% CI 1.31-5.3) were statistically significant in multivariate analysis.
CONCLUSIONS
In patients with splanchnic artery stenosis, the clinical history is of limited value for detection of CSS. A diagnostic test to detect ischemia is indispensable for proper selection of patients with splanchnic artery stenosis who might benefit from treatment.
背景
内脏动脉狭窄很常见，且大多无症状，但可能导致胃肠道缺血（慢性内脏综合征，CSS）。本研究旨在评估内脏动脉狭窄患者病史中 CSS 的危险因素，以及这些危险因素是否可用于识别 CSS 风险高低的患者。
方法
所有疑似 CSS 的患者均接受了标准化检查，包括病史问卷调查、双功超声、胃肠测压和血管造影。多学科团队做出明确诊断和治疗建议。将确诊 CSS 的患者与无 CSS 患者进行比较。
结果
共分析了 270 例（102 例男性，168 例女性；平均年龄 53 岁）内脏动脉狭窄患者，其中 109 例（40%）有 CSS，161 例无 CSS。CSS 患者更常报告餐后疼痛（87%比 72%，p=0.007）、体重减轻（85%比 70%，p=0.006）、调整饮食模式（90%比 79%，p=0.005）和腹泻（35%比 22%，p=0.023）。如果这些危险因素均不存在，CSS 的可能性为 13%；如果均存在，可能性为 60%。调整饮食模式（比值比（OR）3.1；95%置信区间（CI）1.08-8.88）和腹泻（OR 2.6；95% CI 1.31-5.3）在多变量分析中具有统计学意义。
结论
在有内脏动脉狭窄的患者中，病史对于 CSS 的检测价值有限。对于可能受益于治疗的内脏动脉狭窄患者，需要进行缺血检测的诊断性检查。
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