Medical College of Nanchang University, Nanchang 330006, Jiangxi Province, China.
Department of medical image, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
World J Gastroenterol. 2018 Sep 21;24(35):4054-4060. doi: 10.3748/wjg.v24.i35.4054.
To investigate the incidence and risk factors of portosplenomesenteric vein thrombosis (PSMVT) in the early stage of severe acute pancreatitis (SAP).
Patients with SAP in a tertiary care setting from January 2014 to December 2016 were retrospectively reviewed. All contrast-enhanced computed tomography (CT) studies were reassessed and reviewed. Clinical outcome measures were compared between SAP patients with and without PSMVT in the early stage of the disease. Univariate and multivariate logistic regression analyses were sequentially performed to assess potential risk factors for the development of PSMVT in SAP patients. A receiver operating characteristic (ROC) curve was generated for the qualifying independent risk factors.
Twenty-five of the one hundred and forty (17.86%) SAP patients developed PSMVT 6.19 ± 2.43 d after acute pancreatitis (AP) onset. PSMVT was confirmed by contrast-enhanced CT. Multivariate stepwise logistic regression analyses showed that Balthazar's CT severity index (CTSI) scores [odds ratio (OR): 2.742; 95% confidence interval (CI): 1.664-4.519; = 0.000], hypoalbuminemia (serum albumin level < 25 g/L) (OR: 32.573; 95%CI: 2.711-391.353; = 0.006) and gastrointestinal wall thickening (OR: 4.367, 95%CI: 1.218-15.658; = 0.024) were independent risk factors for PSMVT developed in patients with SAP. The area under the ROC curve for Balthazar's CTSI scores was 0.777 ( = 0.000), the sensitivity was 52%, and the specificity was 93% at a cut-off value of 5.5.
High Balthazar's CTSI scores, hypoalbuminemia and gastrointestinal wall thickening are independent risk factors for PSMVT developed in the early stage of SAP.
探讨重症急性胰腺炎（SAP）早期发生门静脉脾静脉血栓形成（PSMVT）的发生率和危险因素。
回顾性分析 2014 年 1 月至 2016 年 12 月在一家三级医疗机构中 SAP 患者的病例资料。对所有增强 CT 扫描进行重新评估和复查。比较 SAP 患者在疾病早期有无 PSMVT 的临床结局。采用单因素和多因素逻辑回归分析，评估 SAP 患者发生 PSMVT 的潜在危险因素。生成合格的独立危险因素的受试者工作特征（ROC）曲线。
140 例 SAP 患者中有 25 例（17.86%）在急性胰腺炎（AP）发病后 6.19 ± 2.43 d 时发生 PSMVT。PSMVT 通过增强 CT 确诊。多因素逐步逻辑回归分析表明，Balthazar CT 严重程度指数（CTSI）评分（比值比[OR]：2.742；95%置信区间[CI]：1.664-4.519； = 0.000）、低白蛋白血症（血清白蛋白水平<25 g/L）（OR：32.573；95%CI：2.711-391.353； = 0.006）和胃肠壁增厚（OR：4.367，95%CI：1.218-15.658； = 0.024）是 SAP 患者发生 PSMVT 的独立危险因素。Balthazar CTSI 评分的 ROC 曲线下面积为 0.777（ = 0.000），当截断值为 5.5 时，灵敏度为 52%，特异性为 93%。
高 Balthazar CTSI 评分、低白蛋白血症和胃肠壁增厚是 SAP 早期发生 PSMVT 的独立危险因素。
