Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Department of Radiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Clin Transl Gastroenterol. 2020 Aug;11(8):e00200. doi: 10.14309/ctg.0000000000000200.
This study aimed to determine the incidence of chronic mesenteric ischemia (CMI) and to examine the influence of the etiological cause, location, and severity of a mesenteric artery stenosis on the probability of having CMI.
A prospective database, containing the details of all patients with suspected CMI referred to a renowned CMI expert center, was used. Patients residing within the expert centers' well-defined region, between January 2014 and October 2019, were included. CMI was diagnosed when patients experienced sustained symptom improvement after treatment.
This study included 358 patients, 75 had a ≥50% atherosclerotic stenosis of 1 vessel (CMI 16%), 96 of 2 or 3 vessels (CMI 81%), 81 celiac artery compression (CMI 25%), and 84 no stenosis (CMI 12%). In total, 138 patients were diagnosed with CMI, rendering a mean incidence of 9.2 (95% confidence interval [CI] 6.2-13.7) per 100,000 inhabitants. Atherosclerotic CMI was most common, with a mean incidence of 7.2 (95% CI 4.6-11.3), followed by median arcuate ligament syndrome 1.3 (95% CI 0.5-3.6) and chronic nonocclusive mesenteric ischemia 0.6 (95% CI 0.2-2.6). The incidence of CMI was highest in female patients (female patients 12.0 [95% CI 7.3-19.6] vs male patients 6.5 [95% CI 3.4-12.5]) and increased with age. CMI was more prevalent in the presence of a ≥70% atherosclerotic single-vessel stenosis of the superior mesenteric artery (40.6%) than the celiac artery (5.6%).
The incidence of CMI is higher than previously believed and increases with age. Probability of CMI seems highest in suspected CMI patients with multivessel disease or a ≥70% atherosclerotic single-vessel superior mesenteric artery stenosis.
本研究旨在确定慢性肠系膜缺血（CMI）的发病率，并探讨肠系膜动脉狭窄的病因、部位和严重程度对 CMI 发生概率的影响。
使用包含所有疑似 CMI 患者详细信息的前瞻性数据库，这些患者被转诊至著名的 CMI 专家中心。研究对象为 2014 年 1 月至 2019 年 10 月期间居住在专家中心划定区域内的患者。当患者接受治疗后出现持续症状改善时，即可诊断为 CMI。
本研究共纳入 358 例患者，75 例患者存在 1 支血管（肠系膜上动脉）≥50%的粥样硬化狭窄（CMI 占 16%），96 例患者存在 2 或 3 支血管狭窄（CMI 占 81%），81 例患者存在腹腔动脉压迫（CMI 占 25%），84 例患者不存在狭窄（CMI 占 12%）。共有 138 例患者被诊断为 CMI，这意味着每 10 万人中 CMI 的平均发病率为 9.2（95%置信区间 [CI]：6.2-13.7）。其中最常见的是动脉粥样硬化性 CMI，平均发病率为 7.2（95% CI：4.6-11.3），其次是中位弓状韧带综合征 1.3（95% CI：0.5-3.6）和慢性非闭塞性肠系膜缺血 0.6（95% CI：0.2-2.6）。女性患者的 CMI 发病率最高（女性患者 12.0 [95% CI：7.3-19.6] vs 男性患者 6.5 [95% CI：3.4-12.5]），且发病率随年龄增长而增加。与腹腔动脉狭窄（5.6%）相比，肠系膜上动脉存在≥70%的粥样硬化性单支血管狭窄（40.6%）的患者中 CMI 更为常见。
CMI 的发病率高于以往的认识，且随年龄增长而增加。在疑似 CMI 患者中，多血管疾病或肠系膜上动脉存在≥70%的粥样硬化性单支血管狭窄的患者发生 CMI 的概率似乎最高。
