Yu Chen, Ding Ling, Jiang Meilan, Liao Qian, Huang Xin, Lei Yupeng, Ke Huajing, Xiong Huifang, He Wenhua, Xia Liang, Zeng Xianjun, Lu Nonghua, Zhu Yin
Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Jiangxi Province Medical Imaging Research Institute, Nanchang, China.
Front Med (Lausanne). 2022 May 26;9:875263. doi: 10.3389/fmed.2022.875263. eCollection 2022.
To investigate the dynamic changes in gastric varices in patients with acute pancreatitis (AP) and to develop a novel nomogram for the early prediction of sinistral portal hypertension (SPH).
This was a retrospective, case-control study with an analysis of the quantitative, dynamic computed tomography imaging results of SPH in patients with moderate and severe AP with a long-term follow-up. Multivariate logistic regression analysis and nomogram were employed.
The SPH group ( = 94) and non-SPH group ( = 94) were matched. The dynamic changes showed an increasing trend in the diameter of gastric fundus, short gastric, gastric coronary, and gastroepiploic veins, which did not recover during the one-year follow-up. Multivariate analysis showed that male (adjusted odds ratio (adjOR), 8.71; 95% confidence interval (CI), 2.86-26.53; < 0.001), body mass index ≥27.5 kg/m (adjOR, 5.49; 95% CI, 1.85-16.29; = 0.002), prothrombin time ≥12.6 s (adjOR, 2.82; 95% CI, 1.11-7.17; = 0.03), and the patency of splenic vein [stenosis (adjOR, 8.48; 95% CI, 2.13-33.71; = 0.002), and occlusion (adjOR, 34.57; 95% CI, 10.87-110.00; < 0.001)] were independently associated with the development of SPH. The nomogram incorporating these factors demonstrated good discrimination, calibration and clinical utility. The area under the curve was as high as 0.92 (95% CI, 0.87-0.95).
The dynamic changes in varices in SPH are long-term and slowly progressing. Males and obese patients with abnormal splenic veins and coagulopathies are at high risk for developing SPH. A simple nomogram tool helps in the early, accurate prediction of SPH.
研究急性胰腺炎（AP）患者胃静脉曲张的动态变化，并开发一种用于早期预测左侧门静脉高压（SPH）的新型列线图。
这是一项回顾性病例对照研究，分析了中重度AP患者SPH的定量动态计算机断层扫描成像结果，并进行长期随访。采用多因素逻辑回归分析和列线图。
SPH组（n = 94）和非SPH组（n = 94）进行了匹配。动态变化显示胃底、胃短、胃冠状和胃网膜静脉直径呈增加趋势，在一年随访期间未恢复。多因素分析显示，男性（调整优势比（adjOR），8.71；95%置信区间（CI），2.86 - 26.53；P < 0.001）、体重指数≥27.5 kg/m²（adjOR，5.49；95% CI，1.85 - 16.29；P = 0.002）、凝血酶原时间≥12.6秒（adjOR，2.82；95% CI，1.11 - 7.17；P = 0.03）以及脾静脉通畅情况[狭窄（adjOR，8.48；95% CI，2.13 - 33.71；P = 0.002）和闭塞（adjOR，34.57；95% CI，10.87 - 110.00；P < 0.001）]与SPH的发生独立相关。纳入这些因素的列线图显示出良好的区分度、校准度和临床实用性。曲线下面积高达0.92（95% CI，0.87 - 0.95）。
SPH中静脉曲张的动态变化是长期且进展缓慢的。脾脏静脉异常和凝血功能障碍的男性及肥胖患者发生SPH的风险较高。一个简单的列线图工具有助于早期、准确地预测SPH。
