Liver Cirrhosis Study Group, Department of Gastroenterology, The General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China.
Postgraduate College, Jinzhou Medical University, Jinzhou, China.
Adv Ther. 2024 Jun;41(6):2217-2232. doi: 10.1007/s12325-023-02690-z. Epub 2023 Oct 6.
Bowel wall thickening is commonly observed in liver cirrhosis, but few studies have explored its impact on the long-term outcomes of patients with cirrhosis.
Overall, 118 patients with decompensated cirrhosis were retrospectively enrolled, in whom maximum wall thickness of small bowel, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum could be measured in computed tomography (CT) images. X-tile software was employed to determine the best cut-off values of each segment of bowel wall thickness for predicting the risk of further decompensation and death. Cumulative rates of further decompensation and death were calculated by Nelson-Aalen cumulative risk curve analyses. Predictors of further decompensation and death were evaluated by competing risk analyses. Sub-distribution hazard ratios (sHRs) were calculated.
Cumulative rates of further decompensation were significantly higher in patients with wall thickness of ascending colon ≥ 11.7 mm (P = 0.014), transverse colon ≥ 3.2 mm (P = 0.043), descending colon ≥ 9.8 mm (P = 0.035), and rectum ≥ 7.2 mm (P = 0.045), but not those with wall thickness of small bowel ≥ 8.5 mm (P = 0.312) or sigmoid colon ≥ 7.1 mm (P = 0.237). Wall thickness of ascending colon ≥ 11.7 mm (sHR = 1.70, P = 0.030), transverse colon ≥ 3.2 mm (sHR = 2.15, P = 0.038), and rectum ≥ 7.2 mm (sHR = 2.38, P = 0.045) were independent predictors of further decompensation, but not wall thickness of small bowel ≥ 8.5 mm (sHR = 1.19, P = 0.490), descending colon ≥ 9.8 mm (sHR = 1.53, P = 0.093) or sigmoid colon ≥ 7.1 mm (sHR = 0.63, P = 0.076). Small bowel, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum wall thickness were not significantly associated with death.
Colorectal wall thickening, but not small bowel wall, may be considered for the prediction of further decompensation in cirrhosis.
肠壁增厚在肝硬化中很常见，但很少有研究探讨其对肝硬化患者长期预后的影响。
回顾性纳入 118 例失代偿期肝硬化患者，在 CT 图像中可测量小肠、升结肠、横结肠、降结肠、乙状结肠和直肠的最大壁厚度。使用 X-tile 软件确定各肠壁厚度节段预测进一步失代偿和死亡风险的最佳截断值。通过 Nelson-Aalen 累积风险曲线分析计算进一步失代偿和死亡的累积发生率。通过竞争风险分析评估进一步失代偿和死亡的预测因素。计算亚分布风险比（sHR）。
升结肠壁厚度≥11.7mm（P=0.014）、横结肠壁厚度≥3.2mm（P=0.043）、降结肠壁厚度≥9.8mm（P=0.035）和直肠壁厚度≥7.2mm（P=0.045）的患者，进一步失代偿的累积发生率显著升高，但小肠壁厚度≥8.5mm（P=0.312）或乙状结肠壁厚度≥7.1mm（P=0.237）的患者无显著差异。升结肠壁厚度≥11.7mm（sHR=1.70，P=0.030）、横结肠壁厚度≥3.2mm（sHR=2.15，P=0.038）和直肠壁厚度≥7.2mm（sHR=2.38，P=0.045）是进一步失代偿的独立预测因素，但小肠壁厚度≥8.5mm（sHR=1.19，P=0.490）、降结肠壁厚度≥9.8mm（sHR=1.53，P=0.093）或乙状结肠壁厚度≥7.1mm（sHR=0.63，P=0.076）不是。小肠、升结肠、横结肠、降结肠、乙状结肠和直肠壁厚度与死亡均无显著相关性。
结直肠壁增厚而非小肠壁增厚，可用于预测肝硬化的进一步失代偿。
