背景:在肝硬化中通常观察到肠壁增厚,但很少有研究探讨其对肝硬化患者长期结局的影响。
方法:总的来说,回顾性纳入118例失代偿期肝硬化患者,其中小肠的最大壁厚,升结肠,横结肠,降结肠,乙状结肠,直肠可以在计算机断层扫描(CT)图像中进行测量。X-tile软件用于确定肠壁厚度各段的最佳临界值,以预测进一步失代偿和死亡的风险。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率。通过竞争性风险分析评估了进一步代偿失调和死亡的预测因素。计算子分布危险比(sHRs)。
结果:升结肠壁厚≥11.7mm的患者进一步失代偿的累积率明显更高(P=0.014),横结肠≥3.2mm(P=0.043),降结肠≥9.8mm(P=0.035),直肠≥7.2mm(P=0.045),但小肠壁厚度≥8.5mm(P=0.312)或乙状结肠厚度≥7.1mm(P=0.237)的患者除外。升结肠壁厚≥11.7mm(sHR=1.70,P=0.030),横结肠≥3.2mm(sHR=2.15,P=0.038),直肠≥7.2mm(sHR=2.38,P=0.045)是进一步失代偿的独立预测因子,肠壁厚度≥8.5mm(sHR=1.19,P=0.490),降结肠≥9.8mm(sHR=1.53,P=0.093)或乙状结肠≥7.1mm(sHR=0.63,P=0.076)。小肠,升结肠,横结肠,降结肠,乙状结肠,直肠壁厚度与死亡无显著相关性。
结论:结肠壁增厚,但不是小肠壁,可以考虑用于预测肝硬化的进一步代偿失调。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: Colorectal wall thickening, but not small
bowel wall, may be considered for the prediction of further decompensation in cirrhosis.