收稿日期: 2023-11-14
网络出版日期: 2024-03-26
基金资助
国家自然科学基金项目(82070680)
Prediction of risks of early anastomotic recurrence following primary bowel resection in patients with Crohn′s disease based on preoperative magnetic resonance enterography
Received date: 2023-11-14
Online published: 2024-03-26
目的 基于术前磁共振小肠成像（MRE）构建列线图模型预测克罗恩病（CD）患者首次肠切除术后早期吻合口复发（EAR）风险的价值。 方法 回顾性纳入术前行MRE和初次肠切除术的CD患者，分为EAR组（18例）和无EAR组（12例）。EAR组包括内镜下Rutgeerts评分≥I2或术后12个月内需要切除吻合口的患者。分析患者术前人口学特征、实验室检查、切除肠段及其邻近肠系膜的MRE参数、组织学分析和术后药物治疗数据共38个参数。采用LASSO回归分析多因素二分类logistic回归筛选出与EAR相关的独立危险因素，构建列线图预测模型并评估其预测性能。 结果 MRE上的梳状征和肠系膜爬行脂肪指数为CD术后发生早期吻合口复发的独立因素，一致性指数为0.882 （95%CI：0.764~1）。校准图显示了实际观测和预测早期吻合口复发概率之间的强相关性。 结论 基于术前MRE构建的列线图模型可能是一种预测CD患者术后早期吻合口复发的潜在工具，有利于CD患者肠切除术后个体化管理。为EAR高风险患者术后早期个体化药物辅助治疗方案的制定提供参考。
何伟涛 , 申晓迪 , 王杨迪 , 杜金芳 , 李雪华 , 熊珊珊 , 李周雷 , 林少春 . 基于术前磁共振小肠成像预测克罗恩病患者首次肠切除术后早期吻合口复发风险[J]. 实用医学杂志, 2024 , 40(5) : 664 -671 . DOI: 10.3969/j.issn.1006-5725.2024.05.013
Objective To develop a nomogram for predicting the risks of early anastomotic recurrence （EAR） after primary bowel resection in patients with Crohn′s disease （CD）. Methods The patients with CD undergoing preoperative magnetic resonance enterography （MRE） and primary bowel resection were enrolled in this retrospective study and divided into an EAR group （18 patients） and EAR?free group （12 patients）. The EAR group included the patients having an endoscopic Rutgeerts score of ≥ I2 month or the need for anastomotic resection within 12 months after surgery. All the 38 indexes including preoperative demographic characteristics， laboratory examinations， multi?parameter MRE features of the resected intestine and its adjacent mesentery， histological findings， and postoperative pharmacotherapy were analyzed. Least absolute shrinkage and selection operator （LASSO） regression and multivariate binary logistic regression analysis were performed to identify independent risk factors to be incorporated into the nomogram for predicting the risks of early anastomotic recurrence and the prediction performance was evaluated. Results Mesenteric creeping fat index on MRE and comb sign were independent risks of EAR， with a concordance index of 0.882 （95%CI： 0.764~1）. The calibration plot revealed a strong relationship between actual observation and predicted probability of EAR. Conclusions The preoperative MRE?based nomogram may be a potential tool for predicting EAR following surgery in patients with CD， which is beneficial to individual management in those patients. It provides reference for the formulation of early postoperative individualized drug adjuvant therapy in patients at high risk of EAR.
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