缺血性肠病预后的相关因素分析

目的探讨需住院的缺血性肠病患者病情严重性和病死率相关因素，并探讨复发的相关危险因素。方法回顾性分析2000年1月～2009年6月期间诊断为缺血性肠病的住院患者的临床资料，定性变量采用费希尔精准检验分析，参数变量采用斯氏t检验分析。具有统计学意义的变量纳入考克斯症状消退模型。结果研究期间，169例缺血性肠病住院患者，10例手术，8例死亡，13例重症。与病情严重程度独立相关的变量有：心血管疾病（OR：6．63，95％CI：1．59—27．61，P=0．009）、无便血（OR：4．43，95％CI：1．12～17．47，P=0．033）、腹胀（OR：6．39，95％CI：1．65～24．70，P=0．007）和肠梗阻（OR：8．76，95％CI：2．12～36．06，P=0．003）。仅弥漫性腹膜炎与病死率有关（OR：26．07，95％CI：5．67～119．93，P〈0．001）。出院后，7例（4．5％）患者复发，复发平均时间（5．31±3．67）个月，其中6例有狭窄。有缺血性肠病史（OR：13．21，95％CI：2．52～69．28，P=0．002）、服用阿司匹林（OR：6．41，95％CI：1．12～36．64，P=0．037）及降压药（OR：0．089，95％CI：0．01～0．754，P=0．027）与复发独立相关。结论合并便血、腹胀和肠梗阻的缺血性肠病患者预后较差，使用阿司匹林或降压药的患者出院后有较高的复发率，但二者之间是否存在因果关系有待进一步研究证实。

The clinic predictive factors of ischemic colitis

Objective The study was designed to determine the relationship between the predictors and the severity and mortality of ischemic colitis （ I. C. ） in the in-patient with I. C. and explore the risk factors of the relapse. Methods Patients with I. C. diagnosed between January 2000 and June 200 enrolled in this retrospective study9. Qualitative variables were analyzed using Fisher exact test and parametric variables were analyzed using Student＇ s t-test. Those variables statistically significant were test by using a Cox regression model. Results During the study, 169 patients with I. C. were admitted into hospital. Ten patients required surgury,8 patients died and 13 were considered severe. The variables independently associated to severity were ： cerebrovascular disease （ OR ： 6.63,95 % CI ： 1.59-27.61, P = 0. 009 ）, absence of hematochezia（ OR ：4.43,95 % CI ： 1.12-17.47, P = 0. 033 ） , abdominal distention （ OR ： 6.39, 95 % CI ： 1.65-24.70, P = 0. 007 ） and ileus （ OR ： 8.76,95 % CI ： 2.12-36.06, P = 0. 003 ）. Only diffuse peritonism was associated to mortality（ OR：26.07,95% CI ： 5. 67-119. 93 ,P 〈 0. 001 ）. After discharge, seven patients（4.5% ） had a relapse（ mean time：5.31 ± 3.67 months） ,with a stricture in 6 of them. A second episode of I. C. （ OR ： 13.21,95% CI：2. 52-69. 28, P = 0.002 ） , treatment with asprin （ OR ：6.41, 95 % CI ： 1.12-36.64, P = 0.037 ） and with antihypertensive drugs （ OR ： 0. 089,95 % CI：0.01-0. 754, P = 0. 027） were independently associated to relapse. Conclusions We found that treatment with asprin,antihypertensive drugs was associated with relapse,which should be confirmed in prospective studies.