切换至 "中华医学电子期刊资源库"

中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (06) : 549 -554. doi: 10.3877/cma.j.issn.2095-2015.2024.06.013

论著

联合腹部CT 图像特征和临床指标的列线图模型对腹内高压评估的临床研究
张敏伟1, 翟天旭1, 张子秋1, 王驰1, 刘胜中1, 李德春1,2,()   
  1. 1.221009 江苏省,徐州医科大学徐州临床学院
    2.221009 江苏省,徐州市中心医院放射科
  • 收稿日期:2024-04-05 出版日期:2024-12-01
  • 通信作者: 李德春

Development of a predictive nomogram model integrating abdominal CT imaging and clinical parameters for assessing the risk of elevated intra-abdominal pressure

Minwei Zhang1, Tianxu Zhai1, Ziqiu Zhang1, Chi Wang1, Shengzhong Liu1, Dechun Li1,2,()   

  1. 1.Xuzhou Clinical College of Xuzhou Medical University,Xuzhou 221009,China
    2.Department of Radiology,Xuzhou Central Hospital,Xuzhou 221009,China
  • Received:2024-04-05 Published:2024-12-01
  • Corresponding author: Dechun Li
引用本文:

张敏伟, 翟天旭, 张子秋, 王驰, 刘胜中, 李德春. 联合腹部CT 图像特征和临床指标的列线图模型对腹内高压评估的临床研究[J]. 中华消化病与影像杂志(电子版), 2024, 14(06): 549-554.

Minwei Zhang, Tianxu Zhai, Ziqiu Zhang, Chi Wang, Shengzhong Liu, Dechun Li. Development of a predictive nomogram model integrating abdominal CT imaging and clinical parameters for assessing the risk of elevated intra-abdominal pressure[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(06): 549-554.

目的

分析并确定能够预测腹内高压的CT 图像特征和临床指标,以便建立可靠的腹内高压(IAH)列线图预测模型。

方法

收集了2021 年1 月至2023 年3 月于徐州市中心医院重症监护室住院并行膀胱测压及腹部CT 检查的患者。研究共纳入58 例患者,其中IAH组25 例,非IAH组33 例。收集患者的临床指标和腹部CT 图像特征,并使用logistic 回归对临床指标和CT 图像特征进行统计学分析,以此结果构建列线图预测模型,并对该模型进行验证及临床价值判断。

结果

研究发现腹壁纵横比(P=0.043;OR=3.102;95% CI 1.034~9.307)、腹腔腹壁纵径比(P=0.002;OR=12.105;95% CI 2.575~56.897)是IAH 独立影响因素。列线图预测模型的AUC 为0.925,校正曲线显示列线图模型预测的概率和实际概率相一致。决策曲线显示本列线图模型在阈值范围为0.1~1.0 时具有较好的临床效用。临床影响曲线表明该列线图模型在较宽泛的阈值范围内是可行的,在阈值超过0.4 尤为显著。

结论

利用腹部CT 图像特征及临床指标构建了一个列线图模型来预测患者IAH 的风险程度,该模型有助于提示IAH 及腹腔间室综合征。

Objective

To analyze and identify CT imaging characteristics and clinical indicators that can predict increased intra-abdominal pressure,in order to establish a reliable nomogram for the prediction of intra-abdominal hypertension (IAH).

Methods

A retrospective collection was made of patients who were admitted to the ICU of Xuzhou Central Hospital from January 2021 to March 2023 and underwent bladder pressure measurement and abdominal CT scans. A total of 58 patients were included in this study,with 25 patients constituting the IAH group and 33 patients forming the non-IAH group. Clinical indicators and CT imaging features of these patients were collected. Logistic regression was used to perform statistical analysis on these clinical and CT imaging characteristics. The results were then used to construct a nomogram,which was validated and judged for clinical value.

Results

The study found that the transverse to longitudinal ratio of the abdominal wall (P=0.043; OR=3.102; 95% CI: 1.034-9.307),the ratio of the abdominal cavity to the abdominal wall longitudinal diameter (P=0.002; OR=12.105; 95% CI:2.575-56.897) were independently associated with IAH. The AUC of the nomogram prediction model was 0.925. The calibration curve indicated that the predicted probabilities of the nomogram were consistent with the actual probabilities. Decision curve analysis revealed that the nomogram model had good clinical utility within a threshold range of 0.1 to 1.0. The clinical impact curve suggested that the nomogram model was feasible across a broad range of threshold probabilities,particularly notable when the threshold exceeded 0.4.

Conclusion

Using the abdominal CT imaging features and clinical indicators,a nomogram model is constructed to predict the risk level of IAH in patients,which is helpful to indicate IAH and abdominal compartment syndrome.

图1 腹壁纵横比及腹腔腹壁纵径比的测量示意图
表1 两组患者一般资料比较
组别 例数 年龄(岁,P75-P25) 性别[例(%)] 收缩压(mmHg,x¯±s 舒张压(mmHg,x¯±s 心率(次/min,x¯±s 体温(℃,x¯±s
IAH组 25 64.0(40.0,82.0) 14(56.0) 11(44.0) 116.2±22.9 72.4±15.2 77.8±15.2 36.6±0.32
非IAH组 33 67.0(47.0,82.0) 19(57.6) 14(42.4) 123.6±25.9 73.2±16.2 72.6±11.8 36.5±0.43
P 0.289 0.904 0.338 0.848 0.144 0.275
组别 例数 白细胞计数[例(%)] C反应蛋白[例(%)] 尿素[例(%)] 肌酐[例(%)]
异常 正常 异常 正常 异常 正常 异常 正常
IAH组 25 17(68.0) 8(32.0) 23(92.0) 2(8.0) 11(44.0) 14(56.0) 10(40.0) 15(60.0)
非IAH组 33 16(48.5) 17(51.5) 27(81.8) 6(18.2) 16(48.5) 17(51.5) 8(24.2) 25(75.8)
P 0.137 0.445 0.735 0.199
组别 例数 谷丙转氨酶[例(%)] 天冬氨酸转氨酶[例(%)] 横膈位置[例(%)] 下腔静脉狭窄[例(%)]
异常 正常 异常 正常 抬高 正常
IAH组 25 12(48.0) 13(52.0) 11(44.0) 14(56.0) 16(64.0) 9(36.0) 3(12.0) 22(88.0)
非IAH组 33 8(24.2) 25(75.8) 15(45.5) 18(54.5) 8(24.2) 25(75.8) 0(0.0) 33(100.0)
P 0.059 0.912 0.002 0.075
组别 例数 病理性腹腔积液[例(%)] 实质脏器变形[例(%)] 腹壁纵横比(P75-P25) 腹膜腹壁纵径比(P75-P25)
IAH组 25 11(44.0) 14(56.0) 1(4.0) 24(96.0) 0.83(0.76,0.87) 0.53(0.48,0.56)
非IAH组 33 17(51.5) 16(48.5) 1(3.0) 32(97.0) 0.71(0.66,0.75) 0.40(0.35,0.44)
P 0.571 1 <0.001 <0.001
表2 多因素分析结果
图2 列线图模型及其ROC 曲线、校准曲线
图3 列线图模型的临床决策曲线及临床影响曲线
[1]
Kirkpatrick AW,Roberts DJ,De Waele J,et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome[J]. Intensive Care Med,2013,39(7): 1190-1206.
[2]
施建设,郑佳隆,陈佳海,等. 腹腔高压持续时间对危重症患者预后的影响[J]. 中华急诊医学杂志,2022,31(4): 544-550.
[3]
Malbrain ML,Chiumello D,Cesana BM,et al. A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology,a Unifying Project(WAKE-Up!)[J]. Minerva Anestesiol,2014,80(3): 293-306.
[4]
Murphy PB,Parry NG,Sela N,et al. Intra-Abdominal Hypertension Is More Common Than Previously Thought: A Prospective Study in a Mixed Medical-Surgical ICU[J]. Crit Care Med,2018,46(6):958-964.
[5]
Smit M,Koopman B,Dieperink W,et al. Intra-abdominal hypertension and abdominal compartment syndrome in patients admitted to the ICU[J]. Ann Intensive Care,2020,10(1): 130.
[6]
Bahten L,Lange P,Alves R,et al. Abdominal compartment syndrome: knowledge of the medical staff of a University Hospital in Curitiba[J]. Rev Col Bras Cir,2018,45(3): e1884.
[7]
Wise R,Rodseth R,Blaser A,et al. Awareness and knowledge of intra-abdominal hypertension and abdominal compartment syndrome:results of a repeat,international,cross-sectional survey[J].Anaesthesiol Intensive Ther,2019,51(3): 186-199.
[8]
Wachsberg RH,Sebastiano LL,Levine CD. Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure[J]. Abdom Imaging,1998,23(1): 99-102.
[9]
Epelman M,Soudack M,Engel A,et al. Abdominal compartment syndrome in children: CT findings[J]. Pediatr Radiol,2002,32(5):319-322.
[10]
Bouveresse S,Piton G,Badet N,et al. Abdominal compartment syndrome and intra-abdominal hypertension in critically ill patients:diagnostic value of computed tomography[J]. Eur Radiol,2019,29(7): 3839-3846.
[11]
Katz R,Meretyk S,Gimmon Z. Abdominal compartment syndrome due to delayed identification of a ureteral perforation following abdomino-perineal resection for rectal carcinoma[J]. Int J Urol,1997,4(6): 615-617.
[12]
Nozawa Y,Michimoto K,Ashida H,et al. Inferior vena cava diameter on CT angiography predicts mesenteric angiography positive for extravasation in colonic diverticular bleeding[J]. Radiol Med,2022,127(12): 1412-1419.
[13]
Pickhardt PJ,Shimony JS,Heiken JP,et al. The abdominal compartment syndrome: CT findings[J]. AJR Am J Roentgenol,1999,173(3): 575-579.
[14]
Verma S,Rana Ss,Kang M,et al. Computed tomography features predictive of intra-abdominal hypertension in acute necrotizing pancreatitis: A prospective study[J]. Indian J Gastroenterol,2021,40(3): 326-332.
[15]
Al-Bahrani AZ,Abid GH,Sahgal E,et al. A prospective evaluation of CT features predictive of intra-abdominal hypertension and abdominal compartment syndrome in critically ill surgical patients[J]. Clin Radiol,2007,62(7): 676-682.
[16]
Chen B,Yang S,Lyu G,et al. A nomogram for predicting the risk of intra-abdominal hypertension in critically ill patients based on ultrasound and clinical data[J]. Quant Imaging Med Surg,2023,13(10): 7041-7051.
[17]
He L,Yi C,Hou Z,et al. Intraabdominal hypertension/abdominal compartment syndrome after pelvic fractures: How they occur and what can be done?[J]. Injury,2019,50(4): 919-925.
[18]
Lu Z,Zhu X,Hua T,et al. Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis[J]. BMJ Open,2021,11(8): e045031.
[19]
Wen Y,Zhuo W Q,Liang HY,et al. Abdominal paracentesis drainage improves outcome of acute pancreatitis complicated with intra-abdominal hypertension in early phase[J]. Am J Med Sci,2023,365(1): 48-55.
[20]
De Waele JJ,Malbrain ML,Kirkpatrick AW. The abdominal compartment syndrome: evolving concepts and future directions[J].Crit Care,2015,19(1): 211.
[1] 白瑞球, 李荣, 郑惠琼, 梁文婷. 肝胆胰脾外科危重患者观察腹内压指标的临床意义[J]. 中华普通外科学文献(电子版), 2010, 04(05): 499-501.
[2] 彭雪峰, 杨华, 李慧, 宋应寒, 张雨晨, 雷文章. 腹壁切口疝分型与手术前后腹腔压力的相关性[J]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 418-422.
[3] 赵振国, 邵国益. 腹腔开放所致复杂腹壁缺损的确定性修复[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(05): 408-412.
[4] 王乃金, 闫波, 应浩杰, 史进, 马军伟, 苏珂. 疝补片修补及开腹减压术在腹腔间室综合征伴腹腔感染治疗中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2019, 13(02): 162-165.
[5] 孙瑞琼, 王爽. 原发性肺黏液腺癌多层螺旋CT影像表现[J]. 中华肺部疾病杂志(电子版), 2022, 15(02): 260-262.
[6] 杨爽, 余宏亮, 谢敏. CT 与超声检查对急性胰腺炎合并脂肪肝的诊断价值[J]. 中华消化病与影像杂志(电子版), 2024, 14(06): 541-544.
[7] 田娜, 韩飞天. 基于CT平扫影像组学模型与系统免疫炎症指数预测急性胰腺炎复发模型的建立[J]. 中华消化病与影像杂志(电子版), 2024, 14(04): 355-359.
[8] 莫鹏, 郭杏春, 梁秀娟, 王耀明. 超声引导与CT引导射频消融治疗肝细胞癌患者疗效及预后比较[J]. 中华消化病与影像杂志(电子版), 2024, 14(02): 151-154.
[9] 许莹, 叶枫, 赵心明. 能谱计算机体层成像在肝脏疾病影像诊断中的应用研究进展[J]. 中华消化病与影像杂志(电子版), 2022, 12(04): 241-245.
[10] 黄文鹏, 李林峰, 刘晨晨, 赵慧萍, 李莉明, 于扬, 高剑波. 基于CT影像组学模型预测人表皮生长因子受体-2弱阳性胃癌患者基因扩增的价值[J]. 中华消化病与影像杂志(电子版), 2022, 12(02): 69-75.
[11] 张青菊, 许建林, 南永刚, 施常备, 牛锦云. 99mTc-MDP SPECT/CT定量骨显像测定腰椎标准化摄取值的分析及应用[J]. 中华临床医师杂志(电子版), 2024, 18(03): 238-244.
阅读次数
全文


摘要