CAJ | 학술논문

目的：探讨顽固性便秘患者并发肠系膜上动脉综合征（SMAS）的危险因素，并观察予以营养支持治疗的疗效。方法2008年6月至2012年12月间，南京军区南京总医院对连续收治的973例顽固性便秘患者作为研究队列，采用1∶4匹配的前瞻性巢式病例对照研究方法，确定顽固性便秘人群发生SMAS的危险因素；并评价营养支持治疗的疗效。结果973例顽固性便秘患者中确诊SMAS 26例，累计发病率为2．7％。多因素条件Logistic回归分析发现，体质量指数（BMI）低于18 kg/m2（OR＝2．89，95% CI：1.141~7.307）和结肠传输时间延长（OR＝3．57，95% CI：1.362~9.350）是发生SMAS的独立危险因素。经营养支持治疗，26例SMAS中有22例（84．6％）痊愈。与治疗前相比，SMAS患者的胃肠生活质量评分、Wexner便秘评分和营养指标（血清白蛋白、前清蛋白和纤维连接蛋白）均有明显改善（均P＜0.05）。结论 BMI低于18 kg/m2和结肠传输时间延长是顽固性便秘患者发生SMAS的危险因素。便秘并发SMAS应按病情和营养状况予以营养支持保守治疗，同时结合便秘对症治疗。
목적：탐토완고성편비환자병발장계막상동맥종합정（SMAS）적위험인소，병관찰여이영양지지치료적료효。방법2008년6월지2012년12월간，남경군구남경총의원대련속수치적973례완고성편비환자작위연구대렬，채용1∶4필배적전첨성소식병례대조연구방법，학정완고성편비인군발생SMAS적위험인소；병평개영양지지치료적료효。결과973례완고성편비환자중학진SMAS 26례，루계발병솔위2．7％。다인소조건Logistic회귀분석발현，체질량지수（BMI）저우18 kg/m2（OR＝2．89，95% CI：1.141~7.307）화결장전수시간연장（OR＝3．57，95% CI：1.362~9.350）시발생SMAS적독립위험인소。경영양지지치료，26례SMAS중유22례（84．6％）전유。여치료전상비，SMAS환자적위장생활질량평분、Wexner편비평분화영양지표（혈청백단백、전청단백화섬유련접단백）균유명현개선（균P＜0.05）。결론 BMI저우18 kg/m2화결장전수시간연장시완고성편비환자발생SMAS적위험인소。편비병발SMAS응안병정화영양상황여이영양지지보수치료，동시결합편비대증치료。
Objective To determine the incidence and risk factors associated to with refractory constipation patients complicated with superior mesenteric artery syndrome (SMAS), and to observe the role of nutritional support in its treatment. Methods A prospective nested case-control study was conducted from a constipation cohort (n=973) to assess the incidence and risk factors of SMAS. Pitents with SMAS were matched to controls with a ratio of 1∶4 by age and gender. Cases developed SMAS in long-term follow-up (n=26) and controls did not (n=104). Nutritional support was used in 26 patients with SMAS. The efficacy of nutritional support was evaluated by retrospective analysis. Results The incidence of SMAS in this cohort of patients was 2 . 7%. Multivariate logistic analysis revealed BMI≤18 kg/m2 (OR=2.89, 95% CI:1.14-7.31) and prolonged colon transit time (OR=3.57, 95%CI:1.36-9.35) were independent risk factors of SMAS in patients with refractory constipation. A total of 22 patients recovered after treatment of nutritional support. The successful rate of conservative treatment was 84.6%. The clinical symptoms, gastrointestinal quality of life index, Wexner constipation score and nutritional status were all significantly improved after treatment. Conclusion A BMI of less than 18 kg/m2 and prolonged colon transit time are independent risk factors in refractory constipation patients complicated with SMAS. Nutrition support should be carried out according to illness condition and nutritional status, and combined with theatment of constipation simultaneously.