胰源性门静脉高压症的临床特征及其影响因素

摘要/Abstract

摘要： 目的探讨胰源性门静脉高压症(PPH)的临床特征及其影响因素。方法选取上海交通大学医学院附属瑞金医院2021年7月至2024年7月收治的190例PPH患者临床资料作为PPH组,另选取同期190例健康体检者作为健康组。收集所有研究对象临床资料,分析PPH病因构成、临床症状、治疗及预后情况,比较PPH组与健康组临床资料,采用logistic回归分析PPH发病影响因素,并建立列线图模型。结果 190例PPH患者主要胰腺原发疾病为胰腺肿瘤72例(37.89%)、慢性胰腺炎50例(26.32%);主要临床症状为不规则腹痛165例(86.84%)、孤立性胃底静脉曲张131例(68.95%);121例行手术治疗(63.68%),18例行脾动脉栓塞术(9.47%),51例行保守治疗(26.84%)。PPH组胰腺肿瘤、急性胰腺炎占比,血清CRP、FIB高于健康组(P<0.05);胰腺肿瘤、急性胰腺炎、高水平CRP、高水平FIB均是PPH发病的独立危险因素(P<0.05);380例研究对象按照7∶3比例拆分为训练集与验证集,训练集266例,验证集114例,训练集和验证集预测PPH发病的ROC曲线的AUC(95%CI)分别为0.91(0.87~0.95)和0.91(0.86~0.97);列线图模型预测活动性肺结核的校正曲线趋近于理想曲线(P=0.000、0.148);DCA曲线显示列线图模型概率阈值在50%~100%时具有更高正向净收益。结论 PPH临床表现多样,发病原因复杂,胰腺肿瘤、急性胰腺炎、血清CRP、FIB是PPH发病影响因素,构建的列线图模型具有较好区分度、校准度及临床实用性。

关键词: 胰源性门静脉高压症, 临床特征, 胰腺肿瘤, 影响因素, 列线图

Abstract: Objective To investigate the clinical features and influencing factors of pancreatic portal hypertension (PPH). Methods The clinical data of 190 patients with PPH admitted to Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2021 to July 2024 were selected as the PPH group, and 190 healthy physical examination patients during the same period were selected as the healthy group. Clinical data of all subjects were collected, the etiology, clinical symptoms, treatment, and prognosis of PPH were analyzed, the clinical data of the PPH group and the healthy group were compared, the influencing factors of the incidence of PPH were analyzed by logistic regression, and a nomogram model was established. Results Among the 190 patients with PPH, the main primary pancreatic diseases were pancreatic tumor in 72 cases (37.89%) and chronic pancreatitis in 50 cases (26.32%). The main clinical symptoms were irregular abdominal pain in 165 cases (86.84%) and solitary fundus varicose veins in 131 cases (68.95%). 121 cases were treated with operation (63.68%), 18 cases were treated with splenic artery embolization (9.47%) and 51 cases were treated with conservative treatment (26.84%). The proportion of pancreatic tumor, acute pancreatitis, serum CRP and FIB in PPH group were higher than those in healthy group (P<0.05). Pancreatic tumors, acute pancreatitis, high levels of CRP, high levels of FIB were independent risk factors for PPH (P<0.05). 380 subjects were divided into the training set and the validation set according to the ratio of 7:3, with 266 in the training set and 114 in the validation set. The AUC (95%CI) of the ROC curve for predicting the incidence of PPH in the training set and the validation set were 0.91 (0.87-0.95) and 0.91 (0.86-0.97), respectively. The correction curve predicted by the nomogram model was close to the ideal curve (P=0.000, 0.148). The DCA curve showed that the probability threshold of the nomogram model at 50% to 100% has a higher positive net benefit. Conclusion The clinical manifestations of PPH are diverse and the pathogenesis is complex. Pancreatic tumor, acute pancreatitis, serum CRP and FIB are the influencing factors of PPH pathogenesis. The constructed nomogram model demonstrated good differentiation, calibration and clinical practicability.

Key words: Pancreatic portal hypertension, Clinical features, Pancreatic tumor, Influencing factors, Nomograph

王晔龙, 王洋, 沈华, 于海文, 李佑. 胰源性门静脉高压症的临床特征及其影响因素[J]. 肝脏, 2025, 30(4): 552-556.

WANG Ye-long, WANG Yang, SHEN Hua, YU Hai-wen, LI You. Clinical features and influencing factors of pancreatic portal hypertension[J]. Chinese Hepatolgy, 2025, 30(4): 552-556.

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