Small and large bowel anatomy is associated with enteral autonomy in infants with short bowel syndrome: A retrospective cohort study.
Small and large bowel anatomy is associated with enteral autonomy in infants with short bowel syndrome: A retrospective cohort study.
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小肠和大肠解剖结构与短肠综合征婴儿的肠自主权相关：一项回顾性队列研究。
DOI：
10.1002/jpen.2587
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Avitzur,Yaron
中科院分区：
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作者：
Sandy,NataschaS;Roberts,AminJ;Wales,PaulW;Toma,RicardoK;Belza,Christina;Dogra,Harween;Evans,HelenM;Gattini,Daniela;Hind,Jonathan;Mercer,David;Povondra,JillM;Turner,Justine;Yap,Jason;Wong,Theodoric;Avitzur,Yaron
背景实现肠内自主性（EA）是儿童肠功能衰竭（IF）的最终治疗目标。本研究旨在评估儿童短肠综合征（SBS） EA的预测因素，并探讨残留小肠（SB）和大肠（LB）长度对EA的影响。方法回顾性队列研究2010 - 2015年间转诊的年龄<12月龄的SBS患儿（n= 367, 6个中心）。根据EA结果对队列进行分层。统计检验采用t -检验、卡方、Cox比例风险回归模型和Kaplan - Meier分析完成。结果229例患者达到sea。在多变量分析中,剩余的百分比磅(危险比[HR] = 1.02; 95%可信区间-1.02 = 1.01)和某人(HR = 1.01; 95%置信区间CI = 1.01 - -1.02)长度的回盲瓣(HR = 2.02; 95%置信区间CI = 1.41 - -2.88),而不是来自高体积移植中心(HR = 2.42; 95%置信区间CI = 1.68 - -3.49)与EA呈正相关,而负面协会被认为与气孔的存在时最短遗迹是记录(HR = 0.72; 95%可信区间-1.00 = 0.52)。解剖亚组之间EA成就有显著差异（log‐rank检验p < 0.001）， SB和LB≥50%的婴儿EA率为80.4%（中位时间209天）；62.5% SB≥50% LB <50%（397天）；58.3%的患者SB <50%, LB≥50%（1192天），25.9%的患者SB和LB <50%。坏死性小肠结肠炎（NEC）与EA的更好实现无关（NEC与其他病因：log‐rank testP= 0.33）。总体而言，62%继发于SBS的IF患儿在平均2.3年的随访时间内实现了EA。结肠长度为>50%可以弥补小肠的损失（<50%），并且与残余SB >50%的儿童的EA发生率相似。
BackgroundAchievement of enteral autonomy (EA) is the ultimate treatment goal in pediatric intestinal failure (IF). We aimed to assess predictors of EA in pediatric short bowel syndrome (SBS) and explore the impact of residual small bowel (SB) and large bowel (LB) length on EA.MethodsA retrospective cohort study was performed on infants aged <12 months (n= 367, six centers) with SBS referred between 2010 and 2015. The cohort was stratified based on the achievement of EA. Statistical testing was completed usingt‐test, chi‐square, Cox proportional hazards regression model, and Kaplan‐Meier analysis.ResultsEA was achieved in 229 patients. In the multivariable analysis, the percentage of residual LB (hazard ratio [HR] = 1.02; 95% CI = 1.01–1.02) and SB (HR = 1.01; 95% CI = 1.01–1.02) length, presence of the ileocecal valve (HR = 2.02; 95% CI=1.41–2.88), and not coming from a high‐volume transplantation center (HR = 2.42; 95% CI = 1.68–3.49) were positively associated with EA, whereas a negative association was seen with the presence of stoma at the time when shortest remnant was documented (HR = 0.72; 95% CI = 0.52–1.00). EA achievement was significantly different between the anatomical subgroups (log‐rank testP< 0.001) with an EA rate of 80.4% in infants with ≥50% SB and LB (median time 209 days); 62.5% with ≥50% SB and <50% LB (397 days); 58.3% with <50% SB and ≥50% LB (1192 days), and 25.9% with <50% SB and LB. Necrotizing enterocolitis (NEC) was not associated with a better achievement of EA (NEC vs other etiologies: log‐rank testP= 0.33).ConclusionsOverall, 62% of infants with IF secondary to SBS achieved EA over a mean time of follow‐up of 2.3 years. A colon length of >50% can compensate for the loss of small bowel (<50%) and account for similar EA rates as those in children with residual SB > 50%.