The Risk Factors Of Strangulated Intestinal Obstruction And The Meta-analysis Of Intestinal Fatty Acid Binding Protein

Objective: Consult the clinical data of patients with intestinal obstruction,analyze the related factors of intestinal strangulation,and assess the risk of strangulated intestinal obstruction.At the same time,meta-analysis was conducted to clarify the value of intestinal fatty acid binding protein(I-FABP)in the early diagnosis of strangulated intestinal obstruction,and provide evidence-based evidence for clinicians’ early intervention in intestinal obstruction.Methods:(1)This paper checked the clinical data of 611 patients with intestinal obstruction admitted in our hospital from January 1,2012 to June 30,2020 in emergency surgery and gastrointestinal surgery.According to the inclusion and exclusion criteria,they were divided into strangulated intestinal obstruction group(119 cases)and simple intestinal obstruction group(492 cases).The diagnosis of strangulated intestinal obstruction is based on the intraoperative findings and postoperative pathology.The basic information,clinical manifestations,blood tests and imaging CT signs of the two groups of patients were collected,and the logistic regression analysis method was used to analyze the relevant influencing factors of intestinal strangulation.(2)Search the literature on I-FABP for diagnosis of strangulated intestinal obstruction in the Chinese and English literature database,screen the literature according to the inclusion and exclusion criteria and extract relevant data information,evaluate the quality of the literature that meets the standards,and use Meta-Disc 1.4,Stata15.1 software for meta-analysis.Results:(1)(1)Univariate analysis results: the levels of heart rate,C-reactive protein(CRP),white blood cells(WBC),neutrophils,lactate dehydrogenase(LDH),creatine kinase(CK),and D-dimer(D-D)in the strangulated intestinal obstruction group were statistically higher than those in the simple intestinal obstruction group.The proportion of patients with clinical manifestations such as persistent abdominal pain,peritonitis and CT signs like ascites,mesenteric edema and decreased intestinal wall density in the strangulated intestinal obstruction group was higher than that in the simple intestinal obstruction group.While the level of lymphocytes and the proportion of patients with previous abdominal surgery were relatively higher in the simple intestinal obstruction group.The above differences were statistically significant(P<0.05).There was no significant difference between the two groups in age,gender,body temperature,hemoglobin,monocytes,platelets,etc.(P>0.05).(2)Multivariate Logistic regression analysis results: the independent risk factors for strangulation of intestinal obstruction were peritonitis(OR: 18.1;95% CI: 8.09-40.53),CT showed decreased intestinal wall density(OR: 8.35;95% CI: 2.92-23.84),persistent abdominal pain(OR: 5.13;95% CI: 2.46-10.7),CT showed abdominal effusion(OR:3.76;95% CI: 1.38-10.27),D-D(OR: 1.48;95% CI: 1.07-2.04),WBC(OR: 1.32;95% CI: 1.20-1.46),CRP(OR: 1.03;95% CI: 1.02-1.04),LDH(OR: 1.01;95% CI:1.01-1.02),CK(OR: 1.01;95% CI: 1.00-1.01),etc.(P<0.05).Patients with a history of abdominal surgery are more likely to develop nonstrangulated intestinal obstruction(OR: 0.45;95% CI: 0.21-0.95;P<0.05).(2)A total of 8 articles were included in this meta-analysis.The pooled results are as follows: sensitivity: 0.75(95% CI: 0.66-0.81),specificity: 0.83(95% CI:0.71-0.91),positive likelihood ratio(PLR): 4.35(95% CI: 2.57-7.36),negative likelihood ratio(NLR): 0.31(95% CI: 0.24-0.39),diagnosis odds ratio(DOR): 14.19(95% CI: 8.08-24.92).The area under the curve(AUC)was 0.83.Conclusion:(1)Persistent abdominal pain,peritonitis,WBC,CRP,LDH,CK,D-D,abdominal effusion and decreased intestinal wall density are independent risk factors for strangulated intestinal obstruction.The history of abdominal surgery is a protective factor for strangulation of intestinal obstruction.(2)I-FABP has a high value in the early diagnosis of strangulated intestinal obstruction and can be used to distinguish strangulated intestinal obstruction from intestinal obstruction in a timely manner,enabling accurate planning of the timing of surgery.