Ju Shenghong, Chen Feng, Liu Shengli, Zheng Kaier, Teng Gaojun
Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, China.
Eur J Radiol. 2006 Jan;57(1):102-7. doi: 10.1016/j.ejrad.2005.07.010. Epub 2005 Aug 22.
To re-assess the value of CT and clinical criteria as prognostic and severity indicators in acute pancreatitis and the correlation between them.
Sixty-five cases with acute pancreatitis (AP) were included in the study. The hospitalization days, fevering days and overall complications were regarded as clinical endpoints for the patient group. CT criteria used for AP evaluation included Balthazar's plain CT scan score, CT severity index (CTSI) and London's pancreatic size index (PSI) score. Clinical criteria was Ranson score. The correlations between each criterion and the clinical endpoints, and the relation between CT and clinical criteria were analyzed. The power of each criterion and combination of CT and clinical criteria in predicting overall complications of AP were assessed and compared by using a receiver operative characteristic curve (ROC) analysis.
The mean scores of PSI, Ranson among the three groups classified according to overall complications were significantly different. Except Balthazar's plain CT scan criterion, each criterion's mean score in-groups with local complications was significantly higher than that in-group without. The overall complications were significantly more in severe group than that in mild group classified according to each criterion except plain CT scan criterion. Mean days of hospital stay and fevering were significantly longer in severe group with Ranson score than that in mild group. PSI and Ranson score had a linear correlation with fevering days, and Ranson score had a linear correlation with hospitalization days. In CT criteria, only PSI had a linear correlation with Ranson score. The findings of plain CT scan was found to be some laggard compared with that of clinic. ROC analysis showed the largest A(Z) of Ranson score, and there was no A(Z) increase when CT criteria were added to clinical criteria.
The predictive values of Ranson and PSI score in AP patients are superior to that of other criteria. CT criteria are superior to clinical criterion in predicting local complications, and short-term CT follow-up examination is important in the evaluation of AP.
重新评估CT及临床标准作为急性胰腺炎预后和严重程度指标的价值以及它们之间的相关性。
本研究纳入65例急性胰腺炎（AP）患者。将住院天数、发热天数及总体并发症作为患者组的临床终点。用于AP评估的CT标准包括巴尔萨泽平扫CT评分、CT严重指数（CTSI）及伦敦胰腺大小指数（PSI）评分。临床标准为兰森评分。分析各标准与临床终点之间的相关性以及CT与临床标准之间的关系。采用受试者工作特征曲线（ROC）分析评估并比较各标准以及CT与临床标准联合在预测AP总体并发症方面的效能。
根据总体并发症分类的三组中，PSI、兰森评分的平均分有显著差异。除巴尔萨泽平扫CT标准外，有局部并发症组的各标准平均分显著高于无局部并发症组。根据各标准（除平扫CT标准外）分类，重度组的总体并发症明显多于轻度组。兰森评分重度组的平均住院天数和发热天数明显长于轻度组。PSI与兰森评分与发热天数呈线性相关，兰森评分与住院天数呈线性相关。在CT标准中，只有PSI与兰森评分呈线性相关。发现平扫CT扫描结果与临床结果相比有些滞后。ROC分析显示兰森评分的A（Z）最大，将CT标准加入临床标准时A（Z）无增加。
兰森评分和PSI评分在AP患者中的预测价值优于其他标准。CT标准在预测局部并发症方面优于临床标准，AP评估中短期CT随访检查很重要。
