Service of Gastroenterology, Hospital General de México, México.
Rev Esp Enferm Dig. 2010 Jun;102(6):376-80. doi: 10.4321/s1130-01082010000600006.
The acute pancreatitis is an inflammatory process that may involve peripancreatic tissue and distant organs. According to the Atlanta criteria, in 10 to 20% of the patients the disease is severe. Nowadays there are different clinical and biochemical severity scales such as the Ranson, APACHE-II (Acute Physiology and Chronic Health Evaluation) and hematocrit, which have discrepancies when being compared to tomographic scales such as the Balthazar. There exist few studies that correlate these parameters.
To evaluate the severity of the acute pancreatitis according to the Ranson, APACHE-II and serous hematocrit criteria at the moment of admission of the patient and correlate these scales with the local pancreatic complications according to the Balthazar classification.
Retrospective, observational and analytic study. There were included patients of any gender above the age of 18, with diagnosis of acute pancreatitis of any etiology, who had performed an abdominal tomography 72 hours after the beginning of the clinical condition in order to stage the pancreatic damage. The diagnosis of acute pancreatitis was established with 2 of the 3 following criteria: a) characteristic abdominal pain; b) uprising of the amylase and/or lipase more than 3 times above the superior normal limit; and c) characteristic finds of acute pancreatitis in the computed tomography. In order to make the correlation, the Pearson or the Spearman tests were used according to the distribution of the variables.
There were included 28 patients (21 masculine, 75%). The most frequent etiology was due to alcohol (53.6%, bile (21.4%) and hypertriglyceridemia (17.9%). The age average was 38.1 years old. Fifty per cent of the patients had acute severe pancreatitis according to the Atlanta criteria. Of the patients with APACHE-II less than 8 points, 62.5% were classified according to the Balthazar tomographic scale as D or E degree. Ninety-two point nine per cent of the patients had less than 3 Ranson criteria of which 57.6% got D or E degree. Fifty-seven per cent of the patients with hematocrit value lower than 44% got D and E Balthazar degree, and 64.2% of the patients with hematocrit above 44% got D and E degree.The Pearson correlation (PC) for APACHE-II and Ranson p = 0.013 of 0.476 PC for APACHE-II and Balthazar p = 0.367 of 0.476 and Spearman s correlation p = 0.460 PC for APACHE-II and hematocrit p = 1.32 of 0.476.
There does not exist a good correlation between the seriousness scale of Ranson and APACHE-II with the tomographic Balthazar degrees, therefore it is more likely to find very ill patients with an A or B Balthazar and on the other hand patients with acute low pancreatitis with a D or E Balthazar.
急性胰腺炎是一种炎症过程，可能涉及胰周组织和远处器官。根据亚特兰大标准，10%至 20%的患者病情严重。如今，有不同的临床和生化严重程度评分，如 Ranson、APACHE-II（急性生理学和慢性健康评估）和血细胞比容，与 Balthazar 等断层扫描评分相比存在差异。很少有研究将这些参数联系起来。
根据入院时患者的 Ranson、APACHE-II 和血清血细胞比容标准评估急性胰腺炎的严重程度，并将这些评分与 Balthazar 分类的局部胰腺并发症相关联。
回顾性、观察性和分析性研究。纳入任何性别、年龄在 18 岁以上的急性胰腺炎患者，病因不明，发病后 72 小时内进行腹部 CT 以分期胰腺损伤。急性胰腺炎的诊断采用以下三个标准中的两个：a）特征性腹痛；b）淀粉酶和/或脂肪酶升高超过正常上限的 3 倍以上；c）CT 检查有特征性的急性胰腺炎表现。为了进行相关性分析，根据变量的分布使用 Pearson 或 Spearman 检验。
共纳入 28 例患者（21 例男性，75%）。最常见的病因是酒精（53.6%）、胆汁（21.4%）和高三酰甘油血症（17.9%）。平均年龄为 38.1 岁。根据亚特兰大标准，50%的患者为急性重症胰腺炎。APACHE-II 评分低于 8 分的患者中，62.5%根据 Balthazar 断层扫描评分分为 D 或 E 度。92.9%的患者有少于 3 个 Ranson 标准，其中 57.6%为 D 或 E 度。血细胞比容值低于 44%的 57%患者获得 D 和 E Balthazar 度，血细胞比容值高于 44%的 64.2%患者获得 D 和 E 度。APACHE-II 和 Ranson 的 Pearson 相关系数（PC）为 0.013，为 0.476；APACHE-II 和 Balthazar 的 PC 为 0.367，为 0.476；APACHE-II 和血细胞比容的 Spearman s 相关系数（PC）为 0.460，为 1.32。
Ranson 和 APACHE-II 严重程度评分与断层扫描 Balthazar 程度之间没有良好的相关性，因此更有可能发现非常严重的 A 或 B Balthazar 患者，而另一方面，急性低胰腺炎患者可能为 D 或 E Balthazar。
