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胸部CT特征对急性胰腺炎严重程度及预后评估的价值

[The value of chest CT features evaluating the severity and prognosis for acute pancreatitis].

作者信息

Liu Dan, Song Bin, Huang Zi-Xing, Yuan Fang, Li Wei-Min

机构信息

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.

出版信息

Sichuan Da Xue Xue Bao Yi Xue Ban. 2013 Mar;44(2):319-22.

Abstract

OBJECTIVE

To analyze the chest CT imaging features of AP and explore the clinical value of diagnosis and prognosis for acute pancreatitis.

METHODS

Using the new standard of Atlanta for Acute Pancreatitis, 130 cases AP were divided into two groups, mild acute pancreatitis (MAP, 80 cases) and severe acute pancreatitis (SAP, 50 cases). The patients of clinical and CT features were analyzed. Explore bilateral pleural effusion thickness and lung consolidation thickness at mediastinum window of chest transvers CT and investigate results with the scores of CTSI, EPIC, BISAP and APACHE-II.

RESULTS

The chest CT of SAP manifested: The percentage of bilateral pleural effusion, pulmonary consolidation in SAP was more than in MAP, while the percentage of single pleural effusion, pulmonary consolidation and negative damage in SAP was less than in MAP. There was no significant difference between two groups (P > 0.05). The ratios among left pleural effusion/chest thickness, left pulmonary consolidation/chest thickness and right pulmonary consolidation/chest thickness in SAP were more than in MAP, There were significant differences between two groups (P < 0.05). There were significant differences among different groups about CTSI score, EPIC score, BISAP score and APACHE-II score (P < 0.05). After comparison each two groups, there were significant differences among some groups for all scores, especially in the EPIC score and BISAP score. There was middle-grade positive correlation among bilateral pleural effusion and pulmonary consolidation with EPIC score, BISAP score (P < 0.05); there low-grade positive correlation with CTSI score, APACHE-II score (P < 0.05). About the hospital stays, there was no significant differences among all groups, but there were significant differences between group 1 and group 5. AP with double pleural effusion or pulmonary consolidation died each one, the mortality were 1.5% and 1.1% respectively, while single pleural effusion or pulmonary consolidation died no one. There was no significant difference between them (P = 1.000).

CONCLUSION

Bilateral pleural effusion/pulmonary consolidation suggest SAP to some extent. Measuring the values of pleural effusion/pulmonary consolidation has some clinic cost for assessing the severity and the prognosis of Acute Pancreatitis.

摘要

目的

分析急性胰腺炎(AP)的胸部CT影像特征,探讨其对急性胰腺炎诊断及预后评估的临床价值。

方法

采用亚特兰大急性胰腺炎新标准,将130例AP患者分为两组,即轻症急性胰腺炎(MAP,80例)和重症急性胰腺炎(SAP,50例)。分析患者的临床及CT特征。在胸部横断CT纵隔窗观察双侧胸腔积液厚度及肺实变厚度,并与CT严重指数(CTSI)、急诊内科预后指标(EPIC)、床边严重急性胰腺炎评分(BISAP)及急性生理与慢性健康状况评分系统II(APACHE-II)的评分结果进行对比研究。

结果

SAP组胸部CT表现为:双侧胸腔积液、肺实变的比例高于MAP组,而单侧胸腔积液、肺实变及无损伤的比例低于MAP组。两组间差异无统计学意义(P>0.05)。SAP组左侧胸腔积液/胸廓厚度、左侧肺实变/胸廓厚度及右侧肺实变/胸廓厚度的比值高于MAP组,两组间差异有统计学意义(P<0.05)。不同组间CTSI评分、EPIC评分、BISAP评分及APACHE-II评分差异有统计学意义(P<0.05)。两两比较后,各评分在部分组间差异有统计学意义,尤其是EPIC评分和BISAP评分。双侧胸腔积液及肺实变与EPIC评分、BISAP评分呈中度正相关(P<0.05);与CTSI评分、APACHE-II评分呈低度正相关(P<0.05)。关于住院时间,各组间差异无统计学意义,但1组和5组间差异有统计学意义。伴有双侧胸腔积液或肺实变的AP患者各死亡1例,死亡率分别为1.5%和1.1%,而伴有单侧胸腔积液或肺实变的患者无死亡病例。两者间差异无统计学意义(P=1.000)。

结论

双侧胸腔积液/肺实变在一定程度上提示为SAP。测量胸腔积液/肺实变的值对评估急性胰腺炎的严重程度及预后有一定临床价值。

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