早期应用CT评价系统联合D-二聚体评估重症急性胰腺炎的预后

发布时间：2018-04-01 21:15

本文选题：重症急性胰腺炎　切入点：Balthazar　出处：《大连医科大学》2017年硕士论文

【摘要】：目的:本研究通过统计分析重症急性胰腺炎(severe acute pancreatitis,SAP)患者早期CT评价系统,包括Balthazar CT分级和改良CT严重指数(modified CT severity index,MCTSI)评分,以及血浆D-二聚体(D-dimer)水平分别与患者预后的关系,进一步研究CT评价系统和D-二聚体的关系及两者联合对SAP患者预后的评估作用。方法:回顾性分析大连医科大学附属第二医院2014年1月至2016年12月收治的73例重症急性胰腺炎患者的一般资料,其年龄分布在19~89岁。所有患者均24小时内完善血清D-二聚体测定,48小时内完善腹部CT检查(包括平扫CT及增强CT),早期给予入选患者均采取保守治疗。根据Balthazar CT分级标准,以CT分级=C为界,划分为低级组与高级组。根据MCTSI评分标准,以4分和6分为界,划分为低分组与高分组。以D-二聚体=2μg/ml为界,划分为低水平组和高水平组。分析Balthazar CT分级、MCTSI评分和D-二聚体水平与患者住院天数、死亡率等临床参数的关系。应用所有患者的Balthazar CT分级、MCTSI评分和D-二聚体水平绘制受试者工作特征曲线(ROC),通过计算曲线下面积(AUC)来比较三者评估SAP预后的价值。继续分析CT评价系统与D-二聚体水平之间的关系及两者联合对SAP患者预后的评估作用。计量资料采用均数±标准差表示,组间比较应用t检验或方差分析;分类资料的分析采用卡方检验。以P0.05表示差异有统计学意义。结果:Balthazar分级中,低级组患者住院天数、入住ICU率、中转手术率及死亡率均低于高级组,其中两组患者住院天数(p=0.000)及死亡率(p=0.029)的差异具有统计学意义。MCTSI评分中,低分组患者住院天数、入住ICU率、中转手术率及死亡率均低于高分组,其中两组患者住院天数(p=0.000)及死亡率(p=0.039)的差异具有统计学意义。D-二聚体低水平组患者住院天数、中转手术率高于高水平组,入住ICU率、死亡率低于高水平组,其中两组患者死亡率的差异具有统计学意义(p=0.044)。ROC曲线分析显示,Balthazar CT分级的AUC值为0.722(95%CI:0.560~0.884),改良CT严重指数评分的AUC值为0.694(95%CI:0.515~0.872),D-二聚体的AUC值为0.760(95%CI:0.616~0.905)。三者均可预测SAP死亡的发生,曲线下面积比较:D-二聚体Balthazar CT分级改良CT严重指数评分。进一步研究D-二聚体与CT评价系统的关系,CT分级高的患者血浆D-二聚体水平显著高于CT分级低的患者,差异具有统计学意义(P0.05)。同样的,MCTSI评分高的患者血浆D-二聚体水平显著高于MCTSI评分低的患者,差异具有统计学意义(P0.05)。早期CT分级和D-二聚体水平均较高时,患者预后较差。同样的,早期MCTSI评分和D-二聚体水平均较高时,患者预后较差。结论:1.早期CT评价系统和D-二聚体水平可以对重症急性胰腺炎患者的预后进行评估,早期D-二聚体比CT评价系统能更准确地预测SAP死亡的发生;2.CT评价系统和D-二聚体水平相关,早期将二者联合应用可能提高对重症急性胰腺炎预后的评估价值,从而指导临床治疗,降低死亡率。
[Abstract]:Objective: This study through the statistical analysis of severe acute pancreatitis (severe acute, pancreatitis, SAP) CT patients early evaluation system, including the Balthazar CT score and modified CT (modified CT severity index severity index, MCTSI score), and plasma D- two dimer (D-dimer) respectively, and the relationship with prognosis, further evaluation system based on CT and the two D- dimer and the relationship between the combination evaluation on the prognosis of patients with SAP. Methods: a retrospective analysis of general information of 73 cases of severe acute pancreatitis patients in Second Affiliated Hospital of Dalian Medical University from January 2014 to December 2016 were, their age ranged from 19~89 years old. All patients were within 24 hours of perfect D- two in serum were tested. Within 48 hours of complete abdominal CT examination (including unenhanced CT and enhanced CT), patients were given early conservative treatment. According to the Balthazar CT classification standard, the CT grade =C Circles, divided into junior group and senior group. According to the MCTSI standard for evaluation, with 4 points and 6 points for the sector, divided into low and high packet packet. In two D- dimer =2 g/ml, divided into low level group and high level group. Analysis of Balthazar CT grade, MCTSI score and D- two together body level and patients with hospital stay, mortality and other clinical parameters. The application of Balthazar CT grade in all patients, the scores of MCTSI and D- two dimer level receiveroperating characteristic curve (ROC), by calculating the area under the curve (AUC) to compare the three assessment of the SAP prognosis. Evaluation of relations continue to analysis of the CT evaluation system and D- between the two level of D-dimer and the combination of the two on the prognosis of patients with SAP. The measurement data expressed by the mean and standard deviation, t test or analysis of variance between groups using; analysis and classification of data by chi square test. The P0.05 results indicated significant difference. : Balthazar grade, lower hospitalization patients admitted to the ICU rate, operation rate and mortality were lower than the high group, the two groups of patients hospitalized days (p=0.000) and mortality (p=0.029) and the difference was statistically significant.MCTSI score, hospitalization low score patients admitted to the ICU rate, operation rate and mortality below the high group, including two patients hospitalized days (p=0.000) and mortality (p=0.039) and the difference was statistically significant.D- two dimer levels in patients with low hospitalization days, the operation rate is higher than the high level group, the ICU rate, mortality rate was lower than the high level group, which was statistically significant difference between the two groups in mortality (p=0.044).ROC curve analysis showed that Balthazar CT grade AUC value was 0.722 (95%CI:0.560~0.884), modified CT severity index score of AUC was 0.694 (95%CI:0.515 ~0.872), two D- dimer AUC (95%CI = 0.760 : 0.616~0.905). The three can predict the occurrence of SAP's death and compared the area under the curve: D- two dimer Balthazar CT classification of modified CT severity index score. Further study the relationship between D- two dimer and CT evaluation system, CT D- two high grade plasma level of D-dimer was significantly higher than that of CT patients with low grade, statistically significant difference (P0.05). Similarly, the MCTSI score in patients with high plasma D- two level of D-dimer was significantly higher than that in patients with low MCTSI score, the difference was statistically significant (P0.05). Early CT grade and two D- dimer levels were higher, the prognosis is poor. Similarly, early MCTSI score and D- two the level of D-dimer were higher, patients with poor prognosis. Conclusion: early 1. CT evaluation system and D- two level of D-dimer can evaluate the prognosis of patients with severe acute pancreatitis, early two D- dimer than CT evaluation system can more accurately predict the occurrence of SAP death; 2.C The T evaluation system is related to the D- two dimer level. Early application of the two combination may improve the prognosis of severe acute pancreatitis, so as to guide clinical treatment and reduce mortality.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576

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