中度急性胰腺炎CT检查MCTSI与临床情况的相关性分析

发布时间：2018-06-18 22:14

  本文选题：中度急性胰腺炎 + MCTSI　； 参考：《泸州医学院》2014年硕士论文

【摘要】：目的：肯定通过胰腺增强CT检查改良CT严重指数（MCTSI）对中度急性胰腺炎的诊断价值，探讨中度急性胰腺炎患者MCTSI与临床病情的相关性。为临床制定合理治疗方案及判断预后起指导性作用。方法：随机选取2011年1月—2014年2月入住四川省医学科学院四川省人民医院消化内科198例确诊为中度急性胰腺炎的患者，其中男性146例，女性52例，年龄32岁-76岁，平均（49±13）岁。于发病48h-72h行胰腺增强CT检查，，收集影像学资料及临床资料[包括局部或全身并发症：急性胰腺炎胰周液体积聚(APFC)、急性坏死物积聚(ANC)、胰腺假性囊肿、包裹性坏死(WON)和胰腺脓肿、胸腔积液、胃流出道梗阻、消化道瘘、腹腔出血、假性囊肿出血、脾静脉或门静脉血栓形成、坏死性结肠炎、全身炎症反应综合征（SIRS）、全身感染、腹腔内高压(IAH)或腹腔间隔室综合征(ACS)、胰性脑病(PE)及一过性脏器功能衰竭（呼吸、循环、肾脏）]，并对比分析，观察MCTSI与并发症、生化指标变化的结果，与临床评分（APACHEⅡ、Rason、BISAP）的相关性。结果：1、伴有单个或多个并发症的病例MCTSI集中出现在4、6、8、10分值段，构成比分别为35.6%；42%；18.7%；3.7%。中度急性胰腺炎MCTSI分值越高，临床病情越重。2、MCTSI在8、10分值组的病例中，血尿淀粉酶显著下降，且10分病例下降更明显（P＜0.05）；而CRP数值显著升高，且10分组升高更明显（P＜0.05）；血钙数值显著下降，且10分组下降更明显（P＜0.05）；差异均有统计学意义。表明MCTSI分值越高，反应中度急性胰腺炎炎症程度的生化指标变化越显著，病情越重。3、MCTSI与APACHEⅡ评分呈正相关性（χ2=11.9572;P=0.0177;相关系数=0.1549)，ACHEⅡ评分≥8分的病例，MCTSI集中出现在4～10分值组，表明：MCTSI越高，APACHEⅡ临床评分越高，病情越重。4、MCTSI与Rason评分呈正相关性（χ2=9.7670;P=0.0445;相关系数=0.1266)，Rason评分≥3分的病例，MCTSI集中出现在4～10分值组，表明：MCTSI越高，Rason评分越高，病情越重。5、MCTSI与BISAP评分呈正相关性（χ2=10.6566;P值=0.0307;相关系数=0.1461)，BISAP评分≥3分的病例，MCTSI集中出现在4～10分值组，表明：MCTSI越高，BISAP评分临床评分越高，病情越重。结论：胰腺增强CT检查MCTSI评估系统是诊断中度急性胰腺炎最简便、准确的方法，能直接发现胰腺实质及周围的病变。将CT炎性和坏死分级、MCTSI、临床评分相结合可以明确诊断，对病情的评估、临床分型、判断预后及指导治疗具有重要的临床价值。
[Abstract]:Objective: to evaluate the diagnostic value of modified CT severity index (MCTSII) in patients with moderate acute pancreatitis (MCTSI), and to explore the correlation between MCTSI and clinical conditions in patients with moderate acute pancreatitis. It plays a guiding role in making reasonable treatment plan and judging prognosis in clinic. Methods: 198 patients with moderate acute pancreatitis were randomly selected from January 2011 to February 2014 in the Department of Digestive Medicine, Sichuan Provincial people's Hospital, Sichuan Academy of Medical Sciences, including 146 males and 52 females, aged from 32 to 76 years with an average of 49 卤13 years. Pancreatic enhanced CT was performed on 48h-72h. Imaging and clinical data were collected [including local or systemic complications: acute pancreatitis with peripancreatic fluid accumulation, acute necrotic accumulation with ANC, pancreatic pseudocyst, encapsulated necrotic WON] and pancreatic abscess. Pleural effusion, obstruction of gastric outflow tract, gastrointestinal fistula, abdominal hemorrhage, pseudocyst hemorrhage, splenic vein or portal vein thrombosis, necrotizing colitis, systemic inflammatory response syndrome, systemic infection, Intraperitoneal hypertension (IAH) or celiac septum syndrome (ACS), pancreatic encephalopathy (PED) and transient organ failure (respiratory, circulatory, renal) were compared and analyzed, and the results of MCTSI, complications and biochemical indexes were observed. Correlation with clinical score Apache 鈪

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