Balthazar CT、CTSI及EPIC评价急性胰腺炎预后的价值

  本文关键词：Balthazar CT、CTSI及EPIC评价急性胰腺炎预后的价值，由笔耕文化传播整理发布。

Balthazar CT、CTSI及EPIC评价急性胰腺炎预后的价值

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摘要

目的：
     急性胰腺炎(AP)预后的评估是临床研究的热点。CT评分系统由于操作简便、评价客观且动态观察可比性强,在临床工作中受到越来越多的重视。近期发展起来的胰外炎性浸润程度CT评分(Extrapancreatic Inflammation On CT Score, EPIC)不需要强化且综合考虑胰腺外改变,应该受到临床重视。但其对AP预后的价值尚无定论。本研究通过对入院24小时内对AP患者行增强CT检查,并行Balthazar CT、CTSI (CT Severity Index, CT严重度指数)及EPIC三种CT评分,比较这三者对AP严重度及预后的价值,并与常用的临床评分系统APACHE Ⅱ、Ranson评分进行相关性分析,以期为临床对AP早期预后评估提供帮助。
     方法：
     本研究回顾性分析入院日期在2012.2.28-2013.2.28之间的于山东省立医院住院治疗的所有第一诊断为AP的患者(共167例)的临床及实验室数据,其中符合入选标准的患者共72例,重症急性胰腺炎(SAP)患者49例,轻型急性胰腺炎(MAP)患者23例,以此为标准分为两组,应用SPSS16.0分析得出两组患者在年龄、性别及发病原因上的差别无统计学意义。
     入选及判断标准：AP及SAP的诊断标准依据2004年《中国急性胰腺炎诊治指南(草案)》
     筛除标准为：未在入院24小时内行腹部增强CT的患者。
     应用SPSS16.0评估三种CT评分系统对AP严重度及预后的价值,并绘制受试者工作特征(ROC)曲线,比较各方法的曲线下面积(AUC)以判断其准确性；并将其与常用的临床评分系统APACHE Ⅱ、Ranson评分进行相关性分析。
     结果：
     1.依据上述判断标准,将患者分为SAP组及MAP组,得出三种CT评分系统的得分在两组中有差异(P<0.001),其中EPIC评分在评估AP严重度中的价值最大,准确性最高(AUC=0.960),优于Balthazar CT评分(AUC=0.934)和CTSI评分(AUC=0.931)
     2.在72例患者中,有27例发生局部并发症。依据是否发生局部并发症,将患者分为两组。得出三种CT评分系统的得分在两组中的差异均有统计学意义(P<0.05),其中以EPIC评分在预测AP局部并发症发生中的价值最大,准确性最高(AUC=0.856),优于Balthazar CT评分(AUC=0.763)和CTSI评分(AUC=0.801)。
     3.CTSI及EPIC评分与住院天数相关。CTSI得分0-7分的患者平均住院天数为15.08±10.76天,8-10分的患者平均住院天数为21.2±10.73(P=0.021)；EPIC0-2分的患者平均住院天数为13.51+9.01天,3-6分的患者平均住院天数为20.69±11.97天(P=0.005)
     4.在所有72例患者中,进行了中转手术治疗的共有17例。根据是否进行中转手术治疗将患者分为两组。只有EPIC得分在两组间的差异具有统计学意义(P=0.008)。不需手术治疗的平均得分为2.14+1.977分,需要手术治疗患者的平均的分为3.67±1.633分。
     5.三种CT评分系统与APCHE Ⅱ及Ranson均有良好的相关性(P<0.001)
     结论
     1.三种CT评分系统在预测AP严重度及局部并发症中有重要价值,且EPIC在这三种评分系统中的预测能力最强；
     2EPIC得分与患者住院天数相关,0-2分的患者平均住院天数为13.51天,3-6分的患者平均住院天数为20.69天；
     3CTSI得分与患者住院天数相关,得分0-7分的患者平均住院天数为15.08天,8-10分的患者平均住院天数为21.2天；
     4.EPIC与中转手术治疗相关,不需手术治疗的平均得分为2.14分,需要手术治疗患者的平均得分为3.67分；
     5.三种CT评分系统与APCHE Ⅱ及Ranson均相关。
     对于AP患者,在入院早期(24小时)行CT检查对疾病的预后判断有重要的临床价值。
Purpose:
     Acute pancreatitis is a hot topic in clinical research. Computed tomography (CT) score system, with its simple operation, objective evaluation and dynamic observation, has attracted more and more clinical attention. But there isn't yet a conclusion on the estimating value of the CT score system. This research compare the value of Balthazar CT、CTSI and EPIC score systems in evaluating the severity and prognosis of AP in the early24hours of admission, meanwhile, compare the correlations between the CT score systems and the commonly used clinical score systems such as APACHE Ⅱ、 Ranson score system to help clinical diagnose and early prognosis.
     Methods:
     From2012.2.28-2013.2.28, the clinical and laboratory data of167patients admitted whose first diagnose are AP were collected. A retrospective analysis is carried out. According to the admission standard, there are72cases are involved, of which49cases are severe and23cases are mild. According to the severity, divide them into two groups. There are no significant differences in age, gender and atiology with the SPSS16.0statistical system. Draw a ROC curve, and evaluate the prediction ability of different score systems.
     Admission standard:1. The diagnosis standard of AP and SAP is based on the (Guideline For The Diagnosis And Treatment Of Acute Pancreatitis In China(2004)).
     Exclusion standard:The patients who did not obtain contrast-enhanced abdominal CT within24h of admission.
     Results:
     1. Patients are divided into severe group and mild group, and the scores of the three kinds of CT systems are statistic different detween the two groups(p<0.05), of which the EPIC score (AUC=0.960) for the prediction of severe disease was significantly higher than Balthazar (AUC=0.934) and CTSI (AUC=0.931)
     2. Among the72patients,27cases have local complications. According to the result, divide them into two groups and the scores are statistic different between the two groups(p<0.05), of which the EPIC score (AUC=0.856) for the prediction of local complications was significantly higher than Balthazar (AUC=0.763) and CTSI (AUC=0.801)
     3. CTSI and EPIC are related to the length of hospital stay. The mean day is15.08±10.76when CTSI score is0-7; while21.2±10.73days when the score is8-10(P=0.021). However, the mean day is13.51±9.01when EPIC score is0-2; while20.69±11.97days when the score is3-6(P=0.005)
     4. Among the72patients,17cases have intervention, thus divide them into two groups. Only EPIC scores are different between the two groups(P=0.008). The mean score in the group without surgery is2.14±1.977, while the group with surgery is3.67±1.633.
     5. All of the three kinds CT score systems correlate well with APCHE Ⅱ and Ranson(p<0.001).
     Conclusions:
     1. The three kinds of CT score systems are very valuable to evaluate the severity of acute pancreatitis in the early24hours of admission, among which EPIC score is the most accurate.
     2. EPIC score is related to the length of hospital stay. The mean day is13.51when EPIC score is0-2; while20.69days when the score is3-6
     3. CTSI score is related to the length of hospital stay also. The mean day is15.08when CTSI score is0-7; while21.2days when the score is8-10.
     4. EPIC is related to intervention. The mean score in the group without surgery is2.14, while the group with surgery is3.67.
     5. All of the three kinds CT score systems correlate well with APCHE Ⅱ and Ranson(p<0.001).
     For AP with AP, early CT examination in the first24hours of admission has great value in predicting the prognosis.

引文

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  本文关键词：Balthazar CT、CTSI及EPIC评价急性胰腺炎预后的价值，由笔耕文化传播整理发布。