本文選題：重癥急性胰腺炎　切入點(diǎn)：Balthazar　出處：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究通過(guò)統(tǒng)計(jì)分析重癥急性胰腺炎(severe acute pancreatitis,SAP)患者早期CT評(píng)價(jià)系統(tǒng),包括Balthazar CT分級(jí)和改良CT嚴(yán)重指數(shù)(modified CT severity index,MCTSI)評(píng)分,以及血漿D-二聚體(D-dimer)水平分別與患者預(yù)后的關(guān)系,進(jìn)一步研究CT評(píng)價(jià)系統(tǒng)和D-二聚體的關(guān)系及兩者聯(lián)合對(duì)SAP患者預(yù)后的評(píng)估作用。方法:回顧性分析大連醫(yī)科大學(xué)附屬第二醫(yī)院2014年1月至2016年12月收治的73例重癥急性胰腺炎患者的一般資料,其年齡分布在19~89歲。所有患者均24小時(shí)內(nèi)完善血清D-二聚體測(cè)定,48小時(shí)內(nèi)完善腹部CT檢查(包括平掃CT及增強(qiáng)CT),早期給予入選患者均采取保守治療。根據(jù)Balthazar CT分級(jí)標(biāo)準(zhǔn),以CT分級(jí)=C為界,劃分為低級(jí)組與高級(jí)組。根據(jù)MCTSI評(píng)分標(biāo)準(zhǔn),以4分和6分為界,劃分為低分組與高分組。以D-二聚體=2μg/ml為界,劃分為低水平組和高水平組。分析Balthazar CT分級(jí)、MCTSI評(píng)分和D-二聚體水平與患者住院天數(shù)、死亡率等臨床參數(shù)的關(guān)系。應(yīng)用所有患者的Balthazar CT分級(jí)、MCTSI評(píng)分和D-二聚體水平繪制受試者工作特征曲線(ROC),通過(guò)計(jì)算曲線下面積(AUC)來(lái)比較三者評(píng)估SAP預(yù)后的價(jià)值。繼續(xù)分析CT評(píng)價(jià)系統(tǒng)與D-二聚體水平之間的關(guān)系及兩者聯(lián)合對(duì)SAP患者預(yù)后的評(píng)估作用。計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差表示,組間比較應(yīng)用t檢驗(yàn)或方差分析;分類資料的分析采用卡方檢驗(yàn)。以P0.05表示差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:Balthazar分級(jí)中,低級(jí)組患者住院天數(shù)、入住ICU率、中轉(zhuǎn)手術(shù)率及死亡率均低于高級(jí)組,其中兩組患者住院天數(shù)(p=0.000)及死亡率(p=0.029)的差異具有統(tǒng)計(jì)學(xué)意義。MCTSI評(píng)分中,低分組患者住院天數(shù)、入住ICU率、中轉(zhuǎn)手術(shù)率及死亡率均低于高分組,其中兩組患者住院天數(shù)(p=0.000)及死亡率(p=0.039)的差異具有統(tǒng)計(jì)學(xué)意義。D-二聚體低水平組患者住院天數(shù)、中轉(zhuǎn)手術(shù)率高于高水平組,入住ICU率、死亡率低于高水平組,其中兩組患者死亡率的差異具有統(tǒng)計(jì)學(xué)意義(p=0.044)。ROC曲線分析顯示,Balthazar CT分級(jí)的AUC值為0.722(95%CI:0.560~0.884),改良CT嚴(yán)重指數(shù)評(píng)分的AUC值為0.694(95%CI:0.515~0.872),D-二聚體的AUC值為0.760(95%CI:0.616~0.905)。三者均可預(yù)測(cè)SAP死亡的發(fā)生,曲線下面積比較:D-二聚體Balthazar CT分級(jí)改良CT嚴(yán)重指數(shù)評(píng)分。進(jìn)一步研究D-二聚體與CT評(píng)價(jià)系統(tǒng)的關(guān)系,CT分級(jí)高的患者血漿D-二聚體水平顯著高于CT分級(jí)低的患者,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。同樣的,MCTSI評(píng)分高的患者血漿D-二聚體水平顯著高于MCTSI評(píng)分低的患者,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。早期CT分級(jí)和D-二聚體水平均較高時(shí),患者預(yù)后較差。同樣的,早期MCTSI評(píng)分和D-二聚體水平均較高時(shí),患者預(yù)后較差。結(jié)論:1.早期CT評(píng)價(jià)系統(tǒng)和D-二聚體水平可以對(duì)重癥急性胰腺炎患者的預(yù)后進(jìn)行評(píng)估,早期D-二聚體比CT評(píng)價(jià)系統(tǒng)能更準(zhǔn)確地預(yù)測(cè)SAP死亡的發(fā)生;2.CT評(píng)價(jià)系統(tǒng)和D-二聚體水平相關(guān),早期將二者聯(lián)合應(yīng)用可能提高對(duì)重癥急性胰腺炎預(yù)后的評(píng)估價(jià)值,從而指導(dǎo)臨床治療,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.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R576

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本文編號(hào)：1697321