本文關(guān)鍵詞：Balthazar CT、CTSI及EPIC評價急性胰腺炎預(yù)后的價值，由筆耕文化傳播整理發(fā)布。

Balthazar CT、CTSI及EPIC評價急性胰腺炎預(yù)后的價值

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摘要

目的：
     急性胰腺炎(AP)預(yù)后的評估是臨床研究的熱點(diǎn)。CT評分系統(tǒng)由于操作簡便、評價客觀且動態(tài)觀察可比性強(qiáng),在臨床工作中受到越來越多的重視。近期發(fā)展起來的胰外炎性浸潤程度CT評分(Extrapancreatic Inflammation On CT Score, EPIC)不需要強(qiáng)化且綜合考慮胰腺外改變,應(yīng)該受到臨床重視。但其對AP預(yù)后的價值尚無定論。本研究通過對入院24小時內(nèi)對AP患者行增強(qiáng)CT檢查,并行Balthazar CT、CTSI (CT Severity Index, CT嚴(yán)重度指數(shù))及EPIC三種CT評分,比較這三者對AP嚴(yán)重度及預(yù)后的價值,并與常用的臨床評分系統(tǒng)APACHE Ⅱ、Ranson評分進(jìn)行相關(guān)性分析,以期為臨床對AP早期預(yù)后評估提供幫助。
     方法：
     本研究回顧性分析入院日期在2012.2.28-2013.2.28之間的于山東省立醫(yī)院住院治療的所有第一診斷為AP的患者(共167例)的臨床及實(shí)驗室數(shù)據(jù),其中符合入選標(biāo)準(zhǔn)的患者共72例,重癥急性胰腺炎(SAP)患者49例,輕型急性胰腺炎(MAP)患者23例,以此為標(biāo)準(zhǔn)分為兩組,應(yīng)用SPSS16.0分析得出兩組患者在年齡、性別及發(fā)病原因上的差別無統(tǒng)計學(xué)意義。
     入選及判斷標(biāo)準(zhǔn)：AP及SAP的診斷標(biāo)準(zhǔn)依據(jù)2004年《中國急性胰腺炎診治指南(草案)》
     篩除標(biāo)準(zhǔn)為：未在入院24小時內(nèi)行腹部增強(qiáng)CT的患者。
     應(yīng)用SPSS16.0評估三種CT評分系統(tǒng)對AP嚴(yán)重度及預(yù)后的價值,并繪制受試者工作特征(ROC)曲線,比較各方法的曲線下面積(AUC)以判斷其準(zhǔn)確性；并將其與常用的臨床評分系統(tǒng)APACHE Ⅱ、Ranson評分進(jìn)行相關(guān)性分析。
     結(jié)果：
     1.依據(jù)上述判斷標(biāo)準(zhǔn),將患者分為SAP組及MAP組,得出三種CT評分系統(tǒng)的得分在兩組中有差異(P<0.001),其中EPIC評分在評估AP嚴(yán)重度中的價值最大,準(zhǔn)確性最高(AUC=0.960),優(yōu)于Balthazar CT評分(AUC=0.934)和CTSI評分(AUC=0.931)
     2.在72例患者中,有27例發(fā)生局部并發(fā)癥。依據(jù)是否發(fā)生局部并發(fā)癥,將患者分為兩組。得出三種CT評分系統(tǒng)的得分在兩組中的差異均有統(tǒng)計學(xué)意義(P<0.05),其中以EPIC評分在預(yù)測AP局部并發(fā)癥發(fā)生中的價值最大,準(zhǔn)確性最高(AUC=0.856),優(yōu)于Balthazar CT評分(AUC=0.763)和CTSI評分(AUC=0.801)。
     3.CTSI及EPIC評分與住院天數(shù)相關(guān)。CTSI得分0-7分的患者平均住院天數(shù)為15.08±10.76天,8-10分的患者平均住院天數(shù)為21.2±10.73(P=0.021)；EPIC0-2分的患者平均住院天數(shù)為13.51+9.01天,3-6分的患者平均住院天數(shù)為20.69±11.97天(P=0.005)
     4.在所有72例患者中,進(jìn)行了中轉(zhuǎn)手術(shù)治療的共有17例。根據(jù)是否進(jìn)行中轉(zhuǎn)手術(shù)治療將患者分為兩組。只有EPIC得分在兩組間的差異具有統(tǒng)計學(xué)意義(P=0.008)。不需手術(shù)治療的平均得分為2.14+1.977分,需要手術(shù)治療患者的平均的分為3.67±1.633分。
     5.三種CT評分系統(tǒng)與APCHE Ⅱ及Ranson均有良好的相關(guān)性(P<0.001)
     結(jié)論
     1.三種CT評分系統(tǒng)在預(yù)測AP嚴(yán)重度及局部并發(fā)癥中有重要價值,且EPIC在這三種評分系統(tǒng)中的預(yù)測能力最強(qiáng)；
     2EPIC得分與患者住院天數(shù)相關(guān),0-2分的患者平均住院天數(shù)為13.51天,3-6分的患者平均住院天數(shù)為20.69天；
     3CTSI得分與患者住院天數(shù)相關(guān),得分0-7分的患者平均住院天數(shù)為15.08天,8-10分的患者平均住院天數(shù)為21.2天；
     4.EPIC與中轉(zhuǎn)手術(shù)治療相關(guān),不需手術(shù)治療的平均得分為2.14分,需要手術(shù)治療患者的平均得分為3.67分；
     5.三種CT評分系統(tǒng)與APCHE Ⅱ及Ranson均相關(guān)。
     對于AP患者,在入院早期(24小時)行CT檢查對疾病的預(yù)后判斷有重要的臨床價值。
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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  本文關(guān)鍵詞：Balthazar CT、CTSI及EPIC評價急性胰腺炎預(yù)后的價值，由筆耕文化傳播整理發(fā)布。