胸腔积液联合C-反应蛋白对急性胰腺炎严重程度评估及预后判断的价值

目的 探讨胸腔积液与CRP联合应用对急性胰腺炎(AP)严重程度评估的临床意义及预后判断的价值.方法 对108例AP住院患者通过胰腺增强CT检查进行AP分级,测定影响AP预后的各种临床指标(血钙、血脂、血糖、血气分析),判定AP的轻重分型,记录患者的胸部X线摄片、胸部CT和CRP检测结果 ,并分析胸腔积液、CRP及两者联合与急性胰腺炎严重程度、病因以及病死率的相关性.结果 轻型急性胰腺炎(MAP)57例,重症急性胰腺炎(SAP)51例,SAP患者合并胸腔积液者32例(62.75%,32/51),CRP>20 mg/L 38例(74.51%,38/51),合并胸腔积液及CRP>20 mg/L 27例(52.94%,27/51);MAP患者合并胸腔积液者13例(22.81%,13/57),CRP>20 mg/L 14例(24.56%,14/57),合并胸腔积液伴CRP>20 mg/L 8例(14.04%,8/57);两者从三方面比较均有统计学意义(P均<0.01).胆源性AP患者合并胸腔积液者9例(33.33%,9/27),CRP>20.0 mg/L 15例(55.56%,15/27),合并胸腔积液伴CRP>20.0 mg/L 9例(33.33%,9/27);酒精性AP38例合并胸腔积液者25例(65.79%,25/38),CRP>20 mg/L 20例(52.63%,20/38),胸腔积液伴CRP>20 mg/L 23例(60.53%,23/38);两者比较除了CRP外其余两方面差异具有统计学意义(X2值分别为6.665和4.670,P值分别为0.010和0.031).此外,胸腔积液、CRP>20 mg/L、合并胸腔积液伴CRP>20 ms/L的病死率分别显著高于无胸腔积液、CRP≤20 mg/L、无胸腔积液且CRP≤20 ms/L者,差异有统计学意义(P均<0.01).结论 胸腔积液、CRP均可作为AP疾病严重程度评估及预后判断的一个独立的衡量指标,尤以胸腔积液联合CRP价值更高.

The value of pleural effusion and C-reactlve protein in severity evaluation and prognosis of acute pancreati-tis

Objective To investigate the value of pleural effusion and C-reactive protein in severity evalua-tion and prognosis of acute pancreatitis. Methods Clinical data of 108 patients with acute pancreatitis were ana-lyzed retrospectively. AP classification was conducted on the basis of intensified CT examination and the clinical in-dexes including blood calculus, blood lipid, blood glucose and blood gas were measured. The criteria for diagnosis and severity evaluation of acute pancreatitis were based on results of chest X-ray, CT examination and CRP. The correla-tion between pleural effusion, CRP and the severity, etiology, prognosis of acute pancreaitis were analyzed. Results Of the 108 patients, mild acute pancreatitis (MAP) was found in 57 patients, and severe acute pancreatitis (SAP) in 51. Among SAP, 32 patients (62.75% ) developed pleural effusion, 38 patients (74.51% ) whose CRP > 20.00 mg/L,and 27 patients (52. 94%) had both pleural effusion and CRP > 20. 00 mg/L. There were 13 (22.81% ), 14 (24.56%) and 8 (14.04%) respectively among MAP. The difference between the two groups was sig-nificant(P<0.01). Among acute biliarv pancreatitis,9 patients (33.33%) developed pleural effusion and 15 (55.65%) whose CRP>20 mg/L and 9 (33.33%) had beth pleural effusion and CRP>20.00 mg/L; Among acholic AP,25 (65.79%) developed pleural effusion and 20 (52.63% ) whose CRP > 20.00 mg/L and 23 (60.53%) had beth pleural effusion and CRP>20.00 mg/L. Case fatality was also significantly different between group with pleural effusion,CRP >20.00 mg/L,both pleural effusion and CRP>20.00 mg/L,and group with non-pleural effusion,CRP≤20.00mg/L,non-pleural effusion or CRP≤20.00mg/L respectively(P<0.01). Conclusion Either pleural effusion or CRP can be used as independent prognostic parameters for severe acute pancreatitis,and the combined use of these two parameters is the most reliable.