新亚特兰大分类下不同评分标准预测急性胰腺炎预后的价值比较

目的 采用基于新亚特兰大分类的急性胰腺炎(AP)定义,比较急性胰腺炎严重程度床边指数(BISAP)、急性生理与慢性健康评分Ⅱ(APACHEⅡ)和Ranson评分对AP患者死亡和持续性器官功能不全的预测价值.方法 回顾性分析前瞻性收集的2009年11月-2012年1月在南昌大学第一附属医院住院的连续AP患者资料350例,其中完成随访的310例纳入本研究,年龄(50.5±16.4)岁.将其分为起病至就诊时间≤7 d组(发病早期)和＞7d组(发病后期).计算患者入院后前3d各评分系统的分值.治疗并随访患者至腹痛消失、血淀粉酶正常.比较3种评分系统预测患者持续性器官功能不全及死亡的接受者操作特征曲线下面积(AUCROC),并计算3种评分预测的最佳阈值、灵敏度、特异度和约登指数.结果 (1)入院第1天BISAP评分、APACHEⅡ评分和入院48 h的Ranson评分预测持续性器官功能不全及死亡的价值中等(AUCRoC0.68 ～0.84),3者比较差异无统计学意义(P值均＞0.05).但3种评分系统对就诊时间＞7d组患者预后的预测均无统计学意义(P值均＞0.05).(2)入院后前3d中,每天的BISAP和APACHEⅡ评分对AP患者预后都有中或高度的预测价值,但各天的预测价值的差异无统计学意义(P值均＞0.05).结论 此3种临床评分系统对新亚特兰大分类下的AP预后预测价值中等,且只适合在发病早期使用.新提出的BISAP评分虽不优于传统的Ranson评分和APACHEⅡ评分,但其使用简便,值得推广.入院后连续3d的动态评分并不能提高APACHEⅡ和BISAP评分对AP预后的预测价值.     

2012年版急性胰腺炎分类标准的临床应用

目的 初步探讨2012年版急性胰腺炎分类标准的临床应用价值.方法 回顾性分析2009年10月至2012年9月广西医科大学第一附属医院诊断为急性胰腺炎患者的临床资料.根据2012年版分类标准将患者分为轻症急性胰腺炎(MAP)、中度重症急性胰腺炎(MSAP)、重症急性胰腺炎(SAP)3组.比较各组患者的好转及治愈例数、住院天数、住院费用、ICU入住率及入住天数、SIRS发生率及持续天数、Ranson评分、APACHEⅡ评分、CTSI评分的差异有无统计学意义.结果 166例患者中MAP 76例,MSAP 65例,SAP 25例;男性119例,女性47例;平均年龄(49±15)岁;平均入院前发病时间为(2.27±1.46)d.3组患者的好转及治愈例数、住院天数、住院费用、入住ICU例数及天数、SIRS发生例数及持续天数、Ranson评分、APACHEⅡ评分、CTSI评分均随着疾病严重程度的增加而升高(P值均＜0.01),其中SAP组患者相应值分别为21例(84.0％)、(23.8±13.6)d、(53900±30260)元、12例(48.0％)及(5.76±13.8)d、24例(96.0％)及(5.00±2.40)d、(3.76±1.30)分、(8.52±4.24)分、(5.44±3.48)分.166例患者中79例发生局部并发症,其中急性胰周液体积聚34例,急性坏死物积聚45例.SAP组急性坏死物积聚发生率高于MSAP组(68.0％比44.6％,P=0.047),而急性胰周液体积聚发生率低于MSAP组(16.0％比46.1％,P=0.016).166例患者中42例发生器官功能衰竭,其中35例发生呼吸功能衰竭,2例发生肾功能衰竭,5例合并发生呼吸功能和肾功能衰竭.SAP组器官功能衰竭发生率为100％,MSAP组为26.2％,两组差异有统计学意义(P＜0.05).结论 2012年版急性胰腺炎分类标准简便易行,能准确反映急性胰腺炎的严重程度,适于临床应用.     

老年急性胰腺炎的临床特征以及严重程度评分系统的对比优化

目的 分析老年患者急性胰腺炎临床特征,并对急性胰腺炎严重程度评分系统预测模型进行对比优化。方法 收集2011.01.01—2021.12.31入住复旦大学附属华东医院并确诊为急性胰腺炎的患者的临床资料及检验检查结果,将患者分为老年组和非老年组,总结分析老年急性胰腺炎的临床特征。比较4种临床常用评分系统在预测老年急性胰腺炎严重程度,局部及全身并发症等方面的准确性,并对评分系统进行组合优化。结果 本研究共纳入急性胰腺炎患者437例,其中老年组224例。老年组最常见病因为胆源性胰腺炎,其次是特发性急性胰腺炎,占27.68%。急性胰周液体积聚和胸腔积液分别是老年急性胰腺炎最常见的局部并发症和全身并发症。在临床常用评分系统方面,老年组的Ranson标准、 APACHEⅡ评分以及BISAP评分得分高于非老年组(p<0.05)。在评估急性胰腺炎严重程度,局部及全身并发症等方面MCTSI评分优于其他评分系统。APACHEⅡ评分和MCTSI评分组合能够更准确的预测急性胰腺炎严重程度(AUC=0.797, 95%CI 0.735～0.858)。结论 老年AP患者较非老年患者有其特殊性,应加强对老年急...     

基于修订版亚特兰大分类的中重度急性胰腺炎的异质性分析

背景：近年研究发现,中重度急性胰腺炎(MSAP)不同亚组之间的临床结局存在差异。目的：进一步细分MSAP,探讨MSAP亚组间的异质性。方法：回顾性分析2016年1月—2020年12月江苏省苏北人民医院收治的急性胰腺炎(AP)患者,包括538例轻度急性胰腺炎(MAP)患者和461例MSAP患者。其中,MSAP患者根据局部并发症和一过性器官衰竭(TOF)分为单发急性胰周液体积聚(APFC)且不伴TOF组(A组)、多发APFC且不伴TOF组(B组)、其他局部并发症且不伴TOF组(C组)、伴有TOF组(D组)。比较4亚组的基线资料、病情严重程度,同时比较A组与MAP患者的病情严重程度,运用Logistic回归分析评估MSAP发生的危险因素。结果：D组患者的年龄明显高于A组(P<0.05)。4亚组不同评分系统相比差异均有统计学意义(P<0.05),D组APACHEⅡ评分≥8分、Glasgow评分≥3分、BISAP≥3分的比例均显著高于其他3组(P<0.05)。4亚组间Ca²⁺、LDH、CRP、PCT、BUN水平相比差异均有统计学意义(P<0.05),...     

急性胰腺炎分类——2012：亚特兰大分类和定义修订的国际共识

急性胰腺炎的亚特兰大分类使相关研究得以标准化,有助于临床医生之间的相互交流。但由于此分类存在不足以及对该病认识的深入,有必要对其进行修订。在2007年进行了基于网络形式的商讨,以确保胰腺病学家的广泛参与。首次会议之后,工作组向11个国家和国际性的胰腺学会函寄了修订草案,该草案被转发给所有相关成员,     

急性胰腺炎死亡病例的临床特征

目的研究住院期间急性胰腺炎死亡患者的临床特征。方法回顾性分析2004年1月～2010年8月在我院住院期间急性胰腺炎患者的性别、年龄、住院天数、病因及诊断数目,并探索死亡的相关危险因素。结果589例急性胰腺炎患者平均年龄为（45．64±16．43）岁,住院期间死亡21例,总死亡率为3．565％,其中男性死亡率为4．726％,女性死亡率为1．069％（OR=4．589,P=0．0467）。60岁以上的死亡率为4．310％,60岁以下的死亡率为3．383％（OR=1．287,P=0．8388）。酒精性急性胰腺炎的死亡率为5．677％,非酒精性胰腺炎的死亡率为2．222％（OR=2．648,P=0．0481）。多于3个诊断的患者死亡率7倍于少于3个诊断的患者（OR=6．954,P=0．0001）。住院天数仅1～2d的患者死亡率高达40．909％,而住院超过14d的患者死亡率仅为3．289％（OR=31．853,P=0．0000）。结论本研究显示住院期间急性胰腺炎的总死亡率为3．565％。男性、酒精因素及含多个诊断与急性胰腺炎的死亡密切相关,而且住院天数仅1～2d患者的死亡率较高。     

重症急性胰腺炎的严重程度分级

急性胰腺炎 (AP)的临床表现复杂 ,表现形式也多种多样 ,通常将 AP分为轻型和重型 ,轻型 AP仅有轻度脏器功能不全 ,且治疗后胰腺功能可完全恢复正常 ;而重型急性胰腺炎(SAP)在病理形态上可有出血坏死 ,伴有多脏器功能不全和局部并发症形成 ,因此 ,国内外已有 AP的许多分类方法 ,根据其病理生理、病因和临床表现及过程进行的 ,实际上每种分类方法都有不同的临床意义 ,某些分类法对鉴别诊断有重要价值 ,某些则为预后和临床治疗提供了方向。然而 ,不管哪种方法 ,它们都是依据临床表现、化验及影像学检查分类的。SAP的器官功能不全包括休克…     

急性胰腺炎严重程度临床应用评分进展

急性胰腺炎是消化系统常见疾病之一,包括急性轻型胰腺炎及急性重症胰腺炎。重症者病情凶险,死亡率高。早期发现疾病重症趋势能更好地指导临床治疗。本文就急性胰腺炎严重程度的临床应用评分进展进行综述。     

血小板异常评估急性胰腺炎严重程度的临床价值

目的 探讨血小板在急性胰腺炎（AP）患者中的变化及与AP严重程度和预后的关系.方法 比较重症急性胰腺炎（SAP）组和轻症急性胰腺炎（MAP）组血小板的计数变化.SAP组进一步分为血小板降低组和血小板正常组,比较两组局部并发症和多器官功能不全综合征（MODS）的发生率、病死率以及胰腺坏死程度与血小板计数（PLT）之间的关系,并分析差异有无统计学意义.分析血小板与APACHEⅡ评分系统、BISAP评分系统、CT评分系统、Ranson评分系统之间的相关性.结果 AP患者重症组与轻症组相比,PLT下降,血小板平均体积（MPV）升高,两组比较差异有统计学意义（P＜0.05）,PDW及PCT差异无统计学意义（P＞0.05）;SAP患者发病前3d首次PLT计数（＜100×109/L）的比例明显多于MAP组,差异有统计学意义（P＜0.001）;血小板降低组中局部并发症患者、MODS患者及病死率明显高于血小板正常组,两者相比差异有统计学意义（P ＜0.05）;SAP中胰腺坏死程度与血小板计数水平呈负相关性（P＜0.05）;血小板计数水平与CTSI评分标准相关性最强,其次是APACHEⅡ评分系统,而与Ranson评分系统无明显相关性.结论 血小板计数能够比较准确地反映AP的严重程度和预后,尤其在预测SAP局部并发症、MODS、坏死程度中有较高的临床价值.     

急性胰腺炎并发胰性脑病的临床特征

急性胰腺炎出现脑损伤称为胰性脑病（pancreaticencephalopathy,PE）,其临床表现主要是在急性胰腺炎发生和发展过程中出现神经精神症状。PE临床表现具有多样性,且死亡率高,预后差,但由于发生率相对较低,故有关PE的临床报道并不多见。本文回顾性分析了我院近三年急性胰腺炎患者中8例较完整的PE临床资料,就PE的临床特征及其预后报道如下。     

The revised Atlanta criteria 2012 altered the classiifcation,severity assessment and management of acute pancreatitis

BACKGROUND: The Atlanta criteria for acute pancreatitis (AP) has been revised recently. This study was to evaluate its practical value in classiifcation of AP, the severity assessment and management.
METHODS: The clinical features, severity classiifcation, out-come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria (RAC) and the original Atlanta criteria (OAC).
RESULTS: Compared to the OAC group, the incidence of se-vere acute pancreatitis (SAP) was decreased by approximately one half (13.9% vs 28.2%) in the RAC group. The RAC present-ed a lower sensitivity but higher speciifcity, and its predictive value for severity and poor outcome was higher than those of the OAC. The proportion of SAP diagnosis and ICU admission in the early phase in the RAC group was signiifcantly lower than that in the OAC group (P<0.05). Based on the RAC, the risk factors for death among SAP patients were older age, high CT severity index (CTSI), renal failure, cardiovascular failure, acute necrotic collection and walled-off necrosis. Compared to the OAC, the acute physiology and chronic health evalua-tion II (APACHE II) score, Ranson score, idiopathic etiology, respiratory failure and laparotomy debridement were not risk factors of death in contrast to walled-off necrosis. Interest-ingly, hypertriglyceridemia-related SAP had good outcomes in both groups.
CONCLUSIONS: The RAC showed a higher predictive value for severity and poorer outcome than the OAC. However, the RAC resulted in fewer ICU admissions in the early phase due to its lower sensitivity for diagnosis of SAP. Among SAP cases, older age, high CTSI, renal and cardiovascular failure, com-plications of acute necrotic collection and walled-off necrosis were independent risk factors for mortality.     

Clinical characteristics and management of gastric outlet obstruction in acute pancreatitis

ObjectiveThe aim of this study was to describe the clinical characteristics and management of gastric outlet obstruction following acute pancreatitis(AP).BackgroundGastric outlet obstruction (GOO) is not uncommon in acute pancreatitis (AP) and can occur throughout the course. However, the clinical features and related treatment of GOO is rarely reported.MethodsA retrospective review of AP patients with a diagnosis of GOO from March 2017 to June 2020 was performed. The diagnosis and management of GOO, as well as the demographic characteristics and clinical outcomes of the study patients, were collected and analyzed.ResultsOver the three years, there were 60 AP patients developed GOO, constituting an incidence of 5.7%. Thirty-three patients (55.0%, 33/60) developed GOO in the first 4 weeks and 27 patients (45.0%, 27/60) after 4 weeks from onset. Pancreatic necrosis compression (60.6%; 20/33), gastric outlet gastrointestinal edema (27.3%, 9/33) are the main causes of early-onset GOO (≤4 weeks), while wall-off necrosis (92.6%, 25/27) is the leading cause in the late phase (>4 weeks). The management of GOO incorporates both supportive and specific treatment like gastric decompression, gastric juice reinfusion, percutaneous catheter drainage, etc. The mortality of AP patients with GOO (≤4 weeks) was 21.2% and none patients who developed GOO (>4 weeks) died.ConclusionsGOO, as a gastrointestinal complication developed in AP patients, has two peak incidences in the duration of AP and needs to be paid more attention to.     

The revised Atlanta criteria 2012 altered the classification,severity assessment and management of acute pancreatitis

BACKGROUND:The Atlanta criteria for acute pancreatitis(AP) has been revised recently.This study was to evaluate its practical value in classification of AP,the severity assessment and management.METHODS:The clinical features,severity classification,outcome and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria(RAC) and the original Atlanta criteria(OAC).RESULTS:Compared to the OAC group,the incidence of severe acute pancreatitis(SAP) was decreased by approximately one half(13.9% vs 28.2%) in the RAC group.The RAC presented a lower sensitivity but higher specificity,and its predictive value for severity and poor outcome was higher than those of the OAC.The proportion of SAP diagnosis and ICU admission in the early phase in the RAC group was significantly lower than that in the OAC group(P0.05).Based on the RAC,the risk factors for death among SAP patients were older age,high CT severity index(CTSI),renal failure,cardiovascular failure,acute necrotic collection and walled-off necrosis.Compared to the OAC,the acute physiology and chronic health evaluation II(APACHE II) score,Ranson score,idiopathic etiology,respiratory failure and laparotomy debridement were not risk factors of death in contrast to walled-off necrosis.Interestingly,hypertriglyceridemia-related SAP had good outcomes in both groups.CONCLUSIONS:The RAC showed a higher predictive value for severity and poorer outcome than the OAC.However,the RAC resulted in fewer ICU admissions in the early phase due to its lower sensitivity for diagnosis of SAP.Among SAP cases,older age,high CTSI,renal and cardiovascular failure,complications of acute necrotic collection and walled-off necrosis were independent risk factors for mortality.     

老年急性胰腺炎的临床特点

随着老龄化社会的到来,急性胰腺炎在老年人群体中的发病率有着逐渐上升的趋势,现阶段及未来都应得到重视。本文通过相关文献综述,阐述了老年急性胰腺炎患者的病因、病理生理特征、临床表现与并发症、诊断方法、治疗和预后,以期为该病的诊断和治疗提供参考。     

慢性胰腺炎213例的临床特点

目的:回顾性分析9 a间慢性胰腺炎(CP)的临床特点．方法:对住院诊断CP 213例,按发病情况、临床表现、诊断方法及漏误诊等特点进行统计．结果:CP213例,占消化科住院患者的4．38％, 男女之比1:0．84,9 a间每3 a发病增长为 38．6％,病因:胆源性36．2％,酒精性42．7％,高血脂13．6％,原因不明7．5％;临床表现:持续腹痛仅9．9％,进食后腹痛44％,两者相加为 53．5％,而慢性腹泻或脂肪泻占57％,进高脂肪餐(包括饮酒)后腹胀或腹泻81％,吸收不良 41％,糖尿病7．0％;在诊断方面:72．3％是以临床表现、大便脂肪定性或胰腺外分泌功能试验及CT、EUS影象学特征诊断,27．7％超声内镜引导下细针穿插通过病理诊断,在漏误诊方面:33．8％长期诊断为慢性胃炎或萎缩性胃炎,30．5％诊断为慢性腹泻、肠炎或慢性结肠炎,11．3％诊断为胆系结石或胆囊术后综合症, 3．8％诊断为胰腺新生物或胰腺癌．结论:CP发病率在上升,临床表现腹痛不突出,而且多样性,应早期诊断,避免漏诊和误诊     

酒精性急性胰腺炎发病机制及临床特征

动物实验及临床研究表明,酒精及其代谢产物、细菌内毒素、病毒感染、饮酒方式、吸烟、肥胖及宿主的基因突变及基因多态性在酒精性急性胰腺炎发生中具有重要作用.酒精性急性胰腺炎的发病率已明显增加,其以男性为主,病死率高,重症存活者生活质量低下.本文综述了酒精性急性胰腺炎的发病机制及临床特征.     

急性胰腺炎复发相关危险因素及临床特点分析

目的探讨急性胰腺炎(AP)的复发危险因素及其临床特点。方法收集353例AP患者的临床资料,根据是否出现复发分为复发组(96例)和非复发组(257例)。比较两组患者的病因(包括胆源性、高脂血症性、酒精性、其他原因性)构成和临床资料(包括一般资料、疾病史及C反应蛋白检测结果),并分析AP复发的危险因素。结果复发组高脂血症性AP患者比例明显高于非复发组(P<0.05)。复发组患者的住院时间明显短于非复发组(P<0.05)。多因素logistic回归分析结果显示,高脂血症是AP复发的危险因素(OR=3.074,95%CI 1.728~5.469,P<0.01)。结论AP复发患者的平均住院时间低于未复发患者,高脂血症是AP复发的危险因素。