胸腹并发症CT征象、血钙、血清C反应蛋白对急性胰腺炎患者病情严重程度的评估价值

目的探讨胸腹部CT征象和血钙、血清C反应蛋白(CRP)在急性胰腺炎(AP)患者病情严重程度评估中的作用。方法回顾性分析2017年12月-2018年12月在武警特色医学中心接受治疗的95例AP患者的胸腹部CT及血液检查结果,将患者分为重症急性胰腺炎(SAP, n =13)组和轻症急性胰腺炎(MAP, n =82)组。分析胸腹并发症CT征象、血钙、血清C反应蛋白与AP病情严重程度的相关性。符合正态分布的计量资料组间比较采用 t 检验;不满足正态分布的组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ 2 检验。采用多因素二分类logistic回归分析AP患者严重程度的独立危险因素;指标对疾病严重程度预测有效性的评价采用受试者工作特征曲线(ROC曲线)分析。结果 与MAP 组比较,SAP组患者发生腹水、肺炎、胸水的概率显著高于MAP 组(χ 2值分别为8.561、8.120、9.750,P值均<0.05),腹膜炎发生率差异无统计学意义(P >0.05)。 SAP组患者血清CRP水平( Z =19.16)、住院天数( t =3.97)较MAP组显著升高,血钙(t=4.21)水平显著降低(P 值均<0.05)。logistic回归分析显示腹膜炎、腹水、肺炎、胸水的95%可信区间分别为0.990~1.175、2.087~6.543、1.013~1.520、1.080~4.691,腹膜炎、腹水、肺炎、胸水等胸腹CT征象呈现数目、血钙、CRP、数目联合血钙及CRP ROC曲线下面积分别为0.635、0.738、0.714、0.710、0.807、0.789、0.835、0.901。结论 胸腹部CT合并腹膜炎、腹水、肺炎、胸水的数目联合血钙、CRP对AP患者病情评估的敏感度、特异度和准确度较高,具有较高的临床价值。

Role of CT signs of thoracoabdominal complications,serum calcium,and serum C-reactive protein in evaluating disease severity in patients with acute pancreatitis

Objective To investigate the role of CT signs of thoracoabdominal complications, serum calcium, and serum C-reactive protein (CRP) in evaluating disease severity in patients with acute pancreatitis (AP). Methods A retrospective analysis was performed for the results of thoracoabdominal CT and blood examination of 95 patients with AP who were treated in Characteristic Medical Center of Chinese People’s Armed Police Force from December 2017 to December 2018. The patients were divided into severe AP (SAP) group with 13 patients and mild AP (MAP) group with 82 patients. The association of CT signs of thoracoabdominal complications, serum calcium, and serum CRP with the severity of AP was analyzed. The t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups;the chi-square test was used for comparison of categorical data between groups. A logistic regression model was established based on the combination of related indices, and predicted probability was used as a new index for analysis;the receiver operator characteristic (ROC) curve was used to evaluate the effectiveness of each index in predicting disease severity. Results Compared with the MAP group, the SAP group had significantly higher incidence rates of ascites, pneumonia, and pleural effusion (χ 2 =8.561, 8.120, and 9.750, all P <0.05), while there was no significant difference in the incidence rate of peritonitis between the two groups ( P >0.05). Compared with the MAP group, the SAP group had a significantly higher serum level of CRP ( Z=19.16, P <0.05), a significantly longer length of hospital stay (t =3.97, P <0.05), and a significantly lower level of blood calcium ( t=4.21, P <0.05). The logistic regression analysis showed that ascites (odds ratio OR]=4.992, 95% confidence interval CI]: 2.087-6.543, P =0.012), pneumonia (OR=1.273, 95%CI: 1.013-1.520, P =0.042), and pleural effusion (OR=3.521, 95%CI: 1.080-4.691, P =0.022) were independent risk factors for SAP, while peritonitis (OR=1.007, 95%CI: 0.990-1.175, P =0.156) was not an independent risk factor. The ROC curve analysis showed that in the evaluation of disease severity, peritonitis, ascites, pneumonia, and pleural effusion had an area under the ROC curve (AUC) of 0.635, 0.738, 0.714, and 0.710, respectively, and the number of these CT signs had an AUC of 0.807;serum calcium and CRP had an AUC of 0.789 and 0.835, respectively, and serum calcium and CRP combined with the number of CT signs had an AUC of 0.901. Conclusion Serum calcium and CRP combined with the number of thoracoabdominal CT signs (peritonitis, ascites, pneumonia, and pleural effusion) have high specificity, sensitivity, and accuracy in predicting disease severity in patients with AP, and therefore, it has a high clinical value and holds promise for clinical application.