新CT评分系统预测急性胰腺炎病情严重程度的临床研究

目的 在综合急性胰腺炎(AP)患者胰腺外炎症征象及胰腺坏死程度基础上,建立一种新CT评分系统--胰腺外炎症和胰腺坏死CT指数(EPIPN)评分系统.以初步探讨其预测AP病情严重程度和预后的诊断价值.方法 回顾分析2006年8月至2007年12月住院确诊的77例AP患者的临床资料,包括年龄、性别、病因、起病72 h C反应蛋白(CRP)水平、Ranson评分、人院48 h时APACHEⅡ评分,器官衰竭发生情况、腹痛消失时间、住院时间等.所有患者人院后2～3 d行增强CT检查,获得CT严重指数(CTSI)评分和EPIPN评分,CTSI≥7分为重症AP(SAP),EPIPN>5分为SAP.应用ROC曲线比较EPIPN和CTSI预测AP病情严重程度的诊断效力,初步分析EPlPN和CTSI与AP临床预后指标的相关性.结果 77例患者中男34例,女43例,平均年龄51.79岁(22～92岁).胆源性63例,高血脂6例,酒精性1例,原因不明7例.14例(18.2%)患者曾发生器官衰竭.EPIPN和CTSI预测SAP的ROC曲线下面积分别为0.82(95%可信区间0.73～0.91)、0.72(95%可信区间0.59～0.86),CTSI≥7预测SAP的灵敏度、特异度分别为80.4%和55%,EPIPN>5预测SAP的灵敏度、特异度分别为91.3%和63%.EPIPN与AP患者住院时间、APACHEⅡ评分、CRP有良好的相关性.结论 EPIPN可准确预测和评估AP病情严重程度和预后,其诊断效力优于CTSI.EPIPN简便实用,具有良好的临床应用价值.

Clinical study on a novel modified computed tomography severity index for predicting the severity of acute pancreatitis

Objective To introduce a novel modified CT severity index based on the assessment of extrapancreatic inflammation and pancreatic necrosis on CT index (EPIPN) and to evaluate its effect in predicting the severity and prognosis of acute pancreatitis. Methods Seventy-seven consecutive patients diagnosed as acute pancreatitis (AP) from August 2006 to December 2007 were retrospectively analyzed. The clinical data included age, sex, cause, the C-reactive protein(CRP) level with in 72 hours of onset of symptom, Ranson signs, the APACHE I1 score, the disappearing time of the abdominal pain, the presence of organ failure, the length of hospital stay, etc. All patients underwent contrast-enhanced multisection CT scan after admission of 48-72 hours. The CT severity index (CTSI) and EPIPN scores were obtained. The severity of pancreatitis for each patient was then categorized as severe if CTSI≥7 or EPIPN>5. The diagnostic value of EPIPN in predicting the severe acute pancreatitis (SAP) was compared with that of CTSI using ROC curve. The correlation of EPIPN or CTSI with clinical coutcome was conducted. Results Of 77 patients, 34 were males and 43 were females with mean age of 51.79 years (age range 22-92 years). The causes of AP were gallstones (63 cases), hyperlipemia (6 cases), alcohol (1 case) and idiopathic (7 cases). Organ system failure was present in 14 (18.2%) of the 77 patients. The area under the ROC curve of CTSI in predicting the SAP was 0.72 (95% CI: 0.59-0.88) with sensitivity of 80.4% and specificity of 55% when CTSI≥7, and that in EPIPN was 0.82 (95% CI: 0.73-0.91) with sensitivity of 91.3% and specificity of 63% when EPIPN >5. EPIPN was well correlated with hospital stay, APACHE Ⅱ score and CRP levels. Conclusions The EPIPN allows accurate estimation of disease severity and prognosis in AP patients. The diagnostic effect of EPIPN for predicting SAP is superior to CTSI. The EPIPN index is-both convenient and practical, and has clinical value.