CT分类标准在评估重症急性胰腺炎预后中的价值

目的 探讨CT分类标准在评估重症急性胰腺炎(SAP)预后中的价值.方法 回顾性分析2000年1月至2009年12月收治的62例SAP患者的一般资料,所有患者发病早期均行非手术治疗,并于入院后72 h内行CT检查.依照Balthazar CT分级,所有病例被分成3级:C级13例、D级26例、E级23例.依照Balthazar CT严重度指数(CTSI)评分,将此结果分为3级:Ⅰ级11例、Ⅱ级39例、Ⅲ级12例.分析Balthazar CT分级及CTSI评分与患者住院天数、发热天数、禁食天数、白细胞计数恢复天数、血淀粉酶恢复天数、胰腺假性囊肿形成、器官功能衰竭、中转手术、死亡的相关性.用所有患者的两种CT分级评分绘制受试者工作特征曲线(ROC),通过计算曲线下面积来比较各评分系统在判断SAP病情严重程度和预后的意义.结果 不同Balthazar CT分级间白细胞计数恢复天数(F=4.035,P=0.023)及胰腺假性囊肿形成(x2=8.066,P=0.018)之间的差异有统计学意义,而其他判断SAP严重程度的临床病理学指标间差异无统计学意义(P＞0.05).CTSI评分低分值的SAP患者恢复过程较高分值者顺利,Ⅰ级及Ⅱ级患者的器官功能衰竭、中转手术、胰腺假性囊肿形成及病死率均明显低于Ⅲ级患者,差异有统计学意义(P＜0.01).ROC曲线分析显示CTSI评分较Balthazar CT分级能更准确地预测SAP的器官功能衰竭、胰腺假性囊肿形成、中转手术及死亡的发生.结论 CTSI评分对于评估SAP的预后有重要意义.

The value of CT in assessing the prognosis of sever acute pancreatitis: a report of 62 cases

Objective To study the relationship between CT imaging classification criteria and the prognosis of severe acute pancreatitis( SAP). Methods From January 2000 to December 2009,62 cases with SAP were analyzed, retrospectively. They were all executed CT examination in 72 h after admission, and their CT imaging were classified as grade C (n = 13) , grade D (n = 26 ) , and grade E (n = 23) according to the Balthazar classification criteria and also classified as grade Ⅰ ( n = 11), grade Ⅱ (n = 39), grade Ⅲ (n = 12) according to the Balthazar CT severity index (CTSI) criteria,respectively. The values of these two different classification criteria in assessing the prognosis of SAP were studied, such as length of hospital stay, fever days,fasting days,white blood cell recovery days,serum amylase recovery days,pancreatic pseudocyst, organ failure,need for transit operations,and death. By studying the receiver operating characteristic(ROC) curves,which were drawn by the area under cures,the values of the two different classification criteria were compared in assessing the prognosis of SAP. Results The Balthazar classification criteria was valuable in assessing white blood cell recovery days (F=4. 035,P =0. 023) and pseudocyst (χ2 =8. 066, P =0. 018). No statistical differences were found,however,between other clinicopathological parameters and the prognosis of SAP,according to the Balthazar classification criteria.The patients with low-grade of CTSI classification criteria enjoyed better prognosis,and patients in grade Ⅰ or Ⅱ got lower incidence of organ failure,need for transit operations and pseudocyst than that in grade Ⅲ. The results above suggested that CTSI classification criteria,comparing with Balthazar CT classification criteria,was more valuable in predicting the incidence of organ failure, pseudocyst, need for transit operation, and mortality in SAP ( P < 0. 01) . Conclusion The CTSI classification criteria has a great value in assessing the prognosis of SAP.