急性胰腺炎病程与CT变化的相关性研究

目的：通过观察急性胰腺炎（AP）患者病程治疗过程中CT动态变化,进行CT的综合评分,探讨两者相关性,为临床诊治AP提供一个更为可靠的量化指标。方法：选择本院2008年1月-2010年12月收治的50例AP患者为研究对象,其中轻症急性胰腺炎（MAP）患者30例,重症急性胰腺炎（SAP）患者20例,观察患者病程变化的情况。检测两组患者血淀粉酶（AMS）、白细胞（WBC）、C反应蛋白（CRP）、血清肿瘤坏死因子（TNF-α）及白介素6（IL-6）水平及其变化。对MAP及SAP患者发病后不同时段行CT检查,观察胰腺的CT影像变化,并进行影像学综合评分。结果：两组患者临床腹痛缓解时间、体温正常时间及住院时间相比差异有统计学意义（P〈0.05）,AMS比较差异无统计学意义（P〉0.05）。两组患者WBC、CRP、IL-6、TNF-α及CT影像学评分在不同时段比较差异有统计学意义（P〈0.05）。结论：MAP与SAP在影像及WBC、CRP、IL-6、TNF-α等各项指标上均有明显差异,SAP比MAP表现严重。在AP病程中,其临床表现与影像学表现相比,存在时间滞后性,SAP的临床表现早于影像3~4 h;临床表现的高峰早于影像的高峰,影像的高峰变在7 d左右。结果表明CT检查可以作为AP影像学检查的主要手段,但由于有时间和临床的局限性,不能作为诊断SAP病情的金标准。

The study of the correlation between clinical course of acute pancreatitis and CT evolution

Objective： To observe the clinical course of patients with acute pancreatitis（AP） and the CT imaging study of dynamic changes before and after treatment.We carry out the quantitative analysis of CT,to further explore the correlation between AP and CT.We try to get a new reliable proxy for clinical diagnosis and treatment of AP.Methods： 50 patients with acute pancreatitis were collected from 2008 to 2010,including mild acute pancreatitis（30 patients） and severe acute pancreatitis（20 patients）.Changement of temperature and abondom were observed before and after conventional therapy.Serum was detected after ill.The white blood cell（WBC） values,C-reactive protein（CRP） levels,serum tumor necrosis factor-α（TNF-α） and IL-6（IL-6） levels of these two groups were measured.Using the CT images to observe changing in the pancreas in diference,get the new proxy for AP.Results： Clinical results showed that the two groups of clinical pain duration,temperature normal time and hospital stay were significantly different（P〈0.05）,serum amylase was no significant difference（P〈0.05）.WBC,CRP,IL-6,TNF-α,CT imaging rates were significantly different（P〈0.05） in diference.Conclusion： The difference between MAP and SAP in the imaging,WBC,CRP,IL-6,TNF-α and other indicators are significant.The performance of SAP is serious than MAP.In the AP course,its clinical manifestations appeared more early than the imaging performance for 3~4 h.The peak of the clinical manifestation is earlier than the image,the image reached its peak at about 7 d.The CT examination can be used as a principal means for acute pancreatitis,while it could not be a gold standard to diagnose patient＇s condition of acute pancreatitis mainly because of the limitation of time and clinical.