急性胰腺炎时胰腺血循环变化的临床和影像学研究

Clinical and image study of pancreatic hemocirculatory change in patients with acute pacreatitis

目的通过急性胰腺炎(AP)的临床观察结合胰腺磁共振灌注成像(MRP)观察AP时胰腺血流变化及其与胰腺炎严重度的关系。方法前瞻性研究并记录AP患者入院72h内APACHEⅡ积分、全身炎症反应综合征(SIRS)积分、Binder积分和C反应蛋白值。将AP患者按病情轻重分为重症AP组(SAP组,15例)和轻型AP组(MAP组,17例),19例非AP志愿者作为对照组,三组均作MRP检查。SAP组患者治疗后2周再次评估上述指标,其中12例患者复查MRP。所有病例均在团注Gd-DTPA0.2mol/kg后行横轴位同层快速扰相梯度回波序列扫描(FSPGR),获得胰头、体尾部各自时间-信号曲线图,通过Perfxproject软件计算三组病例胰头、体尾部最大增强率值和斜率值。结果①SAP组胰头、体尾部最大增强率值、斜率值显著低于MAP组(P<0.05)。②SAP组治疗前后对照,其最大增强率值、斜率值变化差异无统计学意义(P>0.05)。③MAP组值较正常对照组稍低,但差异无统计学意义(P>0.05)。结论MRP是一种比较客观反映胰腺血流情况的无创影像学检查手段。对AP严重度的评判有一定价值。

Objective To study the change of pancreatic hemocirculation in patients with acute pancreatitis by magnetic resonance perfusion （MRP） and to explore its relationship with pancreatic severity. Methods With a prospective investigation method, APACHE Ⅱ scores, systemic inflammatory response syndrome （SIRS） scores, Binder scores and C-reactive protein （CRP） values were recorded within 72 h in patients with severe acute pancreatitis （SAP,n=15） and mild acute pancreatitis （MAP,n = 17）, while other 19 volunteers were as controls. MRP were performed on 32 patients and 19 controls. Patients in SAP group were evaluated by above criteria after two-weeks treatment and MRP were performed in 12 of them. All cases with bolus injection of Gd-DTPA （0. 2 mol/kg） were scanned by transversal same slice and fast spoil phase gradient echo. Three groups datum of MIR and MSR were gained by ROI time-signal graphy of pancreatic head, body and trail which were calculated by Perfx- project software. Results ① The rates of MIR and MSR in SAP group were lower than MAP group （P 〈0.05）. ②The rates of MIR and MSR had no markedly difference between before and after treatment of SAP . ③There are no statistic difference between MAP and control groups （P〉0.05）. Conclusion MRP is an objective imaging technique, which can reflect the hemocirculatory variety in acute pancreatiffs. It may have a considerable value in evaluating the severity of acute pancratitis.