MRI及临床急性生理和慢性健康评估Ⅲ评分系统评价急性胰腺炎严重程度的研究

MRI versus acute physiology and chronic healthy evaluation HI score for the assessment of the severity of acute pancreatitis

目的 应用MRI及临床急性生理和慢性健康评估Ⅲ（APACHEⅢ）评分系统评价急性胰腺炎（AP）的严重程度,并探讨两者的相关性.方法 回顾性分析100例AP患者的临床资料及MRI表现,采用MR严重程度指数（MRSI）进行评分,分为轻度（0～3分）、中度（4～6分）、重度（7～10分）AP.并按照临床APACHEⅢ评分,分为轻型（＜35分）和重型（≥35分）AP,记录100例AP患者并发症发生率、入住重症监护病房（ICU）及住院天数等情况,采用Spearman等级相关分析法分析MRSI、APACHEⅢ评分及住院时间的关系,MRSI、APACHEⅢ评分与各项临床结果的比较采用x2检验.结果 100例AP,在MRI上80例表现为水肿型,20例表现为坏死型.MRSI评分显示轻度34例,中度59例,重度7例.APACHEⅢ评分为（24.9±12.2）分,APACHEⅢ＜35分者77例,APACHEⅢ≥35分者23例.MRSI评分轻、中、重组之间的局部并发症发生率、系统并发症发生率及ICU入住率的差异均有统计学意义（x2值分别为9.161、19.118和54.767,P值均＜0.01）；APACHEⅢ评分轻、重型之间系统并发症发生率差异有统计学意义（x2=13.120,P=0.000）,而与局部并发症发生率、ICU入住率差异无统计学意义（x2值分别为0.245和2.568,P值均＞0.05）.MRSI评分同住院时间呈低度相关（r =0.235,P=0.019）；APACHEⅢ评分与MRSI评分及与住院时间之间无相关性（r值分别为0.168和0.105,P值均＞0.05）.结论 MRSI评分和APACHEⅢ评分在评估系统并发症方面有预测作用.MRSI评分在预测局部并发症、是否需要ICU治疗以及患者住院时间长短上优于APACHEⅢ评分.

Objective To study the severity of acute pancreatitis （AP） by using MRI and the acute physiology and chronic healthy evaluation Ⅲ （APACHE Ⅲ ） score, and the correlation between corresponding MRI findings and APACHE Ⅲ scores.Methods One hundred patients with AP undergoing abdominal MRI were recruited in the study. The MRI features of acute pancreatitis were recorded. The severity of AP on MRI was graded by MR severity index （MRSI） as mild （0 to 2 points）,moderate （ 3 to 6 points） and severe （7 to 10 points）.APACHE Ⅲ score was denoted for AP was as mild （ 〈35 points）and severe （ ≥ 35 points）.The local and systematic complications,mortality,need to intense care unit （ICU）,and hospitalization time were recorded and compared with MRSI and APACHE Ⅲ score.Nonparametric Spearman correlation was calculated for testing the correlation between the MRSI,the APACHE Ⅲ and hospitalization time.The correlation of clinical results with MRSI and APACHE Ⅲ was calculated by x2 test.Results In the 100 patients with AP,there were respectively 80 and 20 patients with edematous and necrotic pancreatitis on MRI.According to MRSI,34,59 and 7 patients had mild,moderate,and severe acute pancreatitis,respectively.The APACHE Ⅲ score was （24.9 ± 12.2） points.Seventy-seven patients had less than 35 points and 23 patients had more than 35 point of APACHE Ⅲ score.There were significant differences in the local complication,systematic complication,need to ICU among the three groups in MRSI score,respectively（ x2 =9.161,19.118,54.767;P 〈 0.01 ）.There was difference in the systematic complication between mild and severe AP in APACHE Ⅲ score（x2 =13.120,P =0.000）,but there were no differences （x2 =0.245,x2 =2.568;P 〉 0.05） in the local complication,need to ICU between mild and severe AP in APACHE Ⅲ score.There was weak correlation （ r =0.235,P =0.019 ）between MRSI score and hospitalization time,and no difference （r =0.168,0.105; P 〉 0.05）between APACHE Ⅲ and MRSI,APACHE Ⅲ and hospitalization time,respectively.Conclusions Both MRSI and APACHE Ⅲ score may predict systematic complications. However,MRSI is superior to APACHE Ⅲ in predicting the local complications,need to ICU,and hospitalization time in patients with acute pancreatitis.