肾旁后间隙和胃裸区受累CT征象在评估急性胰腺炎严重程度中的价值

Clinical value of CT for assessing acute pancreatitis involving the posterior pararenal space and gastric bare area

目的探讨急性胰腺炎肾旁后间隙和胃裸区受累的CT征象在评估临床严重程度中的价值。方法收集109例经手术及病理和/或临床证实的急性胰腺炎患者的临床和多层螺旋CT资料。按照Atlanta临床分级标准进行临床严重程度分级。CT分析包括:胰腺本身及胰腺周围情况,肾旁后间隙是否受累,胃裸区是否受累。计算肾旁后间隙和/或胃裸区受累判断临床严重程度的敏感性、特异性、阳性预测值、阴性预测值和Youden指数等指标。结果 109例急性胰腺炎中,按临床严重程度分级,重型和轻型胰腺炎分别为48例和61例。以肾旁后间隙受累判断严重程度的敏感性、特异性、阳性预测值、阴性预测值和Youden指数分别为60%、93%、88%、75%和0.53;以胃裸区受累判断重型急性胰腺炎的敏感性、特异性、阳性预测值、阴性预测值和Youden指数分别为54%、92%、84%、72%和0.46;联合二者(其中之一受累即为阳性)判断临床严重程度的敏感性、特异性、阳性预测值、阴性预测值和Youden指数分别为94%、85%、83%、95%和0.79。胃裸区受累和肾旁后间隙受累二重判断方法的吻合度系数kappa=0.027。结论联合胃裸区和肾旁后间隙受累能提高判断急性胰腺炎临床严重程度的敏感性和诊断效能,为临床评估急性胰腺炎严重程度提供一个有价值的指标。

Objective To investigate the CT features of posterior pararenal space （PPS） and gastric bare area （GBA） involvement in evaluation of severity of acute pancreatitis. Methods The clinical records and CT of 109 patients with clinically or pathologically confirmed acute pancreatitis were reviewed. The pancreatitis was clinically graded by Atlanta criteria as mild （61） or severe （48）. The CT features of PPS and GBA involvement were analyzed and compared with the clinical severity of acute pancreatitis. The sensitivity, specificity, positive predictive vale, negative predictive value and Youden index of PPS, GBA and combination of PPS and GBA （PPS and/or GBA） were calculated. Results The sensitivity, specificity, positive predictive value, negative predictive value and Youden index were 60%, 93%, 88%, 75% and 0.53 for PPS involvement; 54%, 92%, 84%, 72% and 0.46 for GBA involvement; 94%, 85%, 83%, 95% and 0.79 for combination of PPS and GBA （PPS and/or GBA） involvement. The Kappa value between GBA and PPS involvement is 0.027. Conclusion Combination of PPS and GBA （PPS and/or GBA） involvement may be an imaging tool for evaluating the severity of acute pancreatitis.