三种CT评分与急性胰腺炎严重程度床边指数评分评估重症急性胰腺炎的相关性研究

Correlative Analysis of Three Computed Tomography Imaging Scoring to Bedside Index of Severity in Acute Pancreatitis in Evaluating for Severe Acute Pancreatitis

目的 探讨重症急性胰腺炎（severe acute pancreatitis,SAP）患者三种CT评分即CT严重指数（CT severity index,CTSI）、修正CT严重指数（modified computed tomography severity index,MCTSI）、胰腺外炎症CT（extra-pancreatic inflammation on CT,EPIC）评分分别与急性胰腺炎严重程度床边指数（bedside index of severity in acute pancreatitis,BISAP）的相关性。方法 前瞻性收集2015年7~11月期间确诊为急性胰腺炎的患者135例,纳入其中诊断为SAP的患者45例,对其采用三种CT评分标准（CTSI、MCTSI及EPIC）和BISAP评分标准进行评分,分析三种CT评分结果与BISAP评分结果的相关性。对于CTSI、MCTSI及EPIC评分在两位观察者间的一致性用Kappa检验分析。MCTSI、CTSI及EPIC分别与BISAP的相关性用Spearman等级相关分析。检验水准α=0.05。结果 BISAP评分Ⅰ级者4例,Ⅱ级者22例,Ⅲ级者19例,总评分为（2.41±0.82）分。CTSI的评分结果为Ⅰ级者6例,Ⅱ级者22例,Ⅲ级者17例,总评分为（6.02±1.96）分,两位观察者间一致性好（Kappa=0.748,95%CI为0.000~0.076,P〈0.01）。MCTSI的评分Ⅰ级者1例,Ⅱ级者13例,Ⅲ级者31例,总评分为（7.91±2.11）分,两位观察者间一致性好（Kappa=0.788,95%CI为0.000~0.076,P〈0.01）。EPIC评分结果为：Ⅰ级者6例,Ⅱ级者11例,Ⅲ级者28例,总评分为（5.57±1.52）分,两位观察者间一致性好（Kappa=0.768,95%CI为0.000~0.076,P〈0.01）。CTSI、MCISI、EPIC评分分别与BISAP评分均呈正相关（rs=0.439,P=0.003;rs=0.640,P=0.000;rs=0.503,P=0.001）。结论胰腺炎三种CT评分与BISAP均趋于正相关,MCTSI和EPIC与BISAP相关性较好,且MCTSI与BISAP较EPIC与BISAP的相关性更好。

Objective To investigate correlation of bedside index for severity in acute pancreatitis （BISAP） and computed tomography severity index （CTSI）, modified computed tomography severity index （MCTSI）, or extra-pancreatic inflammation on CT （EPIC） score, respectively, in assessing severity of acute pancreatitis. Methods Forty-five patients confirmed SAP from July 2015 to November 2015 in West China Hospital of Sichuan University were prospectively included into this study. Contrast-enhanced multi-detector-row CT scan was performed for all the patients. The abnormal imaging features, such as pancreatic and peri-pancreatic inflammatory changes, involvement of other organs and local complications, were observed and used to calculate three CT severity indexes （CTSI, MCTSI, and EPIC）. The clinical data were also collected to calculate BISAP and as compared with CT severity indexes. Correlation between the CT indexes points and BISAP score was estimated using the Spearman test. Interobserver agreement for CTSI, MCTSI or EPIC was calculated using the Kappa statistic. Results The results of BISAP score were as follows： 4 cases grade Ⅰ, 22 cases grade Ⅱ, 19 cases grade Ⅲ The results of CTSI score were as follows： 6 cases grade I, 22 cases grade Ⅱ, 17 cases grade Ⅲ. The results of MCTSI score were as follows： 1 case grade I, 13 cases grade Ⅱ, 31 cases gradeⅢ. The results of EPIC score were as follows： 6 cases grade Ⅰ, Ⅱ cases grade Ⅱ, 28 cases grade Ⅲ. The score ofBISAP, CTSI, MCIST, or EPIC was 2.41＋0.82, 6.02＋1.96, 7.91＋ 2.11, and 5.57＋_1.52, respectively. Interobserver agreements for CTSI, MCTSI, and EPIC were good （CTSI： Kappa=0.748, 95% CI 0.000-0.076, P〈0.01; MCTSI： Kappa=0.788, 95% CI 0.000-0.076, P〈0.01; EPIC： Kappa=0.768, 95% CI 0.000-0.076, P〈0.01）. Spearman statistic showed there was a positive correlation between CTSI score （r, =0.439, P=0.003）, MCTSI score （rs =0.640, P=0.000）, or EPIC （rs =0.503, P=0.001） and BISAP score. Conclusion There is a positive correlation between MCTSI or EPIC and BISAP score, and MCTSI is more strongly correlated with BISAP as compared with EPIC.