急性胰腺炎患者病情严重程度与胸腔积液的相关性研究

Correlation of Disease Severity with Pleural Effusion in Patients with Acute Pancreatitis

目的:探讨急性胰腺炎(AP)患者病情严重程度与胸腔积液的相关性。方法:回顾性分析云南省第三人民医院2008年1月至2014年12月收治的492例AP患者的临床资料,以APACHEⅡ评分、CT严重指数(CTSI)两种评分系统评估患者病情严重程度,探讨其与胸腔积液的关系。结果:492例AP患者中,并发胸腔积液者368例,无胸腔积液者124例,胸腔积液的发生率为74.8%。病情轻重不同组胸腔积液的发生率比较均有统计学意义(P<0.05)。病情越重者胸腔积液程度越重。胸腔积液程度与APACHEⅡ评分(r=0.775,P<0.01)、CTSI(r=0.525,P<0.05)呈正相关。Logisitc回归分析显示高APACHEⅡ、高CTSI是发生胸腔积液的独立危险因素。在判断AP并发胸腔积液患者的预后时,APACHEⅡ评分、CTSI以及两者联合评分的受试者工作特征曲线下面积分别为0.798、0.687、0.812。APACHEⅡ评分、联合评分与CTSI相比差异均有统计学意义(P<0.05)。结论:AP患者病情严重程度与胸腔积液密切相关,综合运用APACHEⅡ评分、CTSI评估病情并积极干预有助于改善患者的预后。

Objective： To investigate the correlation of disease severity with pleural effusion in patients with acute pancreatitis （AP）. Methods： A retrospective analysis was conducted on a prospectively collected database. The demographic, clinical, and laboratory data of 492 consecutive cases of AP in patients admitted to the Yunnan Third Peoples＇ Hospital from January 2008 to December 2014 were reviewed. Acute physiology and chronic health evaluation II （APACHE II） score and computed tomography severity index （CTSI） were used to evaluate the disease severity of AP. The relationship between the severity and pleural effusion was analyzed. Receiver operator characteristic （ROC） curve was used to compare the values of APACHE II score and CTSI in predicting the prognosis of AP patients with pleural effusion. Results＂ Among the 492 patients, there were 368 patients with pleural effusion and 124 patients without pleural effusion. The incidence ofpleural effusion in AP was 74.8%. Further study showed that the difference in the incidences ofpleural effusion between the severe group and the mild group was significant （P〈0.01）. There was a trend that the more serious the patients＇ condition, the more the pleural effusion. Moreover, the level of pleural effusion was significantly and positively correlated with the APACHE II score （r=0.775, P〈0.01） and CTSI （r=0.525, P〈0.05）. Logistic regression analysis showed that high APACHE II score and high CTSI were significantly associated with pleural effusion formation. Areas under the ROC curve of the APACHE II score, CTSI and combined assessment were 0.798, 1.687 and 0.812 for predicting mortality of AP patients with pleural effusion. There were significant differences between the APACHE II score and CTSI as well as combined assessment and CTSI （P〈0.05）. Conclusion： The disease severity was closely related to pleural effusion in patients with AP. Combining the two scoring systems to evaluate the disease severity and providing active treatment were important to improve the prognosis of APCpatients with pleural effusion.