重症急性胰腺炎患者感染炎症与螺旋CT影像分析

Inflammation in patients with severe acute pancreatitis and analysis of spiral CT imaging

目的探讨重症急性胰腺炎患者感染时各炎症指标及螺旋CT影像的变化。方法选取2015年2月-2017年7月医院收治的急性胰腺炎确诊患者80例为研究对象,根据感染情况分为感染组46例和未感染组34例。比较两组患者感染炎症指标及螺旋CT影像。结果感染组患者血清白细胞计数(WBC)、C-反应蛋白(CRP)、降钙素原(PCT)、红细胞压积(HCT)分别为(5.27±0.52)×109/L、(157.31±25.30)mg/L、(5.11±0.62)μg/L、(59.26±25.61)%均高于未感染组(P均<0.05),两组患者红细胞计数(RBC)差异无统计学意义;感染组患者Ranson评分低于未感染组,而APACHEⅡ评分高于未感染组(P均<0.001);感染组患者螺旋CT检查出现胰腺体积增大、胰腺脂肪层模糊不清及周围渗出增多,可见单个或多个区域胰液潴留,且出现片状坏死及气泡征的患者均多于未感染组(P<0.05)。结论重症急性胰腺炎患者合并感染时WBC、HCT、PCT等感染指标会升高,且螺旋CT检查可见胰腺体积增大伴胰腺脂肪层模糊不清及周围渗出,多区域组织坏死、胰液潴留及出现气泡征,对重症急性胰腺炎的临床诊断有一定的意义。

OBJECTIVE To investigate the changes of inflammatory indexes and spiral CT imaging in patients with severe acute pancreatitis（SAP）.METHODS A total of 80 patients with acute pancreatitis admitted to our hospital from Feb.2015 to Jul.2017 were selected,and were divided into infection group（46 cases）and uninfected group（34 cases）.The differences of infection inflammatory indexes and the changes of spiral CT imaging were compared between the two groups.RESULTS The serum white blood cell count（WBC）,C-reactive protein（CRP）,procalcitonin（PCT）and Hematocrit（HCT）of infection group were（5.27±0.52）×109/L,（157.31±25.30）mg/L and（5.11±0.62）μg/L and（59.26±25.61）%,which were significantly higher than of uninfected group（all P〈0.05）.There was no significant difference in the red blood cell count（RBC）between the two groups.The Ranson score of the patients in infection group was significantly lower than that in uninfected group,and the APACHE II score was significantly higher than that of uninfected group（P〈0.001）.The spiral CT examination of pancreatic volume increasing,pancreatic fat layer blurring and the surrounding exudation increasing,single or multiple areas of necrosis and pancreatic juice,and flaky necrosis and bubble syndrome of infected group were all significantly more than those in uninfected group（P〈0.05）.CONCLUSIONIn severe acute pancreatitis patients with infection,inflammation and other indicators of infection of WBC,HCT and PCT increase significantly and the spiral CT imaging can show pancreatic volume increasing accompanied by pancreatic fat blurring and peripheral leakage,multiple regional pancreatic juice retention,bubble signs,and flaky necrosis.It has important guiding significance for the clinical diagnosis of severe acute pancreatitis.