急性胰腺炎螺旋CT灌注参数与病情严重程度的相关性研究

Correlation Between Spiral CT Perfusion Parameters of Acute Pancreatitis and Severity of the Disease

目的分析急性胰腺炎(AP)螺旋电子计算机断层扫描(CT)灌注参数与病情严重程度的相关性。方法将2014年1月~2018年4月收治的74例AP患者按病情严重程度分组,设轻度AP(MAP)组(n=27),中度AP(MSAP)组(n=29),重度AP(SAP)组(n=18);对比三组血流量(BF)、组织血容量(BV)、平均通过时间(MTT)、表面通透性(PS);并分别行spermam相关性及ROC曲线分析CT灌注参数与AP病情严重程度的相关性及其对SAP的预测价值。结果不同病情严重程度、CT分级的AP患者BF、BV参数差异有统计学意义(P<0.001),且MAP组BF、BV>MSAP组>SAP组(P<0.05);经spermam相关性分析,BF、BV与病情严重程度呈显著负相关(r=-0.516、-0.721,P均<0.01),而MTT、PS与病情严重程度无显著相关性;经ROC曲线分析,仅BF、BV对SAP具良好的预测价值,曲线下面积值分别为0.808、0.951;cut-off为78.521ml·100g-1·min-1、10.213mL/100g时敏感度及特异度最佳,敏感度分别为64.30%、8 7. 5 0%,特异度分别为9 4. 4 0%、100.00%。结论 AP螺旋CT灌注参数BF、BV与AP病情严重程度呈负相关,并可作为预测SAP的特异性指标,值得临床重视。

Objective To analyze the correlation between spiral computed tomography(CT)perfusion parameters of acute pancreatitis(AP)and severity of the disease.Methods A total of 74 patients with AP from January 2014 to April 2018 were divided into three groups according to the severity of the disease,including mild AP(MAP)group(n=27),moderate AP(MSAP)group(n=29)and severe AP(SAP)group(n=18).The blood flow(BF),tissue blood volume(BV),mean transit time(MTT)and permeability surface(PS)of three groups were compared.The spearman correlation and the ROC curve were used to analyze the correlation between CT perfusion parameters and the severity of AP and its predictive value for SAP.Results There were significant differences in BF and BV in patients with different severity of disease and CT grade(P<0.001).Arranging the BF and BV from large to small,the corresponding order was MAP group,MSAP group and SAP group(P<0.05).After spermam correlation analysis,BF and BV were significantly negatively correlated with the severity of the disease(r=-0.516,-0.721,both P<0.01).There was no significant correlation between MTT,PS and severity of the disease.By the analysis of ROC curve,only BF and BV had good predictive value for SAP.The areas under the curve were 0.808 and 0.951,respectively.When the cut-off equaled to 78.521 ml·100 g-1·min-1 and 10.213 mL/100 g,the sensitivity and specificity were the best.The sensitivities were 64.30%and 87.50%,specificity.The specificities were 94.40%and 100.00%,specificity.Conclusion The perfusion parameters of BF and BV in spiral CT of AP are negatively correlated with the severity of AP,which can be used as a specific index for predicting SAP.