急性胰腺炎伴脂肪肝征象的CT表现

CT diagnosis of acute pancreatitis with fatty liver signs

目的探讨CT在急性胰腺炎伴脂肪肝诊断和疾病转归判断中的应用价值。方法回顾性分析2015年1月至2018年12月间在佛山市顺德区大良医院就诊的58例胰腺炎患者的临床资料,所有患者于入院前后行腹部CT扫描,观察治疗前后肝脏和胰脏CT征象及变化特征,比较患者治疗前后的甘油三指、胆固醇、谷草转氨酶(ALT)及谷丙转氨酶(AST)等指标。结果本组58例胰腺炎患者中合并脂肪肝征象共30例,CT表现为胰腺以体积增大、胰周渗出为主,同时出现肝脏密度不同程度减低和部分体积增大,经临床综合治疗后,多数患者胰腺炎和脂肪肝征象出现好转,表现为胰腺炎性渗出吸收减少,肝脾肿胀减轻,肝脏密度CT值由治疗前平均(30.02±2.69) Hu,升高到治疗后的(40.26±6.91) Hu,治疗前后比较差异有统计学意义(P<0.05);与治疗前比较,治疗后急性胰腺炎伴脂肪肝患者甘油三指[(2.1±0.9) mmol/L vs (4.8±1.6) mmol/L]、胆固醇[(4.3±1.1) mmol/L vs (6.5±1.3) mmol/L]、ALT[(61.2±13.5) U/L vs (125.6±15.5) U/L]及AST [(56.3±11.5) U/L vs (109.5±23.5) U/L]均明显降低,差异均有统计学意义(P<0.05)。结论急性胰腺炎患者可出现不同程度脂肪肝征象,经临床积极治疗可实现脂肪肝一定程度的逆转,CT对急性胰腺炎合并肝损伤诊断和疾病转归评估均有较大应用价值。

Objective To investigate the value of CT in the diagnosis and prognosis of acute pancreatitis with fatty liver. Methods The clinical data of 58 patients with pancreatitis who were treated in Daliang Hospital of Shunde District of Foshan City from January 2015 to December 2018 were retrospectively analyzed. All patients underwent abdominal CT scanning before and after admission. The CT signs and changes of liver and pancreas before and after treatment were observed. The indexes of triglyceride, cholesterol, alanine aminotransferase(ALT), aspartate aminotransferase(AST) before and after treatment were compared. Results Among 58 patients with pancreatitis, there were 30 cases with fatty liver signs. The CT manifestations mainly included pancreatic volume increase and peripancreatic effusion,complicating liver density decrease and volume increase in different degrees. After comprehensive treatment, the signs of pancreatitis and fatty liver in most patients improved simultaneously, manifested by reduced liver and spleen swelling,and the average CT value of liver density increased from(30.02 ± 2.69) Hu before treatment to(40.26 ± 6.91) Hu after treatment(P<0.05). After treatment, the levels of triglyceride, cholesterol, ALT, AST were significantly lower than those before treatment:(2.1±0.9) mmol/L vs(4.8±1.6) mmol/L,(4.3±1.1) mmol/L vs(6.5±1.3) mmol/L,(61.2±13.5) U/L vs(125.6±15.5) U/L,(56.3±11.5) U/L vs(109.5±23.5) U/L, with statistically significant differences(P<0.05). Conclusion The patients with acute pancreatitis may show signs of fatty liver in different degrees. Active clinical treatment can reverse the fatty liver to a certain extent. CT is of great value in the diagnosis of acute pancreatitis complicated with liver injury and the evaluation of disease prognosis.