CT内脏脂肪面积与急性胰腺炎严重程度和预后相关性分析

Analysis of correlation between visceral fat area on CT and the severity and prognosis of acute pancreatitis

目的急性胰腺炎是临床上诊治棘手的急腹症之一,本研究探讨CT内脏脂肪面积对急性胰腺炎(acute pancreatitis,AP)严重程度和预后的预测价值。方法收集2019-01-27-2019-07-15收治的75例AP患者临床和发病早期(72h内)CT影像学资料,使用灵敏度、特异度和Kappa值等指标评价内脏脂肪面积对AP相关持续性器官功能衰竭和住院期间死亡的预测价值。结果发生持续性器官功能衰竭的AP患者内脏脂肪面积为(180.6±54.2)cm^2,大于未发生持续性器官功能衰竭者的(136.5±39.0)cm^2,t=2.896,P=0.005;住院期间死亡患者内脏脂肪面积为(219.7±39.5)cm^2,大于存活者的(136.8±38.6)cm2,t=5.728,P<0.001。以CT内脏脂肪面积167cm2为界点,预测持续衰竭的灵敏度为75.0%、特异度为82.1%、约登指数为0.571、Kappa值为0.368。以CT内脏脂肪面积175cm^2为界点,预测死亡的灵敏度为100%、特异度为84.5%、约登指数为0.845、Kappa值为0.368。内脏脂肪面积对持续性器官功能衰竭(AUC=0.754,95%CI:0.553~0.954)和住院期间死亡(AUC=0.944,95%CI:0.872~1.015)均具有一定诊断价值。结论急性胰腺炎发病早期CT下脐平面内脏脂肪面积与患者发生持续性器官功能衰竭和住院期间死亡存在相关,但对预测AP严重程度和预后效果有限。

OBJECTIVE Acute pancreatitis is one of the clinically difficult to treat acute abdomen.This study investigated the predictive value of CT visceral fat area on the severity and prognosis of acute pancreatitis(AP).METHODS The CT imaging data of 75patients with AP who were admitted from January 27,2019to July 15,2019 were collected.The sensitivity,specificity,Kappa value and other indicators were used to evaluate the visceral fat area to AP.Predictive value associated with persistent organ failure and death during hospitalization.RESULTS The visceral fat area of AP patients with persistent organ failure was(180.6±54.2)cm^2,which was greater than that of patients without persistent organ failure[(136.5±39.0)cm^2,t=2.896,P=0.005];visceral fat area of patients who died during hospitalization(219.7±39.5)cm2,which was greater than that of survivors[(136.8±38.6)cm^2,t=5.728,P<0.001].With a CT visceral fat area of 167cm^2 as the boundary,the sensitivity for predicting persistent failure was 75.0%,specificity was 82.1%,Yoden index was 0.571,and Kappa value was 0.368.Based on the CT visceral fat area of 175cm^2,the sensitivity of death was predicted to be 100%,the specificity was 84.5%,the Yoden index was 0.845,and the Kappa value was 0.368.Visceral fat area has a certain value for persistent organ failure(AUC=0.754,95%CI:0.553-0.954)and death during hospitalization(AUC=0.944,95%CI:0.872-1.015).CONCLUSION The visceral fat area of the umbilical plane under CT early stage is associated with persistent organ failure and death during hospitalization,but has limited effect on predicting AP severity and prognosis.