修正CT严重指数评分对急性胰腺炎早期并发内脏静脉血栓形成的预测价值

Predictive Value of Modified CT Severity I n d ex Score for Splanchnic Venous T h r ombosis in Early-stage Acute Pancreatitis

目的探讨急性胰腺炎(AP)并发内脏静脉血栓形成(SVT)的临床特征和预测指标。方法对2017年10月至2019年9月收治的165例AP患者的临床和影像学资料进行回顾性分析,早期(AP发病2周内)并发SVT29例(SVT组),无SVT 136例(non-SVT组)。对比2组AP发病72h内修正CT严重指数(MCTSI)评分、临床和预后指标,单因素和多因素Logistic回归分析影响AP早期并发SVT的相关因素,并通过受试者工作特征(ROC)曲线分析相关独立危险因素对SVT的预测价值。结果AP患者中SVT发生率为17.6%(29/165),其中脾静脉、门静脉和肠系膜上静脉受累比例分别为82.8%(24/29)、34.5%(10/29)和13.8%(4/29)。与non-SVT组比较,SVT组男性、坏死性胰腺炎、器官功能衰竭、重度AP比例较高,MCTSI评分较高,ICU住院时间和总住院时间延长,病死率增加,差异均具有统计学意义(P<0.05)。多因素Logistic回归分析显示,坏死性胰腺炎和MCTSI评分>6分是AP早期并发SVT的独立危险因素。ROC曲线分析发现,MCTSI评分预测AP早期并发SVT的曲线下面积(AUC)为0.831(95%CI:0.739~0.923),取最佳截断值6.5时,灵敏度为82.8%,特异度为77.2%。结论SVT在坏死性胰腺炎中发生率较高,AP发病72h内MCTSI评分对预测早期SVT具有重要价值。

Objective To investigate the clinical features and predictive indicators of splanchnic venous thrombosis(SVT)in early stage of acute pancreatitis(AP).Methods The clinical and imaging data of 165 patients with AP from October 2017 to September 2019 were retrospectively analyzed.SVT was present in 29 patients(SVT group)in the early stage(within 2 weeks of AP onset)and absent in 136 patients(non-SVT group).To compare the modified CT severity index(MCTSI)score within 72 hours of AP onset,clinical and prognostic indicators between the two groups.The univariate and multivariate logistic regression analysis was used to analyze the related factors affecting SVT in early stage of AP.The predictive value of independent risk factors for SVT was analyzed by receiver operator characteristic(ROC)curve.Results The incidence of SVT in AP patients was 17.6%(29/165).The proportion of splenic vein,portal vein and superior mesenteric vein involvement was 82.8%(24/29),34.5%(10/29)and 13.8%(4/29),respectively.Compared with non-SVT group,the proportion of male,necrotizing pancreatitis,organ failure and severe AP in SVT group was higher,MCTSI score was higher,ICU hospitalization time and total hospitalization time were prolonged,and mortality was increased,the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that necrotizing pancreatitis(OR=5.683,95%CI:1.237~6.180,P=0.028)and MCTSI score>6(OR=8.518,95%CI:1.694~10.369,P=0.015)were independent risk factors for SVT in early stage of AP(P<0.05).ROC curve analysis showed that the area under curve(AUC)of MCTSI score was 0.831,95%CI:0.739~0.923,and the sensitivity and specificity were 82.8%and 77.2%when the best cut-off value was 6.5.Conclusion The incidence of SVT is high in necrotizing pancreatitis.MCTSI score within 72 hours of AP onset is of great value in predicting early SVT.