CT评估胰周坏死与急性胰腺炎严重程度和预后的相关性分析

Correlation Between CT Evaluation of Peripancreatic Necrosis and Severity and Prognosis of Acute Pancreatitis

目的探讨CT评估胰周坏死与急性胰腺炎(AP)严重程度和预后的相关性。方法回顾性分析2018年11月至2020年12月收治的78例胰周坏死型AP患者的临床和影像资料,通过双变量相关(Spearman)分析胰周坏死体积与AP患者改良CT严重指数评分(MCTSI)、坏死组织继发感染、持续性器官功能障碍、死亡的相关性,采用受试者工作特征(ROC)曲线评价胰周坏死体积对预测重症AP和死亡的效能。结果CT评估胰周坏死体积与MCTSI评分(r=0.413,P<0.001)、坏死组织继发感染(r=0.337,P=0.003)、持续性器官功能障碍(r=0.384,P=0.001)、死亡(r=0.387,P<0.001)均呈显著正相关(P<0.05)。胰周坏死体积预测重症AP(持续性器官功能障碍)和死亡的ROC曲线下面积(AUC)分别为0.769(95%CI:0.647~0.890)和0.821(95%CI:0.668~0.974)。CT评估胰腺坏死体积预测重症AP(持续性器官功能障碍)的最佳截断值为172mL,敏感度为70.6%、特异度为70.5%;预测死亡的最佳截断值为200mL,敏感度为72.7%,特异度为80.6%。结论CT评估胰周坏死体积与胰周坏死型AP严重程度和预后相关,有助于指导临床筛查危重患者。

Objective To investigate the correlation between CT evaluation of peripancreatic necrosis and the severity and prognosis of acute pancreatitis(AP).Methods The clinical and imaging data of 78 patients with peripancreatic necrotic AP treated from November 2018 to December 2020 were analyzed retrospectively.The correlation between peripancreatic necrotic volume and AP patients'modified CT severity index score(mctsi),secondary infection of necrotic tissue,persistent organ failure and death was analyzed by bivariate correlation(Spearman).The working characteristics of subjects(ROC)were used Curve to evaluate the efficacy of peripancreatic necrosis volume in predicting severe AP and death.Resluts CT evaluation of peripancreatic necrosis volume was significantly positively correlated with mctsi score(r=0.413,P<0.001),secondary infection of necrotic tissue(r=0.337,P=0.003),persistent organ failure(r=0.384,P=0.001)and death(r=0.387,P<0.001)(P<0.05).The area under ROC curve(AUC)of peripancreatic necrosis volume predicting severe AP(persistent organ failure)and death were 0.769(95%CI:0.647~0.890)and 0.821(95%CI:0.668~0.974),respectively.The best cut-off value of CT in predicting severe AP(persistent organ failure)was 172 mL,the sensitivity was 70.6%,and the specificity was 70.5%;The best cutoff value for predicting death was 200mL,the sensitivity was 72.7%,and the specificity was 80.6%.Concoloins CT evaluation of peripancreatic necrosis volume is related to the severity and prognosis of peripancreatic necrosis AP,which is helpful to guide clinical screening of critical patients.