酒精性急性胰腺炎的CT特征及其相关血清代谢物改变

CT Characteristics of Alcoholic Acute Pancreatitis and Changes of Related Serum Metabolites

目的:探究酒精性急性胰腺炎(AAP)的CT影像学特征,并分析其相关血清代谢物改变。方法:纳入377例急性胰腺炎(AP)患者为研究对象,其中包括46例AAP患者,331例非AAP (nAAP)患者。分析两组的临床数据:包括年龄、性别、住院天数;对炎症严重程度进行临床分级:采用急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)和2012亚特兰大分级(2012 RAC);评估胰腺炎CT表现、CT严重程度指数评分(CTSI)、CT胰腺外炎症评分(EPIC)。收集40例AAP患者入院3 d内血清,按照病因分布比例在nAAP组随机选择40例血清作为对照组,测定血清中代谢物水平。结果:AAP组的男性构成比高于nAAP组(93.48%vs 50.00%;χ^(2)=32.725,P<0.05),AAP患者年龄小于nAAP (Z=-2.194,P<0.05),CTSI评分、EPIC评分AAP组较nAAP组显著升高(Z=-2.090,P<0.05;Z=-2.771,P<0.05)。住院天数、APACHEⅡ、2012 RAC、胰腺炎CT表现均无显著差异(P>0.05)。总共测定了101种血清代谢物,其中部分患者血清中无法检测出代谢物的种类进行排除,纳入25种血清代谢物,具有显著性差异18种,其中AAP患者血清2种代谢物水平上升,16种代谢物水平下降。AAP患者血清酰基肉碱类代谢物水平下降最为显著。结论:AAP患者在早期具有更高的CTSI和EPIC评分,这可能与血清酰基肉碱类代谢物质水平下降有关,后者有可能成为反映AAP严重程度或预后的特异性血清代谢标志物。

Purpose: To investigate the CT imaging features of alcoholic acute pancreatitis(AAP) and analyze its related changes of serum metabolites. Methods: A total of 377 patients with acute pancreatitis were enrolled,including 46 patients with AAP and 331 patients with non-alcoholic acute pancreatitis(nAAP). The clinical data of the two groups were analyzed, including age, sex and hospitalization days. The pancreatitis severity was clinically graded by acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) and 2012 revision of the Atlanta classification(2012 RAC). CT features of pancreatitis, CT severity index(CTSI) and extra pancreatic inflammation on CT score(EPIC) were analyzed. Serum of 40 AAP patients within 3 days of admission was collected, and serum from 40 nAAP patients were randomly selected as control group according to the proportion of etiological distribution, and serum metabolites were determined.Results: The male composition ratio in AAP group was higher than that in nAAP group(93.48% vs 50.00%;χ^(2)=32.725, P<0.05), and the age in AAP group was younger than that in nAAP group(Z=-2.194, P<0.05). CTSI and EPIC scores in AAP group were significantly higher than those in nAAP group(Z=-2.090, P<0.05;Z=2.771, P<0.05). However, the hospitalization days, APACHE Ⅱ, 2012 RAC and CT findings of pancreatitis were with no significant difference between the two groups(P>0.05). A total of 101 serum metabolites were determined, after eliminating 76 metabolites that cannot be detect in all patients, and 25 serum metabolites were included, of which 18 were significantly different, 2 were up-regulated and 16 were down-regulated in AAP patients. Serum acylcarnitine metabolites decreased most significantly in patients with AAP. Conclusion: AAP patients have higher CTSI and EPIC scores, this may be related to decreased serum acylcarnitine metabolites, the latter may be a specific serum metabolic marker reflecting the severity or prognosis of AAP.