肺超声评分鉴别急性胰腺炎病情危重程度及预后评估

Diagnosis of acute pancreatitis severity and prognosis by pulmonary ultrasound scoring

目的观察肺超声评分(LUS)鉴别急性胰腺炎(AP)病情危重程度及预后评估。方法前瞻性纳入2021年8月至2023年4月郑州大学第二附属医院重症医学科54例AP患者, 根据严重程度将其分为中度急性胰腺炎(MAP)组和重症急性胰腺炎(SAP)组。根据SAP组出院时预后情况将患者分为预后良好组与预后不良组, 于入院24 h内行肺部超声检查及实验室检查, 观察各指标组间差异, 绘制受试者工作特征(ROC)曲线, 采用DeLong检验比较曲线下面积(AUC), 检验LUS对AP患者病情严重程度及预后的评估价值。结果 MAP组LUS低于SAP组[(10.23±2.29)分比(15.15±3.18)分, t=-7.414, P<0.05];MAP组APACHE Ⅱ评分低于SAP组[(5.80±1.63)分比(10.71±3.28)分, t=-7.183, P<0.05];MAP组PCT低于SAP组[(1.24±0.51) ng/ml比(15.35±13.98) ng/ml, t=-5.539, P<0.05];MAP组Lac低于SAP组[(1.10±0.59) mmol/L比(6.95±3.16) mmol/L, t=-9.945, P<0.05];MAP组PaO_(2)/FiO_(2)高于SAP组(331.50±32.86比174.17±39.08, t=16.072, P<0.05);MAP组ALB高于SAP组[(37.87±4.18) g/L比(28.43±4.38) g/L, t=8.072, P<0.05]。预后良好组LUS低于预后不良组[(14.38±2.16)分比(18.50±3.21)分, t=-3.753, P<0.05];预后良好组APACHE Ⅱ低于预后不良组[(9.75±1.97)分比(13.75±3.33)分, t=-4.239, P<0.05];预后良好组PCT低于预后不良组[(9.80±4.56) ng/ml比(26.46±19.65) ng/ml, t=-3.286, P<0.05];预后良好组PCT低于预后不良组[(9.80±4.56) ng/ml比(26.46±19.65) ng/ml, t=-3.286, P<0.05];预后良好组Lac低于预后不良组[(5.87±2.44) mmol/L比(9.13±3.46) mmol/L, t=-2.678, P<0.05];预后良好组PaO_(2)/FiO_(2)高于预后不良组(187.81±29.49比146.88±46.34, t=2.740, P<0.05);预后良好组与预后不良组患者ALB差异无统计学意义(t=8.072, P>0.05)。LUS对于鉴别MAP与SAP的评估价值较高, AUC=0.934(95%CI:0.832~0.984), 敏感性87.5%, 特异性83.3%。LUS评分对于预测预后良好与预后不良具有一定评估价值, AUC=0.879(95%CI:0.681~0.975), 敏感性75%, 特异性93.7%。结论 LUS与急性胰腺炎病情危重程度具有强相关性, 对鉴别急性胰腺炎分型及预后评估具有良好价值。

Objective To evaluate the severity and prognosis of acute pancreatitis(AP)by lung ultrasound score(LUS).Methods A total of 54 patients with AP were prospectively included and divided into a moderate AP(MAP)group and a severe AP(SAP)group based on their severity.According to the prognosis of the SAP group upon discharge,the patients were divided into a good prognosis group and a poor prognosis group.Within 24 h of admission,lung ultrasound and laboratory examinations were per-formed to observe the differences in each indicator between two groups.Receiver operating characteristic(ROC)curves were plotted,and DeLong test was used to compare the area under the curve(AUC)to test the evaluation value of LUS in the severity and prognosis of AP patients.Results The LUS,APACHE II scores,PCT,and Lac in the MAP group were significantly lower than those in the SAP group,and the oxygenation index and ALB levels were significantly higher in the MAP group than those in the SAP group(P<0.05).The LUS of the MAP group was lower than that of the SAP group[(10.23±2.29)points vs.(15.15±3.18)points,t=-7.414,P<0.05].The APACHE II score in the MAP group was lower than that in the SAP group[(5.80±1.63)score vs.(10.71±3.28)score,t=-7.183,P<0.05].The PCT of the MAP group was lower than that of the SAP group[(1.24±0.51)vs.(15.35±13.98)ng/ml,t=-5.539,P<0.05].The Lac in the MAP group was lower than that in the SAP group[(1.10±0.59)vs.(6.95±3.16)mmol/L,t=-9.945,P<0.05].The PaO_(2)/Fi0_(2) in the MAP group was higher than that in the SAP group(331.50±32.86 vs.174.17±39.08,t=16.072,P<0.05).The ALB in the MAP group was higher than that in the SAP group[(37.87±4.18)vs.(28.43±4.38)g/L,t=8.072,P<0.05].The LUS and APACHE II scores,PCT,Lac levels,and oxygenation index in the good prognosis group were lower than those in the poor prognosis group,with the diference between statistically significant(P<0.05).The LUS in the good prognosis group was lower than that in the poor prognosis group[(14.38±2.16)score vs.(18.50±3.21)score,t=-3.753,P<0.05].The APACHE II score in the good prognosis group was lower than that in the poor prognosis group[(9.75±1.97)points vs.(13.75±3.33)points,t=-4.239,P<0.05].The PCT in the good prognosis group was lower than that in the poor prognosis group[(9.80±4.56)vs.(26.46±19.65)ng/ml,t=-3.286,P<0.05].The PCT in the good prognosis group was lower than that in the poor prognosis group[(9.80±4.56)vs.(26.46±19.65)ng/ml,t=-3.286,P<0.05].The Lac in the good prognosis group was lower than that in the poor prognosis group[(5.87±2.44)vs.(9.13±3.46)mmol/L,t=-2.678,P<0.05].The PaO_(2)/FiO_(2) in the good prognosis group was higher than that in the poor prognosis group(187.81±29.49 vs.146.88±46.34,t=2.740,P<0.05).There was no statistically significant difference in ALB between the good prognosis group and the poor prognosis group(t=8.072,P>0.05).LUS has a high evaluation value for distinguishing MAP from SAP,with AUC=0.934[95% confidence interval(CI):0.832-0.984],sensitivity of 87.5%,and specificity of 83.3%.The LUS score has certain evaluation value for predicting good and poor prognosis,with AUC=0.879(95%Cl:0.681-0.975),sensitivity of 75%,and specificity of 93.7%.Conclusion There is a strong correlation between LUS and the severity of AP,which has a good value in distinguishing AP subtypes and evaluating prognosis.