急性胰腺炎不同部位受累的炎症活跃程度、磁共振成像及临床特征对比研究

Comparison of inflammatory activity,MRI and clinical features among involvements of different parts in acute pancreatitis

目的:探讨急性胰腺炎(AP)胰腺不同部位受累(亚型)的炎症活跃程度、磁共振成像(MRI)表现和临床特征。方法:选取257例AP患者作为研究对象,根据胰腺不同受累部位将患者分为三组:Ⅰ型组(主要累及胰头,n=76);Ⅱ型组(主要累及胰体和胰尾,n=118)及Ⅲ型组(主要累及整个胰腺,n=63),观察并比较各组患者入院炎症活跃程度、MRI表现和临床特征。结果:Ⅲ型组入院时炎症活跃程度、病因、C反应蛋白(CRP)水平、严重程度、住院天数、坏死发生率、局部并发症及临床和影像学严重程度评分与Ⅰ型组和Ⅱ型组比较,差异有统计学意义(P<0.05)。全胰腺受累入院炎症活跃程度最高,且是最严重的亚型,主要病因是高脂血症。入院胰腺炎活跃程度评分(PASS)>140分对中重度和重度AP具有最佳预测值(AUC=0.746),且局部并发症(OR=2.58,95%CI:1.262~5.287,P=0.009)和亚型(OR=1.406,95%CI:1.065~1.857,P=0.016)是AP活跃的独立危险因素。结论:根据胰腺不同受累部位将急性胰腺炎分为三个亚型,揭示了各亚型入院时炎症活跃程度、临床和影像学特征。新的分类方法有助于更加简便从影像学维度描述AP的特征。

Objective:To investigate the degree of inflammatory activity,magnetic resonance imaging(MRI)manifestations and clinical features of acute pancreatitis(AP)among different parts of the pancreas involved.Methods:257 eligible AP patients were selected as the study subjects,and they were classified into three subtypes on MRI according to the different parts of the pancreas involved:type Ⅰ mainly involved the head of the pancreas(n=76),type Ⅱ mainly involved the body and tail of the pancreas(n=118),and type Ⅲ involved the whole pancreas(n=63).The degree of admission inflammation activity,MRI manifestations and clinical features were observed and compared among the groups.Results:There were statistically significant differences in admission inflammation activity,etiology,C-reactive protein(CRP),severity,length of hospital stay,incidence of necrosis,local complications,and clinical and imaging severity scores between the type Ⅲ group and the type Ⅰ and type Ⅱ groups(P<0.05).Patients with total pancreatic involvement had the highest degree of admission inflammatory activity and was the most severe subtype,with hyperlipidaemia as the main etiology.Pancreatitis activity scoring system(PASS)at admission>140 score had the best predictive value for moderately severe and severe AP(AUC=0.746).The local complications(OR=2.583,95%CI:1.262~5.287,P=0.009)and subtypes(OR=1.406,95%CI:1.065~1.857,P=0.016)were independent risk factors for active AP.Conclusion:We classified acute pancreatitis into three subtypes based on different sites of pancreatic involvement on MRI,revealing the degree of active admission inflammation,clinical and imaging features of each subtype.The new classification on MRI helps to characterize AP more easily from the imaging dimension.