不同严重程度胰腺炎患者CT灌注成像影像特点表现分析

Imaging features of CT perfusion in patients with different severities of acute pancreatitis

目的 :探讨不同严重程度急性胰腺炎(AP)CT灌注成像特点。方法 :回顾性分析2014年3月~2016年3月医院就诊的AP患者120例(AP组)和同期医院就诊的非胰腺疾病患者40例(对照组)的病例资料,根据Balrhazar CT分级标准将AP组分为轻度胰腺炎(MAP)组71例和重度急性胰腺炎(SAP)组49例,所有研究对象均于入院72h内行胰腺CT灌注成像检查,并记录增强时间-密度曲线(TDC)形态及CT灌注参数[血流量(BF)、血容量(BV)、平均通过时间(MTT)、毛细血管表面通透性(PS)],测定白介素6(IL-6)、IL-8、IL-10、血浆内皮素-1(ET-1)、血管性假血友病因子(v WF)、血栓调节蛋白(TM)水平。结果 :对照组胰腺TDC形态为速升速降型,MAP组为速升速降型或缓升缓降型,SAP组为缓升平坦型。SAP组BF、BV、PS值低于MAP组和对照组,差异有显著性;MAP组、对照组组间比较差异有显著性,3组MTT比较差异无显著性。SAP组IL-6、IL-8、IL-10、ET-1、v WF、TM明显高于MAP组和对照组,MAP组和对照组上述指标组间比较,差异有显著性。结论 :炎性因子、血管内皮功能障碍在AP病情发展中起重要参与作用,CT灌注成像可通过观察微循环状况评估病情严重程度。

Objective To investigate the imaging features of CT perfusion in patients with different severities of acute pan-creatitis (AP).MethodsThe clinical data of120 patients with AP (AP group) and40 patients with non-pancreatic diseases (control group) who were admitted to our hospital between March2014 and March2016 were analyzed retrospectively. Patients in AP group were divided into the mild acute pancreatitis (MAP) group (n=71) and severe acute pancreatitis (SAP) group (n=49) according to the Balrhazar CT grading standard. All subjects were examined by pancreatic CT perfusion imaging within72h after admission. The enhanced time - density curve (TDC) form and CT perfusion parameters [blood flow (BF), blood volume (BV), mean transit time (MTT), permeability surface (PS) ] were recorded, and the levels of interleukin6(IL-6), IL-8, IL-10, endothelin -1(ET-1), von Willebrand factor (vWF) and thrombomodulin (TM) were determined.Results In the control group, the form of pancreatic TDC was quick rise and fall type while in MAP group, it was quick rise and fall or slow rise and fall type, and in SAP group, it was slow rise flat type. The BF, BV and PS values of SAP group were lower than those of MAP group and control group. There were significant differences between MAP group and control group but there was no significant difference in MTT among the three groups. The levels of IL-6, IL-8, IL-10, ET-1, vWF and TM in SAP group were significantly higher than those in MAP group and control group. There was significant difference in the above indexes between the MAP group and the control group.Conclusion Inflammatory factors and endothelial dysfunction play an important role in the development of AP. CT perfusion imaging can be used to evaluate the severity of the disease through observing the status of microcirculation.