Acute pancreatitis:A review of diagnosis,severity prediction and prognosis assessment from imaging technology,scoring system and artificial intelligence

Acute pancreatitis(AP)is a potentially life-threatening inflammatory disease of the pancreas,with clinical management determined by the severity of the disease.Diagnosis,severity prediction,and prognosis assessment of AP typically involve the use of imaging technologies,such as computed tomography,magnetic resonance imaging,and ultrasound,and scoring systems,including Ranson,Acute Physiology and Chronic Health Evaluation II,and Bedside Index for Severity in AP scores.Computed tomography is considered the gold standard imaging modality for AP due to its high sensitivity and specificity,while magnetic resonance imaging and ultrasound can provide additional information on biliary obstruction and vascular complications.Scoring systems utilize clinical and laboratory parameters to classify AP patients into mild,moderate,or severe categories,guiding treatment decisions,such as intensive care unit admission,early enteral feeding,and antibiotic use.Despite the central role of imaging technologies and scoring systems in AP management,these methods have limitations in terms of accuracy,reproducibility,practicality and economics.Recent advancements of artificial intelligence(AI)provide new opportunities to enhance their performance by analyzing vast amounts of clinical and imaging data.AI algorithms can analyze large amounts of clinical and imaging data,identify scoring system patterns,and predict the clinical course of disease.AI-based models have shown promising results in predicting the severity and mortality of AP,but further validation and standardization are required before widespread clinical application.In addition,understanding the correlation between these three technologies will aid in developing new methods that can accurately,sensitively,and specifically be used in the diagnosis,severity prediction,and prognosis assessment of AP through complementary advantages.

Effect of Chaishao Chengqi Decoction on inflammation and prognosis of moderate and severe acute pancreatitis of heat stagnation and Fu-organ excess type

Objective:To explore the curative effect of Chaishao Chengqi Decoction on moderate to severe acute pancreatitis of heat stagnation and Fu-organ excess type and its effect on inflammatory reaction,and to provide new ideas for clinical treatment and prognosis evaluation.Methods:60 patients with moderate to severe acute pancreatitis of heat stagnation and Fu-organ excess type from June 2017 to June 2019 were randomly divided into control group treated with conventional therapy and treatment group treated with Chaishao Chengqi Decoction for 2 weeks.The differences of clinical efficacy and TCM syndromes between the two groups were compared.Ranson score,Balthazar CTSI score,SIRS score and modified Marshall score were recorded before and after treatment.The levels of inflammatory factors and oxidative stress-related molecules were compared before and after treatment.Result:After treatment,the total effective rates of the control group and the treatment group were 80.0%and 93.3%,respectively,with statistical difference(χ2=8.845,P=0.027);after treatment,the total effective rates of TCM syndromes evaluation of the control group and the treatment group were 76.7%and 93.3%,respectively,with statistical difference(χ2=10.024,P=0.012);after treatment,the Ranson score,Balthazar CTSI score,SIRS score and improved Marshall score were all significantly decreased(P<0.05),and the decrease was more significant in the treatment group(P<0.05);after treatment,the serum levels of TNF-α,IL-6 and MDA were significantly decreased in both groups,and superoxide dismutase(SOD)was significantly increased(P<0.05),and the treatment group improved more(P<0.05).Conclusion:Chaishao Chengqi Decoction has a good curative effect on moderate to severe acute pancreatitis of heat stagnation and Fu-organ excess type,and can effectively improve inflammatory response and oxidative stress,which has a high clinical significance.

Prognostic value of red blood cell distribution width for severe acute pancreatitis

BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red blood cell distribution(RDW)was associated with mortality of sepsis patients and could be used as a predictor of prognosis.Similarly,RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.AIM To investigate the prognostic value of RDW for SAP patients.METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017.According to the prognosis at 90 d,SAP patients were divided into a survival group and a non-survival group.RDW was extracted from a routine blood test.Demographic parameters and RDW were recorded and compared between the two groups.The receiver operator characteristic(ROC)curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.RESULTS In this retrospective cohort study,42 SAP patients were enrolled,of whom 22 survived(survival group)and 20 died(non-survival group).The baseline parameters were comparable between the two groups.The coefficient of variation of RDW(RDW-CV),standard deviation of RDW(RDW-SD),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score were significantly higher in the non-survival group than in the survival group(P<0.05).The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score,respectively.The areas under the ROC curves(AUCs)of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score,among which,the AUC of RDW-SD was the greatest.The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients.When the RDW-SD was greater than 45.5,the sensitivity for predicting prognosis was 77.8%and the specificity was 70.8%.Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis,similar to the APACHE II and SOFA scores.CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients.RDW is significantly correlated with the APACHE II and SOFA scores.RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.

Perirenal space blocking restores gastrointestinal function in patients with severe acute pancreatitis

AIM:To investigate effects of perirenal space blocking(PSB)on gastrointestinal function in patients with severe acute pancreatitis(SAP).METHODS:Forty patients with SAP were randomly allocated to receive PSB or no PSB(NPSB).All the SAP patients received specialized medical therapy(SMT).Patients in the PSB group received PSB+SMT when hospitalized and after diagnosis,whereas patients in the NPSB group only received SMT.A modifed gastrointestinal failure(GIF)scoring system was used to assess the gastrointestinal function in SAP patients after admission.Pain severity(visual analog scale,0 to100)was monitored every 24 h for 72 h.RESULTS:Modified GIF score decreased in both groups during the 10-d study period.The median score decrease was initially significantly greater in the PSB group than in the NPSB group after PSB was per-formed.During the 72-h study period,pain intensity decreased in both groups.The median pain decrease was significantly greater in the PSB group than in the NPSB group at single time points.Patients in the PSB group had significantly lower incidences of hospital mortality,multiple organ dysfunction syndrome,systemic inflammatory response syndrome,and pancreatic infection,and stayed in the intensive care unit for a shorter duration.However,no difference in terms of operation incidence was found between the two groups.CONCLUSION:PSB could ameliorate gastrointestinal dysfunction or failure during the early stage of SAP.Moreover,PSB administration could improve prognosis and decrease the mortality of SAP patients.

Enteral nutrition in treatment of severe acute pancreatitis

Objective: To observe the role and the timing of EN inthe treatment of patients with severe acute pancreatitis(SAP).Methods: Eleven patients with severe acute pancreatitisunderwent systemic nutrition support were studied.EN was given through jejunostomy tube (or Beng-mark tube) after a period of PN maintenance. ENstarted when serum and urine amylase activity re-turned to normal with regular peristaltic sound, defe-cation or break wind. The sequence of preparationwas as follows: saline glucose→chemically defined di-et→polymeric diet→normal diet.Results: In all the patients, none died. The rate of latecomplications was lower, and the levels of serum albu-min and transferritin significantly increased in thepost-EN period as compared with the pre-EN period,although the count of lymphocytes was less changed.Conclusions: Nutritional support should be trans-formed from PN to EN as early as possible during thetreatment of patients with severe acute pancreatitis. ENcould not only continue sufficient nutritional support,but also avoid the unfavorable effects of long-timePN, thus reducing complications as well as mortality.

Role of oxygen free radicals in patients with acute pancreatitis

The generation of oxygen free radicals has been implicated in the pathogenesis of experimental pancreatitis.The aim of this study was to determine the role of oxygen free radicals in patients with acute pancreatitis.METHODS: The plasma levels of C-reactive protein (CRP),lipid peroxide (LPO), myeloperoxidase (MPO) and superoxide dismutase (SOD) were measured in 13 patients with acute pancreatitis and 14 healthy volunteers.RESULTS: Among the patients with acute pancreatitis, there were higher plasma levels of LPO and MPO and lower SOD activity in patients with severe pancreatitis than in those with mild pancreatitis. However, there was no significant difference in the serum marker of oxidative stress no matter what the etiology was. The LPO level was especially correlated with the concentration of serum CRP and CT severity index.CONCLUSION: The oxygen free radicals may be closely associated with inflammatory process and the severity of acute pancreatitis. Especially, the concentration of plasma LPO is a meaningful index for determining the severity of the disease.

Can ultrasound predict the severity of acute pancreatitis early by observing acute fluid collection?

INTRODUCTIONThe spectrum of acute pancreatitis (AP) ranges from a mild spontaneously resolved disorder to severe disease with mortality up to 20%-48.4%[1-3]. sAP is defined as the AP with organ failure and /or local complications which developed form acute fluid collection (AFC) including necrosis ,abscess , pseudocyst formation into or around the pancreas [4].

微生态制剂联合依达拉奉注射液对急性重症胰腺炎的疗效及肠道菌群、肠黏膜屏障功能改变

目的探讨复方嗜酸乳杆菌片联合依达拉奉对重症急性胰腺炎患者的临床效果。方法选取河南科技大学第一附属医院收治的172例重症急性胰腺炎患者,利用随机数字表法将其分为甲、乙、丙与丁4组,各43例。4组均接受常规综合治疗,乙组另接受依达拉奉治疗,丙组另接受复方嗜酸乳杆菌片治疗,丁组另接受复方嗜酸乳杆菌片联合依达拉奉治疗。对比治疗前后肠道菌群和肠黏膜屏障功能相关指标、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)及住院时间、并发症、病死率。结果4组双歧杆属、乳酸杆菌属相对丰度在治疗前、治疗7 d及14 d后均依次升高(P<0.05),丙组、丁组治疗7、14 d后均高于甲组、乙组(P<0.05),丁组治疗7、14 d后高于丙组(P<0.05);4组肠杆菌属、葡萄球菌属、肠球菌属相对丰度在治疗前、治疗7 d及14 d后均依次降低(P<0.05),丙组、丁组治疗7、14 d后均低于甲组、乙组(P<0.05),丁组治疗7、14 d后低于丙组(P<0.05);4组D-乳酸、内毒素、二胺氧化酶(DAO)水平在治疗前、治疗7 d及14 d后均依次降低(P<0.05),乙组、丙组、丁组治疗7、14 d后均低于甲组(P<0.05),乙组、丁组治疗7、14 d后均低于丙组(P<0.05),丁组治疗7、14 d后低于乙组(P<0.05);丁组住院时间短于甲组、乙组、丙组(P<0.05),丁组并发症发生率、病死率低于甲组(P<0.05);4组APACHEⅡ评分在治疗前、治疗7及14 d后均依次降低(P<0.05),乙组、丙组、丁组治疗7、14 d后均低于甲组(P<0.05),丁组治疗7、14 d后低于乙组、丙组(P<0.05)。结论在常规综合治疗的基础上接受复方嗜酸乳杆菌片能够调节重症急性胰腺炎患者机体肠道菌群,改善肠黏膜屏障功能,给予依达拉奉可改善肠黏膜屏障功能,二者均可减轻病情,且二者联合可增强对肠黏膜屏障功能的改善作用和对病情的控制作用,还可显著缩短住院时间,减少并发症,改善预后。

血清PCT、CRP、LPS水平联合检测在重症急性胰腺炎患者发生感染性胰腺坏死诊断和预后评估中的应用

目的探讨血清降钙素原(Procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)、脂肪酶(Lipase,LPS)水平联合检测在重症急性胰腺炎(Severe acute pancreatitis,SAP)患者发生感染性胰腺坏死(Infectious pancreatic necrosis,IPN)诊断和预后评估中的应用价值。方法回顾性分析2019年4月—2022年8月本院收治的78例SAP患者的临床资料,根据患者是否发生IPN将其分为SAP发生IPN组(29例)与SAP未发生IPN组(49例),同时根据SAP发生IPN组入院14 d内预后情况将其分为死亡组(11例)与存活组(18例)。记录两组患者入院时基线资料及入院24 h血清PCT、CRP、LPS水平并进行比较,采用ROC曲线评价血清PCT、CRP、LPS单独或联合诊断SAP发生IPN及预后的诊断效果。结果SAP发生IPN组入院24 h APACHE II评分明显大于SAP未发生IPN组、入院14 d内死亡率明显高于SAP未发生IPN组(均P<0.05);而两组SAP患者性别比等其余基线资料之间比较均无明显差异(均P>0.05)。SAP发生IPN组患者入院24 h血清PCT(10.51±2.12)ng/L、CRP(254.25±38.62)mg/L、LPS(667.22±92.18)U/L水平均明显高于SAP未发生IPN组(t值依次为6.135、4.209、3.943,均P<0.05)。PCT+CRP+LPS联合检测SAP发生IPN的AUC值为0.932,敏感度为96.55%,特异度为93.88%,表明三指标联合诊断SAP发生IPN的价值更优。死亡组SAP发生IPN患者入院24 h血清PCT(12.29±2.53)ng/L、CRP(293.62±43.75)mg/L、LPS(789.21±111.23)U/L水平均明显高于存活组(t值依次为3.723、3.431、3.867,均P<0.05)。PCT+CRP+LPS联合检测SAP发生IPN预后的AUC值为0.901,敏感度为90.91%,特异度为94.44%,表明三指标联合诊断SAP发生IPN预后的价值更优。结论SAP发生IPN患者血清PCT、CRP、LPS水平均明显升高,且死亡组患者血清PCT、CRP、LPS水平均分别明显高于存活组,PCT+CRP+LPS联合检测可显著提高SAP发生IPN的诊断和预后评估效果。

建立一个评估重症急性胰腺炎预后的预测模型

目的临床上评估重症急性性肺炎胰腺炎患者预后的评分工具有很多种,目前这些工具的有效性仍然未知。本研究的目的是探讨建立一个准确的模型来评估重症急性性肺炎胰腺炎的预后。方法选取合肥市第二人民医院急诊科2018年01月至2023年12月收治的诊断为重症急性胰腺炎患者62例。通过单因素和Logistic多因素分析出影响重症急性胰腺炎患者预后的因素,建立预测模型Nomogram,并通过bootstrap进行内部验证。结果昊Logistic多因素分析发生严重低蛋白血症、使用血管活性药物和血钙是影响重症急性胰腺炎患者预后的独立危险因素。内部验证经bootstrap验证,具有较好的判别程度。校准曲线表明,模型具有较好的一致性。采用模型、急性生理与慢性健康评分(Acute Physiology and Chronic Health E-valuation,APACHEII)、急性胰腺炎严重程度床边指数(Bedsideindexof severityacutepancreatic,BISAP)和急性胰腺炎Ranson评分系统预测重症急性胰腺炎死亡率,根据受试者工作特征曲线(ROC)曲线下面积(AUC)分析评分系统对重症急性胰腺炎预后预测的准确性。结论基于是否发生严重低蛋白血症、使用血管活性药物和血钙构建的nomogram预测模型可有效筛选出影响重症急性胰腺炎患者预后的因素,为重症急性胰腺炎患者的个体化治疗提供依据。

血清Ghrelin、S100A12、IL-18水平联合检测对急性重症胰腺炎患者预后的预测价值

目的探究入院时血清饥饿素(Ghrelin)、S100钙结合蛋白A12(S100A12)、白介素18(IL-18)水平与急性重症胰腺炎(ASP)严重程度的相关性及其联合检测对ASP患者预后的预测价值。方法选取2022年5月至2023年5月郑州大学第一附属医院收治的90例ASP患者设为重症组,另选取同一时段收治的90例非重症急性胰腺炎(AP)患者设为非重症组。比较两组患者入院时的血清Ghrelin、S100A12、IL-18水平、严重程度评分(BISAP评分、APACHEⅡ评分),采用Pearson相关性分析法分析重症组患者入院时血清Ghrelin、S100A12、IL-18水平与严重程度评分的相关性。重症组患者随访30 d,根据预后情况分为生存亚组62例和死亡亚组28例,比较两亚组患者入院时的血清Ghrelin、S100A12、IL-18水平,采用受试者工作特征(ROC)曲线分析入院时血清Ghrelin、S100A12、IL-18水平联合检测对ASP患者预后的预测价值。结果重症组患者入院时的血清Ghrelin、S100A12、IL-18水平,BISAP、APACHEⅡ评分分别为(642.87±53.61)ng/mL、(364.25±46.59)ng/mL、(47.38±5.41)μg/L、(4.63±0.68)分、(10.17±1.06)分,明显高于非重症组的(437.29±38.24)ng/m L、(197.68±31.67)ng/m L、(20.15±3.36)μg/L、(1.97±0.45)分、(4.35±0.89)分,差异均有统计学意义(P<0.05);Pearson相关性分析结果显示,重症组患者入院时的血清Ghrelin、S100A12、IL-18水平与BISAP、APACHEⅡ评分呈正相关(P<0.05);死亡亚组患者入院时的血清Ghrelin、S100A12、IL-18水平分别为(708.29±72.39)ng/mL、(428.95±52.61)ng/mL、(55.26±7.20)μg/L,明显高于生存亚组的(613.33±48.51)ng/mL、(335.03±41.38)ng/mL、(43.82±5.19)μg/L,差异均有统计学意义(P<0.05);ROC曲线分析结果显示,入院时血清Ghrelin、S100A12、IL-18水平联合检测预测ASP患者死亡的曲线下面积(AUC)为0.859,高于血清Ghrelin、S100A12、IL-18水平单独检测的0.724、0.729、0.716(P<0.05)。结论ASP患者入院时血清Ghrelin、S100A12、IL-18水平明显升高,与病情严重程度密切相关,其联合检测对ASP患者预后具有较高的预测效能,可作为早期评估ASP患者病情严重程度及预后的血清学标志物,为临床早期评估ASP患者病情和预后判断提供参考依据。

CT在急性胰腺炎中的应用进展

急性胰腺炎(AP)是常见的急腹症之一。常规CT作为AP病人的首选影像学检查,在AP的诊断、严重程度评估及预后评价方面发挥着不可或缺的作用。双能CT可实现多参数定量分析并反映胰腺灌注情况,是常规CT的重要补充。影像组学通过高通量提取肉眼无法识别的影像特征可揭示病灶异质性,为AP提供更准确、全面的评估。就常规CT、双能CT及影像组学在AP诊疗中的应用进展进行综述。

血清脂蛋白(a)、降钙素原、红细胞分布宽度水平与急性胰腺炎严重程度关系及其预后评估价值

目的探讨血清脂蛋白(a)[Lp(a)]、降钙素原(PCT)、红细胞分布宽度(RDW)水平与急性胰腺炎(AP)严重程度的关系及其预后评估价值。方法选取2022年1月至12月如皋市人民医院收治的180例AP患者为研究对象。根据AP病情严重程度分为轻症AP组(n=75)、中重症AP组(n=54)与重症AP组(n=51);根据预后情况分为预后良好组(n=137)与预后不良组(n=43)。收集患者一般资料,常规检测血液生化指标和血清Lp(a)、PCT、RDW水平。采用Spearman相关性分析对Lp(a)、PCT和RDW与急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分的相关性进行分析;采用Logistic回归模型分析AP预后不良的独立危险因素;绘制受试者工作特征(ROC)曲线,评估Lp(a)、PCT和RDW对AP预后的预测价值。结果中重症AP组和重症AP组血清Lp(a)、PCT、RDW水平及APACHEⅡ评分高于轻症AP组,且重症AP组高于中重症AP组,差异有统计学意义(P<0.05)。Spearman相关性分析显示,血清Lp(a)、PCT和RDW水平与AP严重程度(APACHEⅡ评分)呈正相关(r=0.711、0.874、0.759,P<0.001)。APACHEⅡ评分、Lp(a)、PCT、RDW、急性胰腺炎严重程度床旁指数评分、Ranson评分是AP预后不良的独立危险因素(P<0.05)。血清Lp(a)、PCT、RDW及三者联合预测AP预后不良的曲线下面积分别为0.816、0.921、0.793、0.951,三者联合的预测价值最高。结论血清Lp(a)、PCT、RDW水平与AP严重程度呈正相关,是AP预后不良的独立危险因素,三者联合对AP预后不良的预测价值最高。

基于降钙素原水平指导抗生素联合连续性血液净化治疗重症急性胰腺炎的效果

目的探讨基于降钙素原(PCT)监测水平指导应用抗生素联合连续性血液净化(CBP)对重症急性胰腺炎(SAP)患者预后转归及免疫内稳状态的影响。方法选取2020年2月至2022年6月赣州市人民医院收治的80例SAP患者作为研究对象,按照随机数字表法分为研究组与对照组,每组40例。入院后两组均采取常规干预、CBP,对照组在上述基础参照SAP诊治指南抗生素应用原则给予抗生素治疗,研究组每天监测PCT指导应用抗生素。比较两组预后转归效果、治疗情况、治疗前后免疫内稳状态相关指标水平。结果研究组治疗总有效率为90.00%,高于对照组的72.50%,差异有统计学意义(P<0.05)。研究组抗生素应用时间、CBP时间、住院时间均短于对照组,住院治疗费用少于对照组,差异有统计学意义(P<0.05)。治疗后,两组CD4^(+)、CD8^(+)水平及CD4^(+)/CD8^(+)均高于治疗前,白细胞介素-1(IL-1)、干扰素γ(IFN-γ)水平均低于治疗前,且研究组CD4^(+)、CD8^(+)水平及CD4^(+)/CD8^(+)均高于对照组,IL-1、IFN-γ水平均低于对照组,差异有统计学意义(P<0.05)。结论基于PCT监测水平指导应用抗生素联合CBP治疗SAP可缩短治疗时间,改善机体免疫内稳状态,增强治疗效果,有助于减轻家庭经济负担。

BISAP评分、NIR、HCT及钙离子评估急性胰腺炎严重程度及预后的临床价值

目的:探讨急性胰腺严重床旁指数(BISAP)评分、中性粒细胞和淋巴细胞比(NLR)、红细胞比容(HCT)、血清钙离子(Ca^(2+))与急性胰腺炎(AP)严重程度和预后的关系。方法:选取371例AP患者为研究对象,根据病情分为轻症AP组(MAP组,n=220)、中度重症AP组(MSAP组,n=111)及重症AP组(SAP组,n=40);根据患者预后分为死亡组(n=15)和生存组(n=356)。比较不同病情患者临床资料(性别、年龄、住院时间、住院费用)及不同病情和预后患者实验室检查指标[中性粒细胞与淋巴细胞比值(NLR)、红细胞比容(HCT)、Ca^(2+)、AP严重程度床旁指数(BISAP)评分],分析实验室检查指标与AP严重程度和预后的关系。结果:不同病情患者NLR、HCT、Ca^(2+)、BISAP评分均有统计学差异(P<0.05),且随病情加重,NLR、HCT、BISAP评分均增加(P<0.05),Ca^(2+)水平均降低(P<0.05)。生存组患者NLR、HCT水平及BISAP评分均低于死亡组(P<0.05),Ca^(2+)水平高于死亡组(P<0.05)。ROC曲线分析显示,NLR、HCT、Ca^(2+)水平与BISAP评分预测AP患者预后死亡的曲线下面积(AUC)分别为0.857(95%CI:0.817~0.891)、0.842(95%CI:0.801~0.878)、0.806(95%CI:0.762~0.845)、0.870(95%CI:0.831~0.902);灵敏度分别为80.00%、66.67%、73.33%、93.33%,特异度分别为92.70%、93.26%、80.06%、76.40%,均对AP患者预后死亡有较好的预测价值(P<0.05)。结论:NLR、HCT及血清钙离子水平及BISAP评分指标均可辅助评估AP病情严重程度,并对患者预后有一定的预测价值。

铁死亡相关指标表达与重症胰腺炎患者临床预后的关系

目的:分析铁死亡相关指标血清铁蛋白(SF)水平与重症胰腺炎(SAP)患者临床预后的关系。方法:本研究回顾性分析了2022年1月至2022年12月期间本院收治的76例SAP患者。在住院后第1、3和7天获得血清SF水平,并根据第1天血清SF水平是否大于275ng/mL将患者人群分为两组:SF水平升高组(n=36)和SF水平正常组(n=40)。分析SF水平与CRP水平、APACHEⅡ评分、CTSI评分的相关性,及其预测SAP患者的能力。结果:与SF水平正常组相比,SF水平升高组第1、7天A-PACHEⅡ评分、第7天CTSI评分、第1、3、7天SF水平和死亡率均显著增加(P<0.05)。第1天SF水平与第1、7天APACHEⅡ评分,第1、7天CTSI评分和第7天CRP水平呈显著正相关性(r=0.236、0.495、0.269、0.582、0.362,均P<0.05)。在Cox生存分析中,病因、第1天SF水平、第7天CTSI评分、持续性器官衰竭是与SAP患者死亡相关的独立影响因素(均P<0.05)。ROC分析显示,入院第1天SF水平对SAP患者的死亡具有最高预测能力(AUC=0.851),显著高于同期的APACHEⅡ评分(AUC=0.630)和CTSI评分(AUC=0.693)。结论:早期SF水平升高与SAP不良预后有关,并可作为患者死亡的潜在预测因子。

急性胰腺炎严重程度及预后的预测指标研究进展

急性胰腺炎为消化科常见急症,病情复杂多样,发病率逐年升高。重症急性胰腺炎病情进展迅速,致死率高,因此早期评估患者病情并积极治疗,有利于降低患者死亡率,改善患者预后。为评估急性胰腺炎严重程度及预后,临床上相继出现了众多的评分系统及血清学指标。评分系统包括Ranson评分、急性生理学和慢性健康状况评价Ⅱ、急性胰腺炎严重程度床边指数、改良CT严重指数等,血清学标志物主要有C反应蛋白、降钙素原、甲状腺激素、D-二聚体、血尿素氮、血肌酐等。本文就预测急性胰腺炎严重程度及预后的相关指标的研究进展进行综述。

MCTSI、CTSI、MPV、HMGB-1、AChE活性与急性胰腺炎患者病情及预后的关系

目的 探讨改良CT严重指数(MCTSI)、CT严重指数(CTSI)、平均血小板体积(MPV)、高迁移率族蛋白-1(HMGB-1)、乙酰胆碱酯酶(AChE)活性与急性胰腺炎(AP)患者病情及预后的关系。方法 选取220例AP患者,根据病情将其分为轻症急性胰腺炎(MAP)组(n=63)、中重症急性胰腺炎(MSAP)组(n=85)和重症急性胰腺炎(SAP)组(n=72)。所有患者行MCTSI、CTSI评分,同时检测血清MPV、HMGB-1、AChE水平,采用Pearson法验证各指标的相关性。随访3个月,依据预后分组,比较不同预后AP患者MCTSI、CTSI评分及MPV、HMGB-1、AChE差异,采用受试者工作特征(ROC)曲线分析上述指标对AP预后的预测价值。结果 三组MCTSI、CTSI评分、MPV、HMGB-1、AChE比较,差异均有统计学意义(F分别=34.90、154.62、230.50、92.35、101.20,P均<0.05),SAP组MCTSI、CTSI评分、MPV、HMGB-1明显高于MSAP组和MAP组(LSD-t分别=8.32、11.43、15.16、24.66、17.50、30.24、14.32、18.28,P均<0.05),AChE明显低于MSAP组和MAP组(LSD-t分别=13.08、19.79,P均<0.05)。AP患者MCTSI、CTSI评分分别与MPV、HMGB-1呈正相关(r分别=0.21、0.21、0.18、0.25,P均<0.05),与AChE呈负相关(r分别=-0.33、-0.34,P均<0.05)。预后不良组MCTSI、CTSI评分、MPV、HMGB-1高于预后良好组,AChE低于预后良好组,差异均有统计学意义(t分别=10.66、5.63、24.15、7.02、-14.54,P均<0.05)。ROC曲线显示,MCTSI、CTSI、MPV、HMGB-1、AChE联合预测AP患者不良预后的ROC曲线下面积(AUC)为0.91(95%CI 0.86~0.94),高于各指标单独预测(Z分别=2.78、3.39、2.78、2.44、2.89,P均<0.05)。结论 AP患者随着病情加重,MCTSI、CTSI评分及MPV、HMGB-1显著升高,AChE活性降低,联合检测MCTSI、CTSI、MPV、HMGB-1、AChE对AP患者病情及预后评估均有较高的应用价值。

急性胰腺炎与甲状腺功能减退症的研究进展

临床工作中我们观察到在许多急性胰腺炎(acute pancreatitis,AP)患者的病程中会出现甲状腺功能减退症,机体内甲状腺激素水平的变化或许会对AP严重程度、病程、治疗及预后产生影响。本文就AP病程中出现的甲状腺功能减退症作一综述。

血浆外泌体miR-155预测急性胰腺炎严重程度及预后的研究

目的探讨急性胰腺炎(AP)严重程度及预后与血浆外泌体miR-155表达水平的相关性。方法选取2022年1-11月宜春市人民医院消化内科入院诊治的100例AP患者作为研究对象,根据AP亚特兰大分类标准分为轻度AP组(n=35)、中度AP组(n=33)与重度AP组(n=32)。比较3组中性粒细胞/淋巴细胞比值(NLR)、载脂蛋白A-Ⅰ(ApoA-Ⅰ)、AP严重程度相关评分[重症胰腺炎病情评估Ranson量表、改良CT严重指数评分(MCTSI)、AP严重程度床边评分(BISAP)]、血浆外泌体miR-155,建立Logistic回归模型分析AP病情严重程度的影响因素;分析血浆外泌体、ApoA-Ⅰ表达与Ranson评分、MCTSI评分、BISAP评分的相关性;绘制ROC曲线分析血浆外泌体miR-155、NLR、ApoA-Ⅰ预测AP严重程度的价值。结果重度、中度AP组血浆外泌体miR-155水平、NLR及BISAP、MCTSI、Ranson评分均高于轻度AP组,ApoA-Ⅰ水平均低于轻度AP组,且重度AP组血浆外泌体miR-155水平、NLR及BISAP、MCTSI、Ranson评分均高于中度AP组,ApoA-Ⅰ水平低于中度AP组,差异有统计学意义(P<0.05)。血浆外泌体miR-155、NLR、BISAP评分、MCTSI评分、Ranson评分是AP病情严重程度的独立危险因素(P<0.05),ApoA-Ⅰ是AP病情严重程度的保护因素(P<0.05)。血浆外泌体miR-155、NLR与BISAP、MCTSI、Ranson评分均呈正相关(P<0.05),ApoA-Ⅰ与BISAP、MCTSI、Ranson评分均呈负相关(P<0.05)。血浆外泌体miR-155、NLR、ApoA-Ⅰ联合预测AP严重程度的AUC(0.863)、灵敏度(87.69%)、特异度(94.29%)均高于单独指标检测(P<0.05)。结论外泌体miR-155、NLR、ApoA-Ⅰ水平与AP严重程度密切相关,病情越严重外泌体miR-155表达与NLR水平越高,ApoA-Ⅰ水平越低,三者联合检测能有效预测和评估AP患者预后。