不同年龄阶段急性胰腺炎局部并发症的MRI特征
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摘要
目的探讨不同年龄阶段急性胰腺炎(AP)局部并发症的MRI特征。方法 591例AP患者纳入研究,患者发病及入院5～7天行3. 0 T MRI检查。根据年龄将研究对象分3组:青年组(18～39岁),中年组(40～64岁),老年组(≥65岁)。分别记录AP患者临床指标和局部并发症MRI表现,比较3个年龄组的差异。结果胆源性和特发性AP常见于老年组(75%,18. 24%),其次中年组(55. 21%,16. 87%),再次青年组(29. 06%,8. 54%)。肝功能异常在青年组(52. 14%)低于中年组和老年组(76. 07%,77. 03%)。在MRI上,胃肠道改变在老年组最少(12. 16%),青年组和中年组(33. 33%,46. 01%)较多,差异具有统计学意义;肾周间隙受累与不同年龄阶段之间呈弱相关性(P <0. 05,r=0. 25)。对于坏死型AP,老年组更易并发弥漫性独立胰周坏死(66. 67%),而青年组和中年组更易并发胰腺坏死(61. 11%,71. 15%),差异具有统计学意义。结论不同年龄阶段AP局部并发症在临床和MRI上有不同的发病趋势。及时采取措施预防不同年龄患者高发的并发症,有助于更好地控制AP病程的进展。
Objective To study the MRI characteristics of local complications of patients with acute pancreatitis( AP)based on different ages. Methods There are 591 patients with AP included in the study. All of them received an abdominal MR scanning on 3. 0T MR scanner within 5-7 days after onset and admission. The patients were divided into three groups based on ages: Group young( 18 to 39 yrs),Group middle-aged( 40-64 yrs) and Group old( ≧ 65 yrs). The clinical records and MRI findings of local complications were assessed and compared among three groups. The clinical records include etiology,sex and liver function. The local complications include the necrosis of pancreas and peripancreatic fat,APassociated gastrointestinal abnormality and perirenal space involvement. Results Biliary and idiopathic AP were the most commonly found in the old age Group( 75%,18. 24%),then were middle age Group( 55. 21%,16. 87%),the last were young Group( 29. 06%,8. 54%). The prevalence of AP-associated liver-function abnormality in the young group( 52. 14%) was lower than those in other groups( 76. 07%,77. 03%). On MRI,the prevalence of AP-associated gastrointestinal abnormality in young and middle-age group( 33. 33%,46. 01%) was more common than those in the old Group( 12. 16%). The prevalence of perirenal space involvement was correlated with the different age stages( P < 0. 05,r =0. 25). For necrotizing AP,old Group was subject to extensive peripancreatic necrosis( 66. 67%) but young and middleaged Groups were subject to pancreatic necrosis( 61. 11%,71. 15%). Conclusion The local complications of AP patients in different age groups have different trends of risk on clinical findings and MRI. Timely measures to prevent high incidence of local complications in AP patients with different age are helpful for controlling the development of AP course.
Objective To study the MRI characteristics of local complications of patients with acute pancreatitis( AP)based on different ages. Methods There are 591 patients with AP included in the study. All of them received an abdominal MR scanning on 3. 0T MR scanner within 5-7 days after onset and admission. The patients were divided into three groups based on ages: Group young( 18 to 39 yrs),Group middle-aged( 40-64 yrs) and Group old( ≧ 65 yrs). The clinical records and MRI findings of local complications were assessed and compared among three groups. The clinical records include etiology,sex and liver function. The local complications include the necrosis of pancreas and peripancreatic fat,APassociated gastrointestinal abnormality and perirenal space involvement. Results Biliary and idiopathic AP were the most commonly found in the old age Group( 75%,18. 24%),then were middle age Group( 55. 21%,16. 87%),the last were young Group( 29. 06%,8. 54%). The prevalence of AP-associated liver-function abnormality in the young group( 52. 14%) was lower than those in other groups( 76. 07%,77. 03%). On MRI,the prevalence of AP-associated gastrointestinal abnormality in young and middle-age group( 33. 33%,46. 01%) was more common than those in the old Group( 12. 16%). The prevalence of perirenal space involvement was correlated with the different age stages( P < 0. 05,r =0. 25). For necrotizing AP,old Group was subject to extensive peripancreatic necrosis( 66. 67%) but young and middleaged Groups were subject to pancreatic necrosis( 61. 11%,71. 15%). Conclusion The local complications of AP patients in different age groups have different trends of risk on clinical findings and MRI. Timely measures to prevent high incidence of local complications in AP patients with different age are helpful for controlling the development of AP course.
引文
1 Forsmark CE,Vege SS,Mel Wilcox C.Acute Pancreatitis[J].New England J Med,2017,376:598-599.
2 Nawaz H,Mounzer R,Yadav D,et al.Revised Atlanta and determinant-based classification:application in a prospective cohort of acute pancreatitis patients[J].Am J Gastroenterol,2013,108:1911-1917.
3 Cavestro GM,Leandro G,Di Leo M,et al.A single-centre prospective,cohort study of the natural history of acute pancreatitis[J].Dig Liver Dis,2014,47:205-210.
4 Banks PA,Bollen TL,Dervenis C,et al.Classification of acut pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62:102-111.
5 Windsor JA,Escott A,Brown L,et al.Novel Strategies for the Treatment of Acute Pancreatitis Based On the Determinants of Severity[J].J Gastroenterol Hepatol,2017.
6 Zheng Y,Zhou Z,Li H,et al.A multicenter study on etiology of acute pancreatitis in Beijing during 5 years[J].Pancreas,2015,44:409-414.
7 Zhu Y,Pan X,Zeng H,et al.A Study on the Etiology,Severity,and Mortality of 3260 Patients With Acute Pancreatitis According to the Revised Atlanta Classification in Jiangxi,China Over an 8-Year Period[J].Pancreas,2017,46:504-509.
8 Bai Y,Jia L,Wang B,et al.Acute Pancreatitis in the Guangdong Province,China[J].Digestion,2007,75:74-79.
9潘华山,张小明.急性胰腺炎的MRI评价[J].国际医学放射学杂志,2010,33:34-37.
10 Huang J,Qu HP,Zheng YF.The revised Atlanta criteria 2012 altered the classification,severity assessment and management of acute pancreatitis[J].Hepatobiliary Pancreat Dis Int,2016,15:310-315.
11唐伟,张小明,黄小华,等.磁共振成像评价急性胰腺炎的严重程度与肝功能的相关性研究[J].磁共振成像,2010,1:46-49.
12 Vriens PW,van de Linde P,Slotema ET,et al.Computed tomography severity index is an early prognostic tool for acute pancreatitis[J].JAm Coll Surg,2005,201:497-502.
13 Koutroumpakis E,Dasyam AK,Furlan A,et al.Isolated Peripancreatic Necrosis in Acute Pancreatitis Is Infrequent and Leads to Severe Clinical Course Only When Extensive:A Prospective Study From a US Tertiary Center[J].J Clin Gastroenterol,2016,50:589-595.
14 Sarr MG,Banks PA,Bollen TL,et al.The New Revised Classification of Acute Pancreatitis 2012[J].Surg Clin North Am,2013,93:549-62.
15严志汉,闵鹏秋,宋彬,等.急性胰腺炎累及肾旁后间隙与其临床严重程度及CT严重指数的相关性研究[J].中华放射学杂志,2005,39:375-378.
16 Florie J,Wasser MN,Arts-Cieslik K,et al.Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn's disease[J].AJR,2006,186:1384-1392.
17 Kim JH,Ha HK,Sohn MJ,et al.Usefulness of MR imaging for diseases of the small intestine:comparison with CT[J].Korean Journal of Radiology Official Journal of the Korean Radiological Society,2000,1:43-50.
18 Punwani S,Rodriguez-Justo M,Bainbridge A,et al.Mural inflammation in Crohn disease:location-matched histologic validation of MRimaging features[J].Radiology,2009,252:712-720.
19 Lee SL,Ku YM,Rha SE.Comprehensive reviews of the interfascial plane of the retroperitoneum:normal anatomy and pathologic entities[J].Emerg Radiol,2010,17:3-11.
20 Ou ZB,Miao CM,Ye MX,et al.Investigation for role of tissue factor and blood coagulation system in severe acute pancreatitis and associated liver injury[J].Biomedicine&pharmacotherapy=Biomedecine&pharmacotherapie,2016,10:380-388.
21 Blamey SL,Imrie CW,O'Neill J,et al.Prognostic factors in acute pancreatitis[J].Gut,1984,25:1340-1346.
22杨琦,李树钧,吴开春.急性胰腺炎合并肝损伤的研究进展[J].胃肠病学和肝病学杂志,2016,25:476-478.
23徐彦哲,丁佑铭,汪斌,等.急性胰腺炎肝损伤的研究进展[J].中华外科杂志,2015,21:284-288.
24 Dellinger EP,Forsmark CE,Layer P,et al.Determinant-basedclassification of acute pancreatitis severity:an internationalmultidisciplinary consultation[J].Ann Surg,2012,256:875-880.
25钱孝先,田尧,郑志存,等.磁共振成像在急性胰腺炎诊断中的价值[J].胃肠病学和肝病学杂志,2013,22:192-194.
26 Sharma V,Rana SS.Extrapancreatic Necrosis in Acute Pancreatitis[J].Journal of Clinical Gastroenterology,2017,51:89-89.
27 Bakker OJ,van Santvoort H,Besselink MG,et al.Extrapancreatic necrosis without pancreatic parenchymal necrosis:a separate entity in necrotising pancreatitis?[J].Gut,2013,62:1475-1480.
28 Wang M,Wei A,Guo Q,et al.Clinical outcomes of combined necrotizing pancreatitis versus extrapancreatic necrosis alone[J].Pancreatology,2016,16:57-65.
29潘华山,张小明,唐伟,等.急性胰腺炎累及肾周间隙的MRI研究[J].中国医学计算机成像杂志,2010,16:123-128.
30冀一帆.急性胰腺炎胃肠道改变的MRI研究[D].川北医学院,2013.
31 Wu LM,Sankaran SJ,Plank LD,et al.Meta-Analysis of Gut Barrier Dysfunction in Patients with Acute Pancreatitis.Brit J Surg,2014,101:1644-1656.
2 Nawaz H,Mounzer R,Yadav D,et al.Revised Atlanta and determinant-based classification:application in a prospective cohort of acute pancreatitis patients[J].Am J Gastroenterol,2013,108:1911-1917.
3 Cavestro GM,Leandro G,Di Leo M,et al.A single-centre prospective,cohort study of the natural history of acute pancreatitis[J].Dig Liver Dis,2014,47:205-210.
4 Banks PA,Bollen TL,Dervenis C,et al.Classification of acut pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62:102-111.
5 Windsor JA,Escott A,Brown L,et al.Novel Strategies for the Treatment of Acute Pancreatitis Based On the Determinants of Severity[J].J Gastroenterol Hepatol,2017.
6 Zheng Y,Zhou Z,Li H,et al.A multicenter study on etiology of acute pancreatitis in Beijing during 5 years[J].Pancreas,2015,44:409-414.
7 Zhu Y,Pan X,Zeng H,et al.A Study on the Etiology,Severity,and Mortality of 3260 Patients With Acute Pancreatitis According to the Revised Atlanta Classification in Jiangxi,China Over an 8-Year Period[J].Pancreas,2017,46:504-509.
8 Bai Y,Jia L,Wang B,et al.Acute Pancreatitis in the Guangdong Province,China[J].Digestion,2007,75:74-79.
9潘华山,张小明.急性胰腺炎的MRI评价[J].国际医学放射学杂志,2010,33:34-37.
10 Huang J,Qu HP,Zheng YF.The revised Atlanta criteria 2012 altered the classification,severity assessment and management of acute pancreatitis[J].Hepatobiliary Pancreat Dis Int,2016,15:310-315.
11唐伟,张小明,黄小华,等.磁共振成像评价急性胰腺炎的严重程度与肝功能的相关性研究[J].磁共振成像,2010,1:46-49.
12 Vriens PW,van de Linde P,Slotema ET,et al.Computed tomography severity index is an early prognostic tool for acute pancreatitis[J].JAm Coll Surg,2005,201:497-502.
13 Koutroumpakis E,Dasyam AK,Furlan A,et al.Isolated Peripancreatic Necrosis in Acute Pancreatitis Is Infrequent and Leads to Severe Clinical Course Only When Extensive:A Prospective Study From a US Tertiary Center[J].J Clin Gastroenterol,2016,50:589-595.
14 Sarr MG,Banks PA,Bollen TL,et al.The New Revised Classification of Acute Pancreatitis 2012[J].Surg Clin North Am,2013,93:549-62.
15严志汉,闵鹏秋,宋彬,等.急性胰腺炎累及肾旁后间隙与其临床严重程度及CT严重指数的相关性研究[J].中华放射学杂志,2005,39:375-378.
16 Florie J,Wasser MN,Arts-Cieslik K,et al.Dynamic contrast-enhanced MRI of the bowel wall for assessment of disease activity in Crohn's disease[J].AJR,2006,186:1384-1392.
17 Kim JH,Ha HK,Sohn MJ,et al.Usefulness of MR imaging for diseases of the small intestine:comparison with CT[J].Korean Journal of Radiology Official Journal of the Korean Radiological Society,2000,1:43-50.
18 Punwani S,Rodriguez-Justo M,Bainbridge A,et al.Mural inflammation in Crohn disease:location-matched histologic validation of MRimaging features[J].Radiology,2009,252:712-720.
19 Lee SL,Ku YM,Rha SE.Comprehensive reviews of the interfascial plane of the retroperitoneum:normal anatomy and pathologic entities[J].Emerg Radiol,2010,17:3-11.
20 Ou ZB,Miao CM,Ye MX,et al.Investigation for role of tissue factor and blood coagulation system in severe acute pancreatitis and associated liver injury[J].Biomedicine&pharmacotherapy=Biomedecine&pharmacotherapie,2016,10:380-388.
21 Blamey SL,Imrie CW,O'Neill J,et al.Prognostic factors in acute pancreatitis[J].Gut,1984,25:1340-1346.
22杨琦,李树钧,吴开春.急性胰腺炎合并肝损伤的研究进展[J].胃肠病学和肝病学杂志,2016,25:476-478.
23徐彦哲,丁佑铭,汪斌,等.急性胰腺炎肝损伤的研究进展[J].中华外科杂志,2015,21:284-288.
24 Dellinger EP,Forsmark CE,Layer P,et al.Determinant-basedclassification of acute pancreatitis severity:an internationalmultidisciplinary consultation[J].Ann Surg,2012,256:875-880.
25钱孝先,田尧,郑志存,等.磁共振成像在急性胰腺炎诊断中的价值[J].胃肠病学和肝病学杂志,2013,22:192-194.
26 Sharma V,Rana SS.Extrapancreatic Necrosis in Acute Pancreatitis[J].Journal of Clinical Gastroenterology,2017,51:89-89.
27 Bakker OJ,van Santvoort H,Besselink MG,et al.Extrapancreatic necrosis without pancreatic parenchymal necrosis:a separate entity in necrotising pancreatitis?[J].Gut,2013,62:1475-1480.
28 Wang M,Wei A,Guo Q,et al.Clinical outcomes of combined necrotizing pancreatitis versus extrapancreatic necrosis alone[J].Pancreatology,2016,16:57-65.
29潘华山,张小明,唐伟,等.急性胰腺炎累及肾周间隙的MRI研究[J].中国医学计算机成像杂志,2010,16:123-128.
30冀一帆.急性胰腺炎胃肠道改变的MRI研究[D].川北医学院,2013.
31 Wu LM,Sankaran SJ,Plank LD,et al.Meta-Analysis of Gut Barrier Dysfunction in Patients with Acute Pancreatitis.Brit J Surg,2014,101:1644-1656.