重症急性胰腺炎患者感染时炎症指标值变化与螺旋CT影像学分析
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摘要
目的探讨重症急性胰腺炎(SAP)患者感染时白细胞计数(WBC)、红细胞(RBC)、降钙素原(PCT)、红细胞压积(HCT)变化与螺旋CT影像学表现,为SAP合并感染的治疗提供参考依据。方法收集2014年1月-2016年6月住院治疗SAP患者80例,根据确诊结果分为未感染组34例与感染组46例,比较患者入院时的血常规及螺旋CT检查结果。结果两组患者RBC水平比较差异无统计学意义;感染组WBC、PCT、HCT水平高于未感染组,差异有统计学意义(P<0.05);感染组螺旋CT诊断为SAP合并感染患者42例,诊断符合率为91.30%,未感染组螺旋CT诊断为SAP无感染患者30例,诊断符合率为88.24%,比较差异无统计学意义;感染组出现胰腺体积增大、胰腺脂肪层模糊不清及周围渗出、可见单个区域胰液潴留、可见多个区域胰液潴留、观察到气泡征、有片状坏死出现均高于未感染组(P<0.05)。结论 SAP合并感染时可出现WBC、PTC、HCT升高,螺旋CT下影像学可表现出胰腺体积增大伴有胰腺脂肪层模糊不清及周围渗出,多个区域胰液潴留、气泡征、片状坏死。
OBJECTIVE To discuss changes of WBC,RBC,PTC,HCT and imaging findings under spiral CT in infected patients with severe acute pancreatitis,so as to provide references for diagnosis and treatment of SAP combined infection.METHODS A total of 80 cases of patients with SAP from Jan.2014 to Jun.2016 treated in the hospital were collected,and were divided into uninfected group(34cases)and infection group(46cases).Routine blood and spiral CT examination results of the patients admitted to hospital were compared.RESULTS The difference of RBC levels of the two groups had no statistical significance.The WBC,PTC,and HCT levels of infection group were significantly higher than those of uninfection group(P<0.05).Totally 42 cases were diagnosed as coinfections with spiral CT in infection group,with the diagnostic coincidence rate of 91.30%,and 30 cases were diagnosed as co-infections with spiral CT in uninfected group,with the diagnostic coincidence rate of 88.24%,and the difference was not significant.The signs of pancreatic volume increasing,pancreatic fat layer blurring and peripheral leakage,single regional pancreatic juice retention,multiple regional pancreatic juice retention,air bubble sign,and flaky necrosis in infection group were all higher than those in uninfected group(P <0.05).CONCLUSION The incidence of WBC,PTC and HCT in SAP combined will increase.Spiral CT imaging can show pancreatic volume increasing accompanied by pancreatic fat layer blurring and peripheral leakage,multiple regional pancreatic juice retention,bubble sign,and flaky necrosis.
OBJECTIVE To discuss changes of WBC,RBC,PTC,HCT and imaging findings under spiral CT in infected patients with severe acute pancreatitis,so as to provide references for diagnosis and treatment of SAP combined infection.METHODS A total of 80 cases of patients with SAP from Jan.2014 to Jun.2016 treated in the hospital were collected,and were divided into uninfected group(34cases)and infection group(46cases).Routine blood and spiral CT examination results of the patients admitted to hospital were compared.RESULTS The difference of RBC levels of the two groups had no statistical significance.The WBC,PTC,and HCT levels of infection group were significantly higher than those of uninfection group(P<0.05).Totally 42 cases were diagnosed as coinfections with spiral CT in infection group,with the diagnostic coincidence rate of 91.30%,and 30 cases were diagnosed as co-infections with spiral CT in uninfected group,with the diagnostic coincidence rate of 88.24%,and the difference was not significant.The signs of pancreatic volume increasing,pancreatic fat layer blurring and peripheral leakage,single regional pancreatic juice retention,multiple regional pancreatic juice retention,air bubble sign,and flaky necrosis in infection group were all higher than those in uninfected group(P <0.05).CONCLUSION The incidence of WBC,PTC and HCT in SAP combined will increase.Spiral CT imaging can show pancreatic volume increasing accompanied by pancreatic fat layer blurring and peripheral leakage,multiple regional pancreatic juice retention,bubble sign,and flaky necrosis.
引文
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[12]Tsuji Y,Takahashi N,Fletcher JG,et al.Subtraction color map of contrast-enhanced and unenhanced CT for the prediction of pancreatic necrosis in early stage of acute pancreatitis[J].AJR Am J Roentgenol,2014,202(4):W349-356.
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[14]Sheu Y,Furlan A,Almusa O,et al.The revised Atlanta classification for acute pancreatitis:a CT imaging guide for radiologists[J].Emerg Radiol,2012,19(3):237-243.
[15]Dobbs NW,Budak MJ,Weir-McCall JR,et al.Acute pancreatitis:a comparison of intervention rates precipitated by early vs guideline CT scan timing[J].Clin Radiol,2016,71(10):993-996.
[2]Tenner S,Baillie J,DeWitt J,et al.American College of Gastroenterology guideline:management of acute pancreatitis[J].Am J Gastroenterol,2013,108(9):1400-1415.
[3]Tang D,Lotze M,Zeh HJ,et al.Targeting HMGB1in acute pancreatitis[J].Austin J Surg,2014,1(9):1045.
[4]Sun JK,Mu XW,Li WQ,et al.Effects of early enteral nutrition on immune function of severe acute pancreatitis patients[J].World J Gastroenterol,2013,19(6):917-922.
[5]Buddingh KT,Koudstaal LG,van Santvoort HC,et al.Early angiopoietin-2levels after onset predict the advent of severe pancreatitis,multiple organfailure,and infectious complications in patients with acute pancreatitis[J].J Am Coll Surg,2014,218(1):26-32.
[6]Zeng YB,Zhan XB,Guo XR,et al.Risk factors for pancreatic infection in patients with severe acute pancreatitis:an analysis of 163cases[J].J Dig Dis,2014,15(7):377-385.
[7]王春友,杨明.《急性胰腺炎诊治指南(2014)》解读-急性胰腺炎外科诊治现状与进展[J].中国实用外科杂志,2015,35(1):8-10.
[8]李凤舞,王红.急性坏死性胰腺炎感染期的诊断与治疗进展[J].临床和实验医学杂志,2013,12(10):812-815.
[9]李维勤,李宁,黎介寿.重症急性胰腺炎坏死感染的诊断与治疗实践[J].中国实用外科杂志,2009,29(12):976-978.
[10]Cardoso FS,Ricardo LB,Oliveira AM,et al.C-reactive protein prognostic accuracy in acute pancreatitis:timing of measurement and cutoff points[J].Eur J Gastroenterol Hepatol,2013,25(7):784-789.
[11]上官艳苹,焦宪法,牛杏果,等.重症胰腺炎患者感染期血清炎性因子的变化与对各器官的影响研究[J].中华医院感染学杂志,2016,26(2):357-359.
[12]Tsuji Y,Takahashi N,Fletcher JG,et al.Subtraction color map of contrast-enhanced and unenhanced CT for the prediction of pancreatic necrosis in early stage of acute pancreatitis[J].AJR Am J Roentgenol,2014,202(4):W349-356.
[13]Shinagare AB,Ip IK,Raja AS,et al.Use of CT and MRI in emergency department patients with acute pancreatitis[J].Abdom Imag,2015,40(2):272-277.
[14]Sheu Y,Furlan A,Almusa O,et al.The revised Atlanta classification for acute pancreatitis:a CT imaging guide for radiologists[J].Emerg Radiol,2012,19(3):237-243.
[15]Dobbs NW,Budak MJ,Weir-McCall JR,et al.Acute pancreatitis:a comparison of intervention rates precipitated by early vs guideline CT scan timing[J].Clin Radiol,2016,71(10):993-996.