CT评价系统联合D-二聚体对重症急性胰腺炎早期预后评估的作用
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摘要
目的观察重症急性胰腺炎(SAP)患者早期Balthazar CT分级、改良CT严重指数(MCTSI)评分、血浆D-二聚体水平与预后之间的关系,进一步探讨联合诊断对SAP早期预后评估的临床价值。方法收集2014年1月至2016年12月73例SAP患者的临床资料。分析24 h血浆D-二聚体水平及48 h腹部CT检查结果。应用Balthazar CT分级、MCTSI评分和D-二聚体水平绘制受试者工作特征曲线(ROC),通过计算曲线下面积(AUC)来比较三者判断SAP预后的价值。结果 Balthazar CT分级的AUC值为0.722(95%CI:0.560-0.884),MCTSI的AUC值为0.694(95%CI:0.515-0.872),D-二聚体的AUC值为0.760(95%CI:0.616-0.905),三者均可预测SAP死亡的发生。D-二聚体与CT评价系统的相关性分析显示,CT分级高的患者血浆D-二聚体水平显著高于CT分级低的患者,差异具有统计学意义(P<0.05);MCTSI评分高的患者血浆D-二聚体水平显著高于MCTSI评分低的患者,差异具有统计学意义(P<0.05)。结论早期应用CT评价系统联合D-二聚体水平有助于判断重症急性胰腺炎患者不良预后。
Objective To observe the relationship between Balthazar CT grading, modified CT severity index(MCTSI) score, plasma D-dimer level and prognosis in early stage of severe acute pancreatitis(SAP) patients, and to further explore the clinical value of combined diagnosis and early stage prognosis assessment of SAP. Methods General datas of 73 SAP patients admitted and treated in the second hospital of Dalian Medical University from January 2014 to December 2016 were retrospectively analyzed. Plasma D-dimer and abdominal CT examination were detected for 24 h and 48 h respectively.The ROC was plotted using Balthazar CT grading, MCTSI score and D-dimer level, and the area under the curve(AUC) was calculated to compare the prognostic value of the three for SAP. Results The AUC value of Balthazar CT grading was 0.722(95% CI: 0.560-0.884), the AUC value of MCTSI was 0.694(95% CI: 0.515-0.872), and the AUC value of D-dimer was 0.760(95% CI: 0.616-0.905), all of which could predict the occurrence of SAP death.To Further study on the correlation between D-dimer and CT evaluation system showed that the plasma D-dimer level of patients with high CT grade was significantly higher than that of patients with low CT grade, and the difference was statistically significant(P<0.05).The plasma D-dimer level of patients with high MCTSI score was significantly higher than that of patients with low MCTSI score, and the difference was statistically significant(P<0.05). Conclusion Early application of CT evaluation system combined with D-dimer level can help to evaluate the poor prognosis of patients with severe acute pancreatitis.
Objective To observe the relationship between Balthazar CT grading, modified CT severity index(MCTSI) score, plasma D-dimer level and prognosis in early stage of severe acute pancreatitis(SAP) patients, and to further explore the clinical value of combined diagnosis and early stage prognosis assessment of SAP. Methods General datas of 73 SAP patients admitted and treated in the second hospital of Dalian Medical University from January 2014 to December 2016 were retrospectively analyzed. Plasma D-dimer and abdominal CT examination were detected for 24 h and 48 h respectively.The ROC was plotted using Balthazar CT grading, MCTSI score and D-dimer level, and the area under the curve(AUC) was calculated to compare the prognostic value of the three for SAP. Results The AUC value of Balthazar CT grading was 0.722(95% CI: 0.560-0.884), the AUC value of MCTSI was 0.694(95% CI: 0.515-0.872), and the AUC value of D-dimer was 0.760(95% CI: 0.616-0.905), all of which could predict the occurrence of SAP death.To Further study on the correlation between D-dimer and CT evaluation system showed that the plasma D-dimer level of patients with high CT grade was significantly higher than that of patients with low CT grade, and the difference was statistically significant(P<0.05).The plasma D-dimer level of patients with high MCTSI score was significantly higher than that of patients with low MCTSI score, and the difference was statistically significant(P<0.05). Conclusion Early application of CT evaluation system combined with D-dimer level can help to evaluate the poor prognosis of patients with severe acute pancreatitis.
引文
[1] 中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南[J].中华普通外科杂志,2015,35(1):69-72.
[2] Otsuki M, Takeda K, Matsuno S, et al. Criteria for the diagnosis and severity stratification of acute pancreatitis[J]. World J Gastroenterol, 2013, 19(35): 5798-5805.
[3] Balthazar EJ, Ranson JH, Naidich DP, et al. Acute pancreatitis: prognostic value of CT[J]. Radiology, 1985, 156(3): 767-772.
[4] Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis[J]. Radiology,1990, 174(2):331-336.
[5] Mortele KJ, Mergo PJ, Taylor HM, et al. Renal and perirenal space involvement in acute pancreatitis: spiral CT findings[J]. BMJ Open,2000,4(8):e004721.
[6] Van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome[J]. Gastroenterology, 2011, 141(4):1254-1263.
[7] Zuidema MJ, van Santvoort HC, Besselink MG, et al. The predictive value of proteinuria in acute pancreatitis[J]. Pancreatology, 2014, 14(6):484-489.
[8] Steensma EA, Napolitano LM. Necrotizing pancreatitis: new definitions and a new era in surgical management[J]. Surg Infect (Larchmt), 2015, 16(1):1-13.
[9] Poxleitner PJ, Seifert G, Richter SC, et al. Infected pan-creatic necrosis increases the severity of experimental necrotizing pancreatitis in mice[J]. Pancreas, 2013, 42(7):1150-1156.
[10] Yao J, Lv G. Association between red cell distribution width and acute pancreatitis: A cross-sectional study[J]. BMJ Open, 2014, 4(8):e004721.
[11] 李绍军,孙世杰,张翠生,等. 重症急性胰腺炎并弥散性血管内凝血四例临床分析[J].中华胰腺病杂志,2013,13(6):405-406.
[12] Kong H, Ding Z, Zhu XC, et al. D-dimer change in human acute pancreatitis as detemined by serum yceride [J]. Pancreas, 2011, 40(7):1103-1106.
[13] Radenkovie D, Bajee D, Ivancevie N, et al. D-dimerin acute pancreatitis: a new approach for an early assessment of organ failure[J]. Pancreas, 2009, 38(6):655-660.
[14] Boskovic A, Pasic S, Soldatovic I, et al. The role of D-dimer in prediction of the course and outcome in pediatric acute pancreatitis[J]. Pancreatology, 2014, 14(5):330-334.
[15] 邓会标,朱涛,周道扬.D-二聚体对重症急性胰腺炎预后预测的价值[J].全科医学临床与教育,2015,13(6):626-629.
[2] Otsuki M, Takeda K, Matsuno S, et al. Criteria for the diagnosis and severity stratification of acute pancreatitis[J]. World J Gastroenterol, 2013, 19(35): 5798-5805.
[3] Balthazar EJ, Ranson JH, Naidich DP, et al. Acute pancreatitis: prognostic value of CT[J]. Radiology, 1985, 156(3): 767-772.
[4] Balthazar EJ, Robinson DL, Megibow AJ, et al. Acute pancreatitis: value of CT in establishing prognosis[J]. Radiology,1990, 174(2):331-336.
[5] Mortele KJ, Mergo PJ, Taylor HM, et al. Renal and perirenal space involvement in acute pancreatitis: spiral CT findings[J]. BMJ Open,2000,4(8):e004721.
[6] Van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome[J]. Gastroenterology, 2011, 141(4):1254-1263.
[7] Zuidema MJ, van Santvoort HC, Besselink MG, et al. The predictive value of proteinuria in acute pancreatitis[J]. Pancreatology, 2014, 14(6):484-489.
[8] Steensma EA, Napolitano LM. Necrotizing pancreatitis: new definitions and a new era in surgical management[J]. Surg Infect (Larchmt), 2015, 16(1):1-13.
[9] Poxleitner PJ, Seifert G, Richter SC, et al. Infected pan-creatic necrosis increases the severity of experimental necrotizing pancreatitis in mice[J]. Pancreas, 2013, 42(7):1150-1156.
[10] Yao J, Lv G. Association between red cell distribution width and acute pancreatitis: A cross-sectional study[J]. BMJ Open, 2014, 4(8):e004721.
[11] 李绍军,孙世杰,张翠生,等. 重症急性胰腺炎并弥散性血管内凝血四例临床分析[J].中华胰腺病杂志,2013,13(6):405-406.
[12] Kong H, Ding Z, Zhu XC, et al. D-dimer change in human acute pancreatitis as detemined by serum yceride [J]. Pancreas, 2011, 40(7):1103-1106.
[13] Radenkovie D, Bajee D, Ivancevie N, et al. D-dimerin acute pancreatitis: a new approach for an early assessment of organ failure[J]. Pancreas, 2009, 38(6):655-660.
[14] Boskovic A, Pasic S, Soldatovic I, et al. The role of D-dimer in prediction of the course and outcome in pediatric acute pancreatitis[J]. Pancreatology, 2014, 14(5):330-334.
[15] 邓会标,朱涛,周道扬.D-二聚体对重症急性胰腺炎预后预测的价值[J].全科医学临床与教育,2015,13(6):626-629.