胸腹并发症CT征象、血钙、血清C反应蛋白对急性胰腺炎患者病情严重程度的评估价值

李嫚华; 张文; 向晓辉; 许威; 夏时海

doi:10.3969/j.issn.1001-5256.2019.08.023

胸腹并发症CT征象、血钙、血清C反应蛋白对急性胰腺炎患者病情严重程度的评估价值

DOI: 10.3969/j.issn.1001-5256.2019.08.023

天津市西青医院消化内科
中国人民武装警察部队特色医学中心消化二科

基金项目:

武警后勤学院附属医院种子基金重点项目(FYZ201508)；国家自然科学基金资助项目(81500489)；天津市自然科学基金联合资助青年项目(15JCQNJC45600)；

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中图分类号: R576
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出版历程
- 收稿日期: 2019-04-09
- 出版日期: 2019-08-20

Role of CT signs of thoracoabdominal complications, serum calcium, and serum C-reactive protein in evaluating disease severity in patients with acute pancreatitis

Department of Gastroenterology, Tianjin Xiqing Hospital

Research funding:

摘要

摘要: 目的探讨胸腹部CT征象和血钙、血清C反应蛋白（CRP）在急性胰腺炎（AP）患者病情严重程度评估中的作用。方法回顾性分析2017年12月-2018年12月在武警特色医学中心接受治疗的95例AP患者的胸腹部CT及血液检查结果,将患者分为重症急性胰腺炎（SAP,n=13）组和轻症急性胰腺炎（MAP,n=82）组。分析胸腹并发症CT征象、血钙、血清C反应蛋白与AP病情严重程度的相关性。符合正态分布的计量资料组间比较采用t检验;不满足正态分布的组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验。采用多因素二分类logistic回归分析AP患者严重程度的独立危险因素;指标对疾病严重程度预测有效性的评价采用受试者工作特征曲线（ROC曲线）分析。结果与MAP组比较,SAP组患者发生腹水、肺炎、胸水的概率显著高于MAP组（χ2值分别为8. 561、8. 120、9. 750,P值均<0. 05）,腹膜炎发生率差异无统计学意义（P> 0. 05）。SAP组患者血清CRP水平（Z=19. 16）、住院天数（t=3. 97）较MAP组显著升高,血钙（t=4. 21）水平显著...
- 胰腺炎 /
- C反应蛋白质 /
- 钙 /
- CT征象
Abstract: Objective To investigate the role of CT signs of thoracoabdominal complications, serum calcium, and serum C-reactive protein (CRP) in evaluating disease severity in patients with acute pancreatitis (AP) . Methods A retrospective analysis was performed for the results of thoracoabdominal CT and blood examination of 95 patients with AP who were treated in Characteristic Medical Center of Chinese People's Armed Police Force from December 2017 to December 2018. The patients were divided into severe AP (SAP) group with 13 patients and mild AP (MAP) group with 82 patients. The association of CT signs of thoracoabdominal complications, serum calcium, and serum CRP with the severity of AP was analyzed. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A logistic regression model was established based on the combination of related indices, and predicted probability was used as a new index for analysis; the receiver operator characteristic (ROC) curve was used to evaluate the effectiveness of each index in predicting disease severity. Results Compared with the MAP group, the SAP group had significantly higher incidence rates of ascites, pneumonia, and pleural effusion (χ2= 8. 561, 8. 120, and 9. 750, all P < 0. 05) , while there was no significant difference in the incidence rate of peritonitis between the two groups (P > 0. 05) . Compared with the MAP group, the SAP group had a significantly higher serum level of CRP (Z = 19. 16, P < 0. 05) , a significantly longer length of hospital stay (t = 3. 97, P < 0. 05) , and a significantly lower level of blood calcium (t = 4. 21, P < 0. 05) . The logistic regression analysis showed that ascites (odds ratio [OR] =4. 992, 95% confidence interval [CI]: 2. 087-6. 543, P = 0. 012) , pneumonia (OR = 1. 273, 95% CI: 1. 013-1. 520, P = 0. 042) , and pleural effusion (OR = 3. 521, 95% CI: 1. 080-4. 691, P = 0. 022) were independent risk factors for SAP, while peritonitis (OR =1. 007, 95% CI: 0. 990-1. 175, P = 0. 156) was not an independent risk factor. The ROC curve analysis showed that in the evaluation of disease severity, peritonitis, ascites, pneumonia, and pleural effusion had an area under the ROC curve (AUC) of 0. 635, 0. 738, 0. 714, and 0. 710, respectively, and the number of these CT signs had an AUC of 0. 807; serum calcium and CRP had an AUC of 0. 789 and0. 835, respectively, and serum calcium and CRP combined with the number of CT signs had an AUC of 0. 901. Conclusion Serum calcium and CRP combined with the number of thoracoabdominal CT signs (peritonitis, ascites, pneumonia, and pleural effusion) have high specificity, sensitivity, and accuracy in predicting disease severity in patients with AP, and therefore, it has a high clinical value and holds promise for clinical application.
- pancreatitis /
- C-reactive protein /
- calcium /
- CT signs

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参考文献(20)

[1] van DIJK SM, NDL H, SANTVOORT HC, et al. Acute pancreatitis:Recent advances through randomised trials[J]. Gut, 2017, 66 (11) :2024-2032.

[2] STIRLING AD, MORAN NR, KELLY ME, et al. The predictive value of C-reactive protein (CRP) in acute pancreatitis-is interval change in CRP an additional indicator of severity[J].HPB (Oxford) , 2017, 19 (10) :874-880.

[3] BIERMA MJ, COFFEY MJ, NIGHTINGALE S, et al. Predicting severe acute pancreatitis in children based on serum lipase and calcium:A multicentre retrospective cohort study[J].Pancreatology, 2016, 16 (4) :529-534.

[4] Pancreas Study Group, Chinese Society of Gastroenterology, Chinese Medical Association, Editorial Board of Chinese Journal of Pancreatology, Editorial Board of Chinese Journal of Digestion. Chinese guidelines for the management of acute pancreatitis (Shanghai, 2013) [J]. J Clin Hepatol, 2013, 13 (9) :656-660. (in Chinese) 中华医学会消化病学分会胰腺疾病学组, 《中华胰腺病杂志》编辑委员会, 《中华消化杂志》编辑委员会.中国急性胰腺炎诊治指南 (2013年, 上海) [J].临床肝胆病杂志, 2013, 13 (9) :656-660.

[5] CHEN Y, LI XQ. An excerpt of International Consensus Statements on early chronic pancreatitis (2018) [J]. J Clin Hepatol, 2018, 34 (8) :1639-1643. (in Chinese) 陈洋, 李晓青.《2018年早期慢性胰腺炎国际共识声明》摘译[J].临床肝胆病杂志, 2018, 34 (8) :1639-1643.

[6] PENG T, PENG X, HUANG M, et al. Serum calcium as an indicator of persistent organ failure in acute pancreatitis[J]. Am J Emerg Med, 2017, 35 (7) :978-982.

[7] LIU B, LI D, HU X, et al. The predictive value of serum calcium for acute pancreatitis with persistent organ failure[J]. Am J Emerg Med, 2018, 36 (4) :726-727.

[8] SEJ H, MADSEN CM, VARBO A, et al. Low-grade inflammation in the association between mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis:A study of more than 115000 individuals from the general population[J]. Clin Chem, 2019, 65 (2) :321-332.

[9] SHI R, ZHOU Q, FANG R, et al. Severe acute pancreatitis with blood infection by Candida glabrata complicated severe agranulocytosis:A case report[J]. BMC Infect Dis, 2018, 18 (1) :706.

[10] VASUDEVAN S, GOSWAMI P, SONIKA U, et al. Comparison of various scoring systems and biochemical markers in predicting the outcome in acute pancreatitis[J]. Pancreas, 2018, 47 (1) :65-71.

[11] STAUBLI SM, OERTLI D, NEBIKER CA. Laboratory markers predicting severity of acute pancreatitis[J]. Crit Rev Clin Lab Sci, 2015, 52 (6) :273-283.

[12] ZHAO ZQ, XI Z, YAN PF. Clinical value of combined detection of amylase, lipase and procalcitonin in the diagnosis of children with acute pancreatitis[J]. Chin J Clin Pharmacol Ther, 2017, 22 (11) :1265-1268. (in Chinese) 赵志强, 席錾, 闫鹏飞.血清脂肪酶、血清淀粉酶与血清降钙素原在儿童急性胰腺炎诊断中的意义[J].中国临床药理学与治疗学, 2017, 22 (11) :1265-1268.

[13] ZAFRIR B, SALIBA W, JUBRAN A, et al. Severe hypertriglyceridemia-related pancreatitis:Characteristics and predictors of recurrence[J]. Pancreas, 2019, 48 (2) :182-186.

[14] YEN HH, HO TW, WU CH, et al. Late acute pancreatitis after pancreaticoduodenectomy:Incidence, outcome, and risk factors[J]. J Hepatobiliary Pancreat Sci, 2019, 26 (3) :109-116.

[15] RANA SS, SHARMA V, SHARMA RK, et al. Clinical significance of presence and extent of extrapancreatic necrosis in acute pancreatitis[J]. J Gastroenterol Hepatol, 2015, 30 (4) :794-798.

[16] AVANESOV M, LOSER A, KELLER S, et al. Diagnosing acute pancreatitis-Clinical and radiological characterisation of patients without threefold increase of serum lipase[J]. Eur J Radiol, 2017, 95:278-285.

[17] PEREZ S, PEREDA J, SABATER L, et al. Pancreatic ascites hemoglobin contributes to the systemic response in acute pancreatitis[J]. Free Radic Biol Med, 2015, 81:145-155.

[18] JAKKA A, JANGALA R, REDDY R, et al. Acinar injury and early cytokine response in human acute biliary pancreatitis[J]. Sci Rep, 2017, 7 (1) :15276.

[19] VENTRE C, NOWELL S, GRAHAM C, et al. Survival and new-onset morbidity after critical care admission for acute pancreatitis in Scotland:A national electronic healthcare record linkage cohort study[J]. BMJ Open, 2018, 8 (12) :e023853.

[20] de OLIVEIRA C, KHATUA B, BAG A, et al. Multimodal transgastric local pancreatic hypothermia reduces severity of acute pancreatitis in rats and increases survival[J]. Gastroenterology, 2019, 156 (3) :735-747. e10.

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