| 摘要: |
| 目的 评价胰周坏死体积（PNV）是否为预测急性胰腺炎严重程度的有用指标，同时比较PNV与现有临床评分系统及48 h-CRP对急性胰腺患者临床结局的预测价值。方法 回顾性分析2020年1月至2021年6月海军军医大学（第二军医大学）第一附属医院收治的急性胰腺炎患者的临床资料。使用Philips-IntelliSpace工作站手动测量PNV，计算各评分系统［急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）、改良Marshall、Ranson、急性胰腺炎严重程度床边指数（BISAP）、Balthazar、计算机断层扫描严重度指数（CTSI）评分]的得分。采用ROC曲线比较PVN与不同评分系统及48 h-CRP预测预后参数［器官功能不全、多脏器功能衰竭（MOF）、住院时间、入住ICU，以及住院期间的并发症、感染坏死、需要手术或介入干预情况]的效能。结果 共纳入150例急性胰腺炎患者，PNV手动测量值为20.0～1 517.5（539.5±413.4） cm3。PNV与住院时间呈正相关（相关系数为0.462，P＜0.05）。PVN预测感染、并发症、MOF、入住ICU、器官功能不全的AUC值（95% CI）分别为0.73（0.60～0.85）、0.72（0.57～0.88）、0.86（0.76～0.97）、0.90（0.82～0.98）、0.88（0.80～0.97），灵敏度分别为0.72、0.67、0.67、0.63、0.81，特异度分别为0.99、0.98、0.75、0.81、0.91。ROC曲线分析结果显示，与各评分系统及48 h-CRP相比，PNV是预测上述急性胰腺炎预后指标的最佳参数。结论 PNV可能成为预测急性胰腺炎严重程度的有用指标。 |
| 关键词: 急性胰腺炎 胰周坏死体积 预后 临床评分系统 |
| DOI：10.16781/j.CN31-2187/R.20230002 |
| 投稿时间：2023-01-02修订日期：2023-07-10 |
| 基金项目: |
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| Predictive value of peripancreatic necrosis volume for severity of acute pancreatitis |
| LIU Xiao,YU Hang* |
(Department of Emergency, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate whether peripancreatic necrosis volume (PNV) is a useful index for predicting the severity of acute pancreatitis (AP), and to compare the predictive value of PNV with the current clinical scoring system and 48 h-Creactive protein (48 h-CRP) for the clinical outcomes of patients with acute pancreatitis. Methods Clinical data of AP patients who were admitted to The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 2020 to Jun. 2021 were retrospectively analyzed. PNV was measured manually using Philips-IntelliSpace Portal. Scoring systems (acute physiological and chronic health evaluation Ⅱ [APACHE Ⅱ］, modified Marshall, Ranson, bedside index for severity of acute pancreatitis[BISAP］, Balthazar, and computed tomography severity index[CTSI］scores) were calculated. Receiver operating characteristic (ROC) curves were used to compare the efficacy of PNV with different scoring systems and 48 h-CRP in predicting prognostic parameters such as organ dysfunction, multiple organ failure (MOF), length of hospital stay, intensive care unit (ICU) stay, and complications during hospitalization, infection and necrosis, and requirement of surgery or intervention. Results A total of 150 AP patients were included, and the PNV (ranged from 20.0 to 1 517.5[539.5±413.4］cm3) was measured manually. PNV was positively correlated with the length of hospital stay (correlation coefficient was 0.462, P＜0.05). The area under curve values (95% confidence interval[CI］) of PNV in predicting infection, complications, MOF, ICU admission, and organ dysfunction were 0.73 (0.60-0.85), 0.72 (0.77-0.88), 0.86 (0.76-0.97), 0.90 (0.82-0.98), and 0.88 (0.80-0.97), the sensitivities were 0.72, 0.67, 0.67, 0.63, and 0.81, and the specificities were 0.99, 0.98, 0.75, 0.81, and 0.91, respectively. The analyses of the ROC curves showed that PNV was the best parameter to predict the prognosis of AP compared with the scoring systems or 48 h-CRP. Conclusion PNV may be useful in predicting the severity of AP. |
| Key words: acute pancreatitis peripancreatic necrosis volume prognosis clinical scoring system |
