急性胰腺炎局部并发症对上腹部多脏器微循环影响的初步研究  

Preliminary study on the effects of local complications of acute pancreatitis on microcirculation of multiple organs in the upper abdomen

作　　者：张仕勇 李洁[1] 兰茜琳 邹庆[1] 张海兵[1] 刘婷[1] 邓鸿义 郭开灿 宋思思[1] 明兵[1] Zhang Shiyong;Li Jie;Lan Xilin;Zou Qing;Zhang Haibing;Liu Ting;Deng Hongyi;Guo Kaican;Song Sisi;Ming Bing(Department of Radiology, People′s Hospital of Deyang City, Deyang 618000, China)

机构地区：[1]德阳市人民医院放射科,618000

出　　处：《中华消化杂志》2020年第6期387-392,共6页Chinese Journal of Digestion

基　　金：2017四川省医学科研课题(S17031);2019德阳市科技计划项目(2019SZ049)。

摘　　要：目的研究急性胰腺炎(AP)不同局部并发症对上腹部多脏器微循环的影响。方法前瞻性地对101例于2019年4月1日至10月31日在德阳市人民医院确诊的AP患者和24例无AP且无明显上腹部病变的患者行上腹部动态容积灌注CT成像检查。86例AP患者(AP组)和21例对照者(对照组)最终纳入研究,AP组分为无局部并发症(21例)、急性液体积聚(APFC,19例)、急性坏死性积聚(ANC,27例)、包裹性坏死(WON,11例)和包裹性坏死伴感染(WONI,8例)组。采用去卷积法测量各组胰腺、肝脏、脾脏、双肾和肾上腺的血流量,采用基于最大斜率法的肝脏模型测量各组肝动脉灌注(HAP)、门静脉灌注(HPP)和动脉灌注指数(HPI)。统计学方法采用t检验。结果ANC组胰腺、脾脏、左肾上腺的血流量分别为(139.89±34.28)、(141.42±47.85)、(107.87±26.41)mL·min-1·(100 g)-1,WON组胰腺、脾脏、左肾上腺的血流量分别为(130.00±44.83)、(106.12±38.16)、(98.38±41.39)mL·min-1·(100 g)-1,WONI组胰腺、脾脏、左肾上腺的血流量分别为(127.91±35.86)、(102.09±23.73)、(105.66±27.01)mL·min-1·(100 g)-1,均低于对照组的(161.22±31.60)、(174.00±62.73)、(134.53±36.36)mL·min-1·(100 g)-1,差异均有统计学意义(t=2.440、2.043、2.943,2.296、3.796、2.548,2.448、4.479、2.154;P均<0.05)。WONI组左肾皮质血流量低于对照组[(247.44±39.32)mL·min-1·(100 g)-1比(294.80±39.13)mL·min-1·(100 g)-1],差异有统计学意义(t=2.910,P<0.05)。ANC、WON、WONI组的HAP分别为(18.63±9.54)、(19.10±7.47)、(19.51±6.26)mL·min-1·(100 g)-1,HPI分别为(25.01±15.51)%、(45.98±31.42)%、(35.92±24.95)%,均高于对照组的(12.18±5.14)mL·min-1·(100 g)-1和(13.44±6.49)%,差异均有统计学意义(t=2.997、3.088、3.235,3.503、3.397、2.517;P均<0.05)。ANC、WON、WONI组的HPP分别为(72.37±21.76)、(48.83±35.10)、(57.55±29.45)mL·min-1·(100 g)-1,均低于对照组的(86.43±17.98)mL·min-1·(100 g)-1,差异均有统计学意义(t=2Objective To investigate the effects of different local complications of acute pancreatitis(AP)on the microcirculation of multiple organs in the upper abdomen.Methods A dynamic volume perfusion computed tomography(DVPCT)scan in the upper abdomen was prospectively conducted in 101 patients with AP and 24 patients with neither AP nor other obvious upper abnominal lesions diagnosed in People′s Hospital of Deyang City from April 1 to October 31,2019,86 patients with AP(AP group)and 21 controls(control group)were enrolled in the study.AP patients were divided into no local complications group(21 cases),acute peripancreatic fluid collection(APFC)group(19 cases),acute necrotic collection(ANC)group(27 cases),walled-off necrosis(WON)group(11 cases)and walled-off necrosis with infection(WONI)group(8 cases).The blood flow(BF)of pancreas,liver,spleen,two kidneys and adrenal glands was measured by deconvolution.The hepatic arterial perfusion(HAP),hepatic portal perfusion(HPP)and hepatic perfusion index(HPI)of each group were calculated by maximum slope.T test was used for statistical analysis.Results The BF of pancreas,spleen and left adrenal gland of ANC group was(139.89±34.28),(141.42±47.85)and(107.87±26.41)mL·min-1·(100 g)-1,respectively,the BF of pancreas,spleen and left adrenal gland of WON group was(130.00±44.83),(106.12±38.16)and(98.38±41.39)mL·min-1·(100 g)-1 respectively,and the BF of pancreas,spleen and left adrenal gland of WONI group was(127.91±35.86),(102.09±23.73)and(105.66±27.01)mL·min-1·(100 g)-1,respectively,which were all lower than those of control group((161.22±31.60),(174.00±62.73)and(134.53±36.36)mL·min-1·(100 g)-1),and the differences were statistically significant(t=2.440,2.043,2.943;2.296,3.796,2.548;2.448,4.479,2.154;all P<0.05).The BF of left kidney cortex of WONI group was lower than that of control group((247.44±39.32)mL·min-1·(100 g)-1 vs.(294.80±39.13)mL·min-1·(100 g)-1),and the difference were statistically significant(t=2.910,P<0.05).The HAP of ANC group,WON group a

关 键 词：动态容积灌注 血流量 急性胰腺炎 局部并发症 

分 类 号：R576[医药卫生—消化系统]