CT评分联合CRP检测评估重症急性胰腺炎的预后价值分析  

Analysis of Value of CT Score Combined with CRP Detection in the Evaluation of Prognosis of Severe Acute Pancreatitis

作　　者：高亚洲[1] 徐之超[1] 殷国志[2] GAO Ya-zhou;XU Zhi-chao;YIN Guo-zhi(Department of Emergency,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,shaanxi Province,China;Department of Hepatobiliary surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,shaanxi Province,China)

机构地区：[1]西安交通大学第一附属医院急诊科,陕西西安710061 [2]西安交通大学第一附属医院肝胆外科,陕西西安710061

出　　处：《中国CT和MRI杂志》2022年第1期122-124,共3页Chinese Journal of CT and MRI

摘　　要：目的研究Balthazar CT严重指数(CTSI)及血清C反应蛋白(CRP)水平检测评估重症急性胰腺炎(SAP)患者病情严重程度和预后的临床价值。方法回顾性分析2014年1月至2019年9月我院SAP患者147例临床资料并根据预后情况将患者分为存活组(n=121)和死亡组(n=26),比较两组CTSI评分和血清CRP水平,采用ROC曲线分析CTSI和CRP对SAP患者预后情况评估效果,分析两者最佳界值联合预测SAP患者死亡率的准确性。结果SAP患者CT平扫可见局限性或弥漫性低密度坏死区和包膜组织水肿,胰周可见胰液渗出和周围组织炎症反应,增强扫描正常胰腺组织可明显强化并与坏死区构成鲜明对比;CTSI严重程度分级为1级19例,2级83例,3级45例;存活组患者CTSI评分及血清CRP水平低于死亡组,差异有统计学意义(P<0.05);ROC曲线分析结果显示CTSI和CRP对SAP患者死亡率预测AUC分别为0.643(95%CI:0.560~0.720)和0.755(95%CI:0.677~822);采用CTSI和CRP最佳临界值对SAP患者预后情况进行联合评估,结果显示其灵敏度为88.46%,特异度为85.95%,准确度为86.39%,一致性Kappa值为0.614。结论CTSI评分和血清CRP水平均是评估SAP患者病情严重程度和预后情况的有效方法,且两者联合应用可明显提升预测患者死亡率的准确性。Objective To study the clinical value of Balthazar CT severity index(CTSI)and serum C-reactive protein(CRP)level in the evaluation of disease severity and prognosis in patients with severe acute pancreatitis(SAP).Methods The clinical data of 147 SAP patients in our hospital from January 2014 to September 2019 were retrospectively analyzed.The patients were divided into survival group(n=121)and death group(n=26)according to the prognosis.The CTSI score and serum CRP level were compared between the two groups.ROC curve was used to analyze the evaluated effects of CTSI and CRP on the prognosis of SAP patients,and the accuracy of optimal cut-off values of the two combination was analyzed in the prediction of mortality of SAP patients.Results The plain CT scan of SAP patients showed localized or diffuse low-density necrosis and capsular tissue edema and pancreatic juice exudation and surrounding tissue inflammatory response in peripancreatic part.Enhanced scan for normal pancreatic tissue showed significant enhancement and contrasted with the necrotic area.The CTSI severity grading showed 19 cases of grade 1,83 cases of grade 2 and 45 cases of grade 3.The CTSI score and serum CRP level in survival group were lower than those in death group(P<0.05).The ROC curve analysis showed the AUC values of CTSI and CRP for mortality of SAP patients were 0.643(95%CI:0.560-0.720)and 0.755(95%CI:0.677-822)respectively.The combined use of optimal cut-off values of CTSI and CRP for the prognosis of SAP patients showed that the sensitivity,specificity,accuracy and consistency Kappa value were 88.46%%,85.95%,86.39%and 0.614.Conclusion CTSI score and serum CRP level are effective methods to evaluate the disease severity and prognosis of SAP patients,and the combination of the two can significantly improve the accuracy of predicting mortality of patients.

关 键 词：重症急性胰腺炎 CT评分 C反应蛋白 预后评估 

分 类 号：R445.3[医药卫生—影像医学与核医学] R657.51[医药卫生—诊断学]