CT评价系统联合血浆D-二聚体在重症急性胰腺炎预后评估中的作用  

The role of CT evaluation system combined with plasma D-dimer in the prognosis evaluation of severe acute pancreatitis

作　　者：刘玉霞 姚金磊 郭芸[2] 孙绍军[3] 魏秀春 LIU Yuxia;YAO Jinlei;GUO Yun;SUN Shaojun;WEI Xiuchun(Department of CT, Liaocheng Traditional Chinese Medicine Hospital, Liaocheng 252000, China;Department of CT, Liaocheng People’s Hospital, Liaocheng 252000, China;Department of Laboratory, Liaocheng People’s Hospital, Liaocheng 252000, China;Department of ICU, Liaocheng Traditional Chinese Medicine Hospital, Liaocheng 252000, China)

机构地区：[1]山东省聊城市中医医院CT室,山东聊城252000 [2]山东省聊城市人民医院CT室,山东聊城252000 [3]山东省聊城市人民医院检验科,山东聊城252000 [4]山东省聊城市中医医院ICU,山东聊城252000

出　　处：《医学影像学杂志》2022年第5期806-811,共6页Journal of Medical Imaging

摘　　要：目的探究CT评价系统联合血浆D-二聚体在重症急性胰腺炎(SAP)预后评估中的价值。方法选取2015年6月~2020年6月本院重症监护病房(intensive care unit,ICU)收治的116例SAP患者的临床资料。根据患者出ICU时的生存状况分为死亡组、生存组,分析改良CT严重指数(MCTSI)评分、D-二聚体对SAP患者ICU预后的影响及其联合预测价值。结果116例SAP患者ICU病死率26.72%(31/116)。死亡组患者年龄、年龄≥65岁占比、入院APACHEⅡ评分、MCTSI评分、血浆D-二聚体水平高于生存组,差异有统计学意义(P<0.05)。Logistic回归分析显示:年龄≥65岁(OR=3.414,95%CI=1.118~10.424)、MCTSI评分增高(OR=1.815,95%CI=1.265~2.606)、血浆D-二聚体水平增高(OR=2.709,95%CI=1.493~4.917)、APACHEⅡ评分增高(OR=1.109,95%CI=1.008~1.220)是SAP患者ICU死亡的危险因素(P<0.05)。ROC曲线分析显示:MCTSI评分、D-二聚体、APACHEⅡ评分预测SAP患者ICU预后的最佳临界值依次为7分、3.61 mg/L、29.5分,有一定预测准确性(AUC=0.748、0.757、0.705,均>0.7);而MCTSI评分+D-二聚体预测的AUC最高(AUC=0.861,95%CI=0.782~0.939,P<0.05);且MCTSI评分+D-二聚体预测敏感度(93.5%)高于APACHEⅡ评分+D-二聚体(74.2%)(χ^(2)=4.292,P<0.05)。结论CT评价系统中的MCTSI评分与血浆D-二聚体、APACHEⅡ评分、年龄共同影响SAP患者ICU预后,且MCTSI评分联合血浆D-二聚体对患者ICU预后具有一定预测价值,预测敏感度高于APACHEⅡ评分联合D-二聚体。Objective To explore the value of CT evaluation system combined with plasma D-dimer in the prognosis assessment of severe acute pancreatitis(SAP).Methods The clinical data of 116 SAP patients admitted to the intensive care unit(ICU)of our hospital from June 2015 to June 2020 were retrospectively analyzed.The patients were divided into death group and survival group according to their survival status at the time of leaving the ICU.The modified CT severity index(MCTSI)score,the effect of D-dimer on the prognosis of SAP patients in ICU and the combined predictive value were analyzed.Results The ICU mortality rate of 116 SAP patients was 26.72%(31/116).The age of patients in the death group,the proportion of patients aged≥65 years,the admission APACHEⅡscore,MCTSI score,and plasma D-dimer levels were higher than those in the survival group,and the difference was statistically significant(P<0.05).Logistic regression analysis showed as follous age≥65 years(OR=3.414,95%CI=1.118~10.424),the increased MCTSI score(OR=1.815,95%CI=1.265~2.606),the increased plasma D-dimer level(OR=2.709,95%CI=1.493~4.917)and increased APACHEⅡscore(OR=1.109,95%CI=1.008~1.220)were risk factors for ICU death in SAP patients(P<0.05).ROC curve analysis showed that the best cut-off values for predicting the ICU prognosis of SAP patients with MCTSI score,D-dimer and APACHEⅡscore were 7 points,3.61 mg/L,and 29.5 points,with certain prediction accuracy(AUC=0.748,0.757,0.705,both>0.7);The MCTSI score+D-dimer predicted the highest AUC(AUC=0.861,95%CI=0.782~0.939,P<0.05);And the prediction sensitivity of MCTSI-score+D-di-mer(93.5%)was higher than APACHEⅡscore+D-dimer(74.2%)(χ^(2)=4.292,P<0.05).ConclusionThe MCTSI score in the CT evaluation system,plasma D-dimer,APACHEⅡscore,and age together affect the prognosis of SAP patients in ICU,and the combination of MCTSI score and plasma D-dimer have a certain predictive value for the prognosis of patients in ICU,and predict sensitivity higher than APACHEⅡscore combined with D-dimer.

关 键 词：重症急性胰腺炎 体层摄影术 X线计算机 D-二聚体 预后 预测 

分 类 号：R576[医药卫生—消化系统] R814.42[医药卫生—内科学]