基于CT和病程分期评估感染性胰腺坏死的临床和预后特征  

Evaluation of Clinical and Prognostic Features of Infectious Pa ncreatic Necrosis Based on CT and Stages of Acute Pancreatitis

作　　者：宋宇 张鹏 杨利 许尚文 肖慧 SONG Yu;ZHANG Peng;YANG Li;XU Shang-wen;XIAO Hui(Department of Diagnostic Radiology,Dongfang Hospital Affiliated to Xiamen University(the 900th Hospital of the Joint Service Support Force),Fuzhou 350025,Fujian Province,China)

机构地区：[1]厦门大学附属东方医院(联勤保障部队第九〇〇医院)放射诊断科,福建福州350025

出　　处：《中国CT和MRI杂志》2023年第5期133-135,共3页Chinese Journal of CT and MRI

基　　金：福建省科技厅社会发展引导性(重点)项目(2018Y0069)。

摘　　要：感染性胰腺坏死(Infected pancreatic necrosis,IPN)又称胰腺坏死继发感染,对急性胰腺炎(Acute pancreatitis,AP)预后有直接影响,通常发生在急性胰腺炎发病2周后也就是病程后期,但也可出现在病程早期。当前,对急性胰腺炎病程后期IPN认识相对深入,而对早期IPN的认识较少,尤其是早期IPN的CT影像学特征和诊断价值上缺乏研究。目的 探讨基于CT和病程分期评估IPN的临床特征和预后特点。方法 回顾性分析2019年1月至2022年4月联勤保障部队第九〇〇医院收治的92例继发IPN的AP患者的临床资料和影像学资料,IPN诊断依靠CT图像存在“气泡征”,根据IPN发生于AP病程分期中的具体阶段,划分为早期(AP发病2周内)和后期(AP发病2周后)IPN组。对比2组年龄、性别、病因、坏死类型、持续性器官功能衰竭、多器官功能衰竭发生情况、重症监护病房(ICU)入住率、 ICU滞留时间、有创干预率和病死率。结果 本组92例IPN中,28例(30.4%)发生于AP病程早期、64例(69.6%)发生于AP病程后期。CT影像学上,早期IPN主要表现为急性坏死物积聚(ANC)合并“气泡征”,后期IPN主要表现为包裹性坏死(WON)合并“气泡征”。早期IPN患者发生持续性器官功能衰竭(64.3%vs.39.1%,χ^(2)=4.978,P=0.026)和多器官功能衰竭(53.6%vs.31.3%,χ^(2)=4.117,P=0,042)的比例较高,ICU住院时间(18.5±5.4 d vs.15.7±4.7d,t=2.511,P=0.014)较长,病死率(53.6%vs.21.9%,χ^(2)=9.066,P=0.003)较高,均具有显著性差异(P<0.05)。2组性别、年龄、ICU入住率、有创干预率等其他指标未见显著性差异(P>0.05)。结论 基于CT和病程分期对IPN进行诊断和分型评估具有临床指导意义,早期IPN更容易导致病情危重、复杂化,有必要尽早采取积极干预以期改善预后。Infectious pancreatic necrosis is a serious complication of acute pancreatitis,which has a direct impact on the prognosis.It usually occurs in the late course of acute pancreatitis,but it can also occur in the early course of acute pancreatitis.At present,the understanding of IPN in the late stage of acute pancreatitis is relatively deep,but the understanding of early IPN is less,especially the CT imaging characteristics and diagnostic value of early IPN are lack of research.Objective To evaluate the clinical and prognostic features of infected pancreatic necrosis(IPN)based on CT and course staging.Methods the clinical and imaging data of 92 patients with acute pancreatitis(AP)diagnosed as IPN by CT from January 2019 to April 2022 were retrospectively analyzed.The"bubble sign"shown by CT was taken as the direct evidence for the diagnosis of IPN.According to the specific stages of IPN in the course of AP,IPN was divided into early(within 2 weeks of AP onset)and late(after 2 weeks of AP onset)IPN groups.The age,sex,etiology,necrosis type,incidence of persistent organ failure,multiple organ failure,ICU occupancy,length of stay in ICU,invasive intervention rate and mortality were compared between the two groups.Results Among 92 cases of IPN,28 cases(30.4%)occurred in the early course of AP and 64 cases(69.6%)occurred in the late course of AP.On CT imaging,early IPN mainly showed acute necrotic accumulation(ANC)with"bubble sign",and late IPN mainly showed wrapping necrosis(won)with"bubble sign".Patients with early IPN had higher rates of persistent organ failure(64.3%vs.39.1%,χ^(2)=4.978,P=0.026)and multiple organ failure(53.6%vs.31.3%,χ^(2)=4.117,P=0.042),and had longer ICU stay(18.5±5.4 d vs.15.7±4.7 d,t=2.511,P=0.014)and higher mortality(53.6%vs.21.9%,χ^(2)=9.066,P=0.003).The differences were statistically significant(P<0.05).There was no significant difference in gender,age,ICU occupancy and invasive intervention rate between the two groups(P>0.05).Conclusion It is of clinical significance to diagnose and cla

关 键 词：感染性胰腺坏死 急性胰腺炎 计算机断层扫描 病程分期 

分 类 号：R445.3[医药卫生—影像医学与核医学]