急性胰腺炎患者肾上腺皮质功能和影像改变在病情评估中的作用  

A Study on Adrenal Cortex Function and Imaging Changes in Patients with Acute Pancreatitis and Their Role in the Evaluation of the Course of Disease

作　　者：吴中楷 张利龙 石乔[1] 余佳[1] 王卫星[1] 邓文宏[1] WU Zhong-kai;ZHANG Li-long;SHI qiao;YU jia;WANG Wei-xing;Deng wen-hong(Department of Gastrointestinal Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院普外科,武汉430060

出　　处：《微循环学杂志》2023年第2期33-37,共5页Chinese Journal of Microcirculation

基　　金：国家自然科学基金(81500488)。

摘　　要：目的:探讨急性胰腺炎(SAP)患者肾上腺功能和影像改变在病情评估中的作用。方法:选取本院67例SAP患者为胰腺炎组,依据病情严重程度分为轻症组(n=42)和中重症组(n=25)两个亚组,并选取14例腰椎骨折患者为对照组。收集患者临床资料和CT数据,分析胰腺炎患者的病情严重程度与肾上腺皮质功能和影像改变的关系。结果:胰腺炎组患者肾上腺CT值显著低于对照组(P<0.05)。轻症组患者血清皮质醇水平(19.08±12.73ng/ml)明显低于中重症组(32.04±15.54ng/ml)(P<0.05)。胰腺炎患者血清皮质醇水平与病情严重程度呈正相关;胰腺炎患者入院至出院的皮质醇变化与左侧肾上腺密度呈负相关。血清皮质醇评估SAP病情严重程度的ROC曲线下面积(AUC)为0.741(P=0.012),灵敏度和特异度分别为93.8%和59.1%,最佳截断值为16.40ng/ml。结论:入院血清皮质醇水平和肾上腺影像学CT值与SAP病情严重程度密切相关,二者可为胰腺炎患者病情严重程度的评估提供有力依据,有助于危险分层和指导治疗。Objective:To explore the role of adrenal function and imaging changes in the evaluation of patients with acute pancreatitis.Method:67 patients with acute pancreatitis diagnosed in our hospital were selected as the pancreatitis group,according to the severity of the disease,it was divided into two subgroups:mild group(n=42)and severe group(n=25).And 14 lumbar fractures diagnosed in our hospital were selected as the control group.Clinical data and CT data of patients were collected to analyze the relationship between the severity of pancreatitis and adrenal cortex function and imaging changes.Results:The adrenal CT value of pancreatitis was significantly lower than that of control group(P<0.05).The serum cortisol level of mild patients was 19.08±12.73 ng/ml,which was significantly lower than that of moderately severe patients 32.04±15.54 ng/ml(P<0.05).The serum cortisol level was positively correlated with the severity of the disease.Cortisol changes from admission to discharge in patients with pancreatitis were inversely associated with left adrenal density.The area under ROC curve(AUC)of serum cortisol in evaluating the severity of acute pancreatitis was 0.741(P=0.012)and the sensitivity and specificity were 93.8%and 59.1%,respectively,with a best cut-off value of 16.40 ng/ml.Conclusion:The serum cortisol level and the changes of adrenal imaging at admission is closely related to the severity of acute pancreatitis,which provides a strong basis for the evaluation of the severity of pancreatitis patients,and is helpful for risk stratification and treatment guidance.

关 键 词：急性胰腺炎 肾上腺 皮质醇 腹部CT 

分 类 号：R657.51[医药卫生—外科学]