急性胰腺炎相关肺损伤的CT表现与肾周间隙受累的相关性  

Correlation between CT imaging of acute pancreatitis-associated lung injury and perirenal space involvement

作　　者：蔺丛丛 林永开 李远章 陈永强 梁健华 LIN Congcong;LIN Yongkai;LI Yuanzhang;CHEN Yongqiang;LIANG Jianhua(Department of Imaging diagnosis,the Fifth Affiliated Hospital of Southern Medical University,Guangzhou 510900,China)

机构地区：[1]南方医科大学第五附属医院影像诊断科,广东广州510900

出　　处：《分子影像学杂志》2024年第4期407-413,共7页Journal of Molecular Imaging

基　　金：南医影像联盟基金(FS2023010024)。

摘　　要：目的回顾性分析急性胰腺炎(AP)相关肺损伤的CT影像学特征,探究AP的严重程度、肺组织损伤程度与肾周间隙受累的相关性。方法收集2018年12月1日~2022年7月31日经南方医科大学第五附属医院临床和实验室检查诊断为AP的402例患者的临床及胸部、上腹部CT影像学资料。根据CT严重指数将AP分为轻症AP(MAP)、重症AP(SAP);根据高分辨率CT形态学将肺损伤程度分为正常肺组织、轻度肺损伤、中度肺损伤和重度肺损伤;根据肾筋膜厚度判别肾周间隙受累情况。结果根据高分辨率CT影像学表现,402例AP患者中急性胰腺炎相关肺损伤发生率为82.34%(331/402),包括轻度肺损伤264例、中度肺损伤34例、重度肺损伤33例。AP相关肺损伤表现:258例表现为胸膜增厚、胸膜下线、支气管血管束增粗;46例表现为小叶间隔增厚;48例表现肺内斑片状实变影或伴胸腔积血、积液。单因素分析显示,年龄、脂肪酶>300 U/L、胰腺CT分级、是否累及肾周与肺损伤程度相关(P<0.05)。逐步多因素无序多分类Logistic回归分析显示:以无肺损伤为对照,年龄为轻度肺损伤的危险因素(OR=1.04,95%CI:1.02~1.06);年龄(OR=1.05,95%CI:1.03~1.08)和累及肾周(OR=6.69,95%CI:2.40~18.66)为中度肺损伤的危险因素,淀粉酶>110 U/L为保护因素(OR=0.24,95%CI:0.06~0.97);年龄(OR=1.04,95%CI:1.01~1.07)和累及肾周(OR=34.86,95%CI:7.03~172.94)为重度肺损伤的危险因素,女性(OR=0.23,95%CI:0.07~0.78)和轻度肺损伤分级(OR=0.09,95%CI:0.01~0.76)为重度肺损伤的保护因素。结论在评估AP肺损伤严重程度及其发展过程中,肾周间隙受累可能比CT严重指数具有更高的临床诊断价值。Objective To retrospectively analyzed the CT imaging features of acute pancreatitis-associated lung injury and investigate the correlation among the severity of acute pancreatitis(AP),the extent of lung tissue injury,and involvement of the perirenal space.Methods A retrospective analysis involving 402 patients diagnosed with AP based on clinical and laboratory examinations were conducted.Clinical data and chest/upper abdomen CT imaging records were collected for analysis.Severity of AP was stratified into categories of mild AP and severe AP using the CT severity indices.Lung injury severity was assessed morphologically and categorized as normal lung tissue,mild lung injury,moderate lung injury,or severe lung injury based on CT findings.Additionally,perirenal space involvement was determined by evaluating renal fascia thickness.Results Based on high resolution CT imaging,the incidence of AP-associated lung injury was 82.34%(331/402)among the AP patients,comprising 264 cases of mild lung injury,34 cases of moderate lung injury,and 33 cases of severe lung injury.The imaging characteristics of AP-associated lung injury include pleural thickening,subpleural lines,and broncho vascular bundle thickening in 258 cases,septal thickening in 46 cases,and patchy consolidation in the lungs or with associated pleural effusion in 48 cases.Univariate analysis showed that the degree of lung injury demonstrated a significant correlation(P<0.05)with age,serum lipase level(>300 U/L),pancreatic CT grading,PS.In the multinomial logistic regression analysis,using normal lung as the reference,age was identified as a significant risk factor for mild lung injury(OR=1.04,95%CI:1.02-1.06).Age(OR=1.05,95%CI:1.03-1.08)and PSI(OR=6.69,95%CI:2.40-18.66)were found to be risk factors for moderate lung injury,while serum amylase level>110 U/L acted as a protective factor(OR=0.24,95%CI:0.06-0.97).Furthermore,age(OR=1.04,95%CI:1.01-1.07)and PSI(OR=34.86,95%CI:7.03-172.94)were identified as risk factors for severe lung injury,while female gender(OR=0.

关 键 词：急性胰腺炎 肾周间隙 急性胰腺炎相关肺损伤 高分辨率CT 

分 类 号：R576[医药卫生—消化系统] R816.4[医药卫生—内科学]