CAJ | 학술논문

目的探讨CT分类标准在评估重症急性胰腺炎(SAP)预后中的价值.方法回顾性分析2000年1月至2009年12月收治的62例SAP患者的一般资料,所有患者发病早期均行非手术治疗,并于入院后72 h内行CT检查.依照Balthazar CT分级,所有病例被分成3级:C级13例、D级26例、E级23例.依照Balthazar CT严重度指数(CTSI)评分,将此结果分为3级:Ⅰ级11例、Ⅱ级39例、Ⅲ级12例.分析Balthazar CT分级及CTSI评分与患者住院天数、发热天数、禁食天数、白细胞计数恢复天数、血淀粉酶恢复天数、胰腺假性囊肿形成、器官功能衰竭、中转手术、死亡的相关性.用所有患者的两种CT分级评分绘制受试者工作特征曲线(ROC),通过计算曲线下面积来比较各评分系统在判断SAP病情严重程度和预后的意义.结果不同Balthazar CT分级间白细胞计数恢复天数(F=4.035,P=0.023)及胰腺假性囊肿形成(x2=8.066,P=0.018)之间的差异有统计学意义,而其他判断SAP严重程度的临床病理学指标间差异无统计学意义(P＞0.05).CTSI评分低分值的SAP患者恢复过程较高分值者顺利,Ⅰ级及Ⅱ级患者的器官功能衰竭、中转手术、胰腺假性囊肿形成及病死率均明显低于Ⅲ级患者,差异有统计学意义(P＜0.01).ROC曲线分析显示CTSI评分较Balthazar CT分级能更准确地预测SAP的器官功能衰竭、胰腺假性囊肿形成、中转手术及死亡的发生.结论 CTSI评分对于评估SAP的预后有重要意义.
목적 탐토CT분류표준재평고중증급성이선염(SAP)예후중적개치.방법 회고성분석2000년1월지2009년12월수치적62례SAP환자적일반자료,소유환자발병조기균행비수술치료,병우입원후72 h내행CT검사.의조Balthazar CT분급,소유병례피분성3급:C급13례、D급26례、E급23례.의조Balthazar CT엄중도지수(CTSI)평분,장차결과분위3급:Ⅰ급11례、Ⅱ급39례、Ⅲ급12례.분석Balthazar CT분급급CTSI평분여환자주원천수、발열천수、금식천수、백세포계수회복천수、혈정분매회복천수、이선가성낭종형성、기관공능쇠갈、중전수술、사망적상관성.용소유환자적량충CT분급평분회제수시자공작특정곡선(ROC),통과계산곡선하면적래비교각평분계통재판단SAP병정엄중정도화예후적의의.결과 불동Balthazar CT분급간백세포계수회복천수(F=4.035,P=0.023)급이선가성낭종형성(x2=8.066,P=0.018)지간적차이유통계학의의,이기타판단SAP엄중정도적림상병이학지표간차이무통계학의의(P＞0.05).CTSI평분저분치적SAP환자회복과정교고분치자순리,Ⅰ급급Ⅱ급환자적기관공능쇠갈、중전수술、이선가성낭종형성급병사솔균명현저우Ⅲ급환자,차이유통계학의의(P＜0.01).ROC곡선분석현시CTSI평분교Balthazar CT분급능경준학지예측SAP적기관공능쇠갈、이선가성낭종형성、중전수술급사망적발생.결론 CTSI평분대우평고SAP적예후유중요의의.
Objective To study the relationship between CT imaging classification criteria and the prognosis of severe acute pancreatitis( SAP). Methods From January 2000 to December 2009,62 cases with SAP were analyzed, retrospectively. They were all executed CT examination in 72 h after admission, and their CT imaging were classified as grade C (n = 13) , grade D (n = 26 ) , and grade E (n = 23) according to the Balthazar classification criteria and also classified as grade Ⅰ ( n = 11), grade Ⅱ (n = 39), grade Ⅲ (n = 12) according to the Balthazar CT severity index (CTSI) criteria,respectively. The values of these two different classification criteria in assessing the prognosis of SAP were studied, such as length of hospital stay, fever days,fasting days,white blood cell recovery days,serum amylase recovery days,pancreatic pseudocyst, organ failure,need for transit operations,and death. By studying the receiver operating characteristic(ROC) curves,which were drawn by the area under cures,the values of the two different classification criteria were compared in assessing the prognosis of SAP. Results The Balthazar classification criteria was valuable in assessing white blood cell recovery days (F=4. 035,P =0. 023) and pseudocyst (χ2 =8. 066, P =0. 018). No statistical differences were found,however,between other clinicopathological parameters and the prognosis of SAP,according to the Balthazar classification criteria.The patients with low-grade of CTSI classification criteria enjoyed better prognosis,and patients in grade Ⅰ or Ⅱ got lower incidence of organ failure,need for transit operations and pseudocyst than that in grade Ⅲ. The results above suggested that CTSI classification criteria,comparing with Balthazar CT classification criteria,was more valuable in predicting the incidence of organ failure, pseudocyst, need for transit operation, and mortality in SAP ( P < 0. 01) . Conclusion The CTSI classification criteria has a great value in assessing the prognosis of SAP.