CAJ | 학술논문

目的探讨急性胰腺炎(AP)患者病情严重程度与胸腔积液的相关性.方法回顾性分析福建医科大学附属协和医院2008年1月至2012年12月收治的246例AP患者的临床资料.以APACHEⅡ评分、CT严重指数(CTSI)两种评分系统评估病情严重程度,探讨其与胸腔积液的关系.通过受试者工作特征曲线分析各评分系统对AP并发胸腔积液患者预后的判断价值.结果全组246例AP患者中,并发胸腔积液者184例,无胸腔积液者62例,胸腔积液的发生率为74.8％.分析显示,病情轻重不同组在胸腔积液发生率上差异均有统计学意义(P＜0.05).病情越重者,胸腔积液程度越重.胸腔积液程度与APACHEⅡ评分(r=0.775,P＜0.01)、CTSI(r=0.525,P＜0.05)呈正相关.Logistic回归分析显示,高APCHEⅡ评分、高CTSI是发生胸腔积液的独立危险因素.在判断并发胸腔积液患者预后上,APACHEⅡ评分、CTSI以及两者联合评分的受试者工作特征曲线下面积分别为0.798、0.687、0.812.APACHEⅡ评分、联合评分与CTSI相比,差异均有统计学意义(P＜0.05).结论 AP病情严重程度与胸腔积液密切相关.综合运用APACHEⅡ评分、CTSI评估病情并积极干预有助于改善预后.
목적 탐토급성이선염(AP)환자병정엄중정도여흉강적액적상관성.방법 회고성분석복건의과대학부속협화의원2008년1월지2012년12월수치적246례AP환자적림상자료.이APACHEⅡ평분、CT엄중지수(CTSI)량충평분계통평고병정엄중정도,탐토기여흉강적액적관계.통과수시자공작특정곡선분석각평분계통대AP병발흉강적액환자예후적판단개치.결과 전조246례AP환자중,병발흉강적액자184례,무흉강적액자62례,흉강적액적발생솔위74.8％.분석현시,병정경중불동조재흉강적액발생솔상차이균유통계학의의(P＜0.05).병정월중자,흉강적액정도월중.흉강적액정도여APACHEⅡ평분(r=0.775,P＜0.01)、CTSI(r=0.525,P＜0.05)정정상관.Logistic회귀분석현시,고APCHEⅡ평분、고CTSI시발생흉강적액적독립위험인소.재판단병발흉강적액환자예후상,APACHEⅡ평분、CTSI이급량자연합평분적수시자공작특정곡선하면적분별위0.798、0.687、0.812.APACHEⅡ평분、연합평분여CTSI상비,차이균유통계학의의(P＜0.05).결론 AP병정엄중정도여흉강적액밀절상관.종합운용APACHEⅡ평분、CTSI평고병정병적겁간예유조우개선예후.
Objective To investigate the correlation between disease severity and pleural effu sion in patients with acute pancreatitis(AP).Methods A retrospective analysis was conducted on a prospectively collected database.The demographic,clinical,and laboratory data of 246 consecutive cases of AP in patients admitted to the Affiliated Union Hospital of Fujian Medical University between January 2008 to December 2012 were reviewed.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and computed tomography severity index (CTSI) were used to evaluate the disease severity of AP.The relationship between the severity and pleural effusion was analyzed.Receiver operator characteristic (ROC) curve was used to compare the values of APACHE Ⅱ score and CTSI in predicting the prognosis of patients with pleural effusion.Results Among the 246 patients,there were 184 patients with pleural effusion and 62 patients without pleural effusion.The incidence of pleu ral effusion in AP was 74.8％.Further study showed that the difference in the incidences of pleural effusion between the severe group and the mild group was significant (P＜0.01).There was a trend that the more serious the patient's condition,the more the pleural effusion.Moreover,the levels of pleural effusion were significantly and positively correlated with the APACHE Ⅱ score (r=0.775,P＜0.01) and CTSI (r=0.525,P＜0.05).Logistic regression analysis showed that the factors significantly associated with pleural effusion formation were a high APACHE Ⅱ score and a high CTSI.Areas under the ROC curve of the APACHE Ⅱ score,CTSI and combined assessment were 0.798,0.687 and 0.812 for predicting mortality of the patients with pleural effusion.Through comparison of the areas under the ROC curve,there was a significant difference between the APACHE Ⅱ score and CTSI as well as combined assessment and CTSI (P＜0.05).Conclusions The disease severity was closely related to pleural effusion in patients with AP.Combining the two scoring systems to evaluate the disease severity and providing active treatment were important to improve the prognosis of patients with pleural effusion.