Correlation of CT imaging of severe pancreatitis with disease progression, serum amylase, red blood cell distribution width and lipocain-2
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摘要:
目的 探究重症胰腺炎CT影像与病情进展及血清淀粉酶(AMS)、红细胞分布宽度(RDW)、脂质运载蛋白2(LCN2)的关系。 方法 回顾性收集2019年3月~2022年12月的105例重症胰腺炎患者临床资料,根据患者临床预后结果分为预后良好组(n=77)和预后不良组(n=28),比较两组患者CT影像结果[胰周外炎症CT评分(EPIC)、改良CT严重指数(MCTSI)]及血清AMS、RDW、LCN2水平,利用ROC曲线分析各指标对重症胰腺炎预后的评估价值。 结果 预后不良组器官功能衰竭数多于预后良好组(P=0.039),APACHE Ⅱ评分水平高于预后良好组(P=0.001);预后不良组EPIC、MCTSI评分高于预后良好组(P < 0.001),血清AMS、RDW、LCN2水平均高于预后良好组(P < 0.001);相关性分析显示,EPIC、MCTSI评分与血清AMS、RDW、LCN2水平呈正相关关系(r=0.591、0.668、0.684,0.573、0.637、0.652,P < 0.001);EPIC、MCTSI评分评估重症胰腺炎预后的曲线下面积为0.791、0.762,敏感度为82.14%、67.86%,特异性为64.94%、72.73%;血清AMS、RDW、LCN2评估重症胰腺炎预后的曲线下面积为0.758、0.754、0.851,敏感度为64.29%、78.57%、78.57%,特异性为76.62%、66.23%、80.52%;血清AMS、RDW、LCN2联合评估重症胰腺炎预后的曲线下面积为0.925,敏感度为92.86%,特异性为79.22%。 结论 重症胰腺炎患者较高的EPIC、MCTSI评分以及血清AMS、RDW、LCN2水平与预后不良有关,上述CT评分与血清学指标水平呈正相关关系,且均可用于评估患者病情进展后的不良结局,血清学指标联合评估效能最高。 Abstract:Objective To explore the relationship between CT imaging of severe pancreatitis and disease progression, serum amylase (AMS), red blood cell distribution width (RDW) and lipocain-2 (LCN2). Methods Clinical data of 105 patients with severe pancreatitis from March 2019 to December 2022 were retrospectively collected. The patients were divided into good prognosis group (n=77) and poor prognosis group (n=28) according to the clinical prognosis results of patients. CT imaging results [extra-pancreatic inflammation on CT (EPIC), modified CT severity index (MCTSI)] and serum AMS, RDW and LCN2 levels were compared between the two groups of patients. ROC curve was used to analyze the evaluated value of each indicator on prognosis of severe pancreatitis. Results The number of cases with organ failure in poor prognosis group was more than that in good prognosis group (P=0.039), and the APACHE Ⅱ score was higher than that in good prognosis group (P=0.001). EPIC score and MCTSI score were higher in poor prognosis group than those in good prognosis group (P < 0.001), and serum AMS, RDW and LCN2 levels were higher compared with those in good prognosis group (P < 0.001). Correlation analysis showed that EPIC score and MCTSI score were positively correlated with serum AMS, RDW and LCN2 levels (r=0.591, 0.668, 0.684 and 0.573, 0.637, 0.652, P < 0.001). The areas under the curves of EPIC score and MCTSI score on evaluating the prognosis of severe pancreatitis were 0.791 and 0.762, and the sensitivities were 82.14% and 67.86% and the specificities were 64.94% and 72.73%. The areas under the curves of AMS, RDW and LCN2 were 0.758, 0.754, 0.851, and the sensitivities were 64.29%, 78.57%, 78.57, the specificities were 76.62%, 66.23%, 80.52% respectively. The area under the curve, sensitivity and specificity of the combination of AMS, RDW and LCN2 on assessing the prognosis of severe pancreatitis were 0.925, 92.86% and 79.22%. Conclusion High EPIC score, MCTSI score and serum AMS, RDW and LCN2 levels in patients with severe pancreatitis are associated with poor prognosis. The above CT scores are positively correlated with serological indicators. All the indicators can be used to evaluate the poor outcomes after disease progression. The combination of serological indicators has the highest efficiency. -
Key words:
- severe pancreatitis /
- CT /
- disease condition /
- serum amylase /
- red blood cell distribution width /
- lipocain-2
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图 1 男性患者,59岁,预后良好
Figure 1. A 59-year-old male patient with good prognosis. A: Before treatment, diffuse pancreatic enlargement, decreased pancreatic tail enhancement, exudation and effusion were observed in peripheral space and bilateral prerenal space, with uniform density and unclear edge. Acute peripancreatic fluid accumulation was considered, with EPIC score of 7 points and MCTSI score of 6 points. B: After treatment, the disease condition was improved and the prognosis was good.
表 1 两组人口学特征与疾病特征
Table 1. Demographic characteristics and disease characteristics of the two groups (n)
Index Good prognosis group(n=77) Poor prognosis group(n=28) χ2/t P Age(years, Mean±SD) 57.26±10.27 61.22±8.79 1.812 0.073 Gender 0.274 0.600 Male 51 17 Female 26 11 Past medical history Hypertension 21 8 0.017 0.895 Diabetes mellitus 14 6 0.140 0.708 Coronary heart disease 18 7 0.030 0.863 Etiological classification 0.218 0.974 Biliary 29 10 Alcoholic 20 7 Hyperlipidemic 16 7 Other 12 4 Number of cases with organ failure 4.252 0.039 1 45 10 ≥2 32 18 APACHE Ⅱ score (point, Mean±SD) 22.96±6.48 27.54±5.86 3.282 0.001 Conversion to surgery 22 10 0.494 0.482 APACHE Ⅱ: Acute physiology and chronic health evaluation Ⅱ. 表 2 两组EPIC、MCTSI评分结果
Table 2. EPIC score and MCTSI score of the two groups (point, Mean±SD)
Group EPIC score MCTSI score Good prognosis group(n=77) 5.06±1.07 5.75±1.51 Poor prognosis group(n=28) 6.21±0.74 7.54±1.73 t 5.242 5.164 P < 0.001 < 0.001 EPIC: Extrapancreatic inflammation on abdominal computed tomography; MCTSI: Modified CT severity index. 表 3 两组血清血清AMS、RDW、LCN2水平
Table 3. Serum AMS, RDW and LCN2 levels in the two groups (Mean±SD)
Group AMS(U/L) RDW(%) LCN2(μg/L) Good prognosis group(n=77) 527.57±201.11 13.91±1.89 275.03±64.47 Poor prognosis group(n=28) 711.35±170.50 15.86±2.22 379.87±77.01 t 4.303 4.459 6.988 P < 0.001 < 0.001 < 0.001 AMS: Serum amylase; RDW: Red blood cell distribution width; LCN2: Lipocain-2. 表 4 EPIC、MCTSI评分与血清AMS、RDW、LCN2水平的相关性分析
Table 4. Correlation between EPIC score and MCTSI score and serum AMS, RDW and LCN2 levels
CT system score AMS RDW LCN2 r P r P r P EPIC score 0.591 < 0.001 0.668 < 0.001 0.684 < 0.001 MCTSI score 0.573 < 0.001 0.637 < 0.001 0.652 < 0.001 表 5 EPIC、MCTSI评分与血清AMS、RDW、LCN2评估重症胰腺炎预后的价值
Table 5. Value of EPIC score and MCTSI score and serum AMS, RDW and LCN2 on evaluating the prognosis of severe pancreatitis
Variables AUC SE 95% CI Cut-off value Sensitivity(%) Specificity(%) EPIC 0.791 0.0418 0.701-0.864 5 82.14 64.94 MCTSI 0.762 0.0549 0.669-0.840 6 67.86 72.73 AMS 0.758 0.0503 0.665-0.836 648.38 64.29 76.62 RDW 0.754 0.0574 0.661-0.833 14 78.57 66.23 LCN2 0.851 0.0479 0.768-0.913 0.851 78.57 80.52 AMS+RDW+LCN2 0.925 0.0273 0.857-0.968 92.86 79.22 -
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