Prediction of severity and prognosis of patients with acute pancreatitis
by helical CT perfusion parameters combined with serum D-dimer

doi:10.3760/cma.j.issn.1007-1245.2022.15.020

Abstract

Abstract: Objective　To investigate the effect of spiral CT perfusion parameters combined with serum D-dimer (D-D) in the prediction of the severity and prognosis of patients with acute pancreatitis (AP). Methods　The clinical data of 117 AP patients were retrospectively analyzed, and these patients were divided into an MAP group (mild, 42 cases), including 25 males and 17 females who were (57.9±8.3) years old, an MSAP group (moderate, 37 cases), including 22 males and 15 females who were (58.6±8.1) years old, and an SAP group (severe, 38 cases), including 24 males and 14 females who were (57.4±8.7) years old, according to the disease severity, and were divided into a survival group (95 cases) and a death group (22 cases) according to the prognosis within 28 days after admission. All the patients underwent helical CT perfusion scan, and the serum D-D expression level was detected by immunolatex turbidimetry. The differences of perfusion related parameters, such as blood flow (BF), blood volume (BV), mean passing time (MTT), and surface permeability (PS), and serum D-D expression levels in each group were compared; the correlation of spiral CT perfusion parameters and serum D-D expression level with the patients' severity and prognosis was analyzed. The value of spiral CT scanning parameters combined with serum D-D in predicting the patients' severity and prognosis was analyzed. The count data and measurement data were compared by χ² and t tests. ANOVA was used for the comparison between the 3 groups. Results　There were statistical differences in BF, BV, and serum D-D expression level between the AP patients with different severities and prognosis (all P<0.05), and no in MTT and PS (P=0.405 and 0.283). With the exacerbation of the disease, the BF and BV significantly decreased (both P<0.05) and the serum D-D expression level significantly increased (P<0.05). The BF [(59.57±8.36) ml·100 g^-1·min^-1 vs. (87.06±23.59) ml·100 g^-1·min^-1] and BV [(6.05±1.87) ml/100 g vs. (15.82±8.63) ml/100 g] in the death group were significantly lower than those in the survival group, and the serum D-D expression level [(1.47±0.28) mg/L vs. (0.84±0.39) mg/L] was significantly higher, with statistical differences (t=9.755, 15.161, and 11.205; all P<0.001). BF and BV were negatively correlated with the patients' severity and prognosis (r=-0.573 and -0.585, both P<0.05); the serum D-D level was positively correlated with the patients' severity and prognosis (r=0.617, P<0.05), while MTT and PS were not significantly correlated with the patients' severity and prognosis (r=0.175 and 0.207, both P>0.05). The AUC, sensitivity, and specificity of BF and BV combined with serum D-D in predicting SAP and death were better than that of single indicator (all P<0.05). Conclusion　Spiral CT perfusion parameters (BF and BV) combined with serum D-D has important clinical value in predicting the severity and prognosis of AP patients.

Key words: Spiral CT perfusion parameters, D-dimer, Acute pancreatitis

摘要： 目的　探讨螺旋CT灌注参数联合血清D-二聚体（D-D）对急性胰腺炎（AP）患者病情严重程度及预后的预测作用。方法　回顾性分析济宁市第三人民医院2017年2月至2021年6月期间收治的117例AP患者病例资料，根据病情严重程度分为MAP组（轻度）： 42例（男25例、女17例），年龄（57.9±8.3）岁；MSAP组（中度）：37例（男22例、女15例），年龄（58.6±8.1）岁；SAP组（重度）：38例（男24例、女14例），年龄（57.4±8.7）岁。根据入院28 d内预后情况分为存活组（95例）、死亡组（22例）。所有患者均行螺旋CT灌注扫描检查，同时采用免疫乳胶比浊法检测血清D-D表达水平。比较各组血流量（BF）、血容量（BV）、平均通过时间（MTT）、表面通透性（PS）等灌注相关参数及血清D-D表达水平的差异性，分析螺旋CT灌注参数、血清D-D表达水平与AP患者病情严重程度、预后的相关性，分析螺旋CT扫描相关参数联合血清D-D预测AP患者病情严重程度及预后的价值。计数和计量资料比较采用χ²和t检验比较，多组间资料比较采用方差分析。结果　不同病情严重程度和预后AP患者BF、BV等参数及血清D-D表达水平比较，差异均有统计学意义（均P<0.001），而MTT、PS等参数比较，差异无统计学意义（P=0.405、0.283，均P>0.05）。随着病情加重，BF、BV明显下降（P<0.05），而血清D-D表达水平明显升高（P<0.05）。死亡组BF［（59.57±8.36）ml·100 g^-1·min^-1比（87.06±23.59）ml·100 g^-1·min^-1］、BV［（6.05±1.87）ml/100 g比（15.82±8.63）ml/100 g］明显低于存活组，而血清D-D［（1.47±0.28）mg/L比（0.84±0.39）mg/L］表达水平明显高于存活组，差异均有统计学意义（t=9.755、15.161、11.205，均P<0.001）；BF、BV等参数与AP患者病情严重程度和预后呈负相关（r=-0.573、-0.585，均P<0.05），血清D-D水平与AP患者病情严重程度和预后呈正相关（r=0.617，P<0.05），而MTT、PS等参数与AP患者病情严重程度、预后无明显相关性（r=0.175、0.207，均P>0.05）；BF、BV等参数联合血清D-D预测重症胰腺炎（SAP）和死亡的曲线下面积（AUC）、灵敏度及特异度均优于单一指标检测（P<0.05）。结论　螺旋CT灌注参数（BF、BV）联合血清D-D在预测AP患者病情严重程度及预后方面具有重要的临床价值。

关键词: 螺旋CT灌注参数, , D-二聚体, , 急性胰腺炎

Wang Ting, Li Wenwu, Zhang Guifeng. Prediction of severity and prognosis of patients with acute pancreatitis by helical CT perfusion parameters combined with serum D-dimer[J]. International Medicine and Health Guidance News, 2022, 28(15): 2160-2165.

王婷　李文武　张桂凤. 螺旋CT灌注参数联合血清D-二聚体对急性胰腺炎患者病情严重程度及预后的预测作用[J]. 国际医药卫生导报, 2022, 28(15): 2160-2165.

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Prediction of severity and prognosis of patients with acute pancreatitis by helical CT perfusion parameters combined with serum D-dimer

螺旋CT灌注参数联合血清D-二聚体对急性胰腺炎患者病情严重程度及预后的预测作用

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