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目的 研究CT及临床分级法对急性胰腺炎 (AP)病情严重性及预后的评估价值及两者的相关性。方法 AP患者 6 5例 ,将住院时间、发热时间、局部及全身并发症作为评价AP病情严重性及预后的临床指标。对CT和临床分级法各组临床指标的差异显著性、两类分级法间的相关性及对全体并发症的预见能力进行统计学分析。结果 全体并发症组的三组之间PSI、Ranson、A PACHEⅡ平均记分有显著性差异。各分级法除CT平扫分级法外 ,有局部并发症组的平均记分明显高于无局部并发症组 ;重症组并发症的平均记分明显高于轻症组。Ranson重症组的住院时间、发热时间也明显长于轻症组。PSI、Ranson记分与发热时间线性相关 ,Ranson记分与住院时间线性相关。各CT分级法中只有PSI与Ranson记分线性相关。ROC分析示Ranson的曲线下面积 (Az)最大 ,两类分级法结合后的Az较Ranson无提高。结论 Ranson及PSI在病情严重性及预后的评估中应用价值最大。临床分级法对全身并发症的预见能力较优 ,CT分级法对局部并发症的预见能力较优。CT与临床分级法结合后不能提高对全体并发症的预见能力。CT平扫表现与临床比较有滞后性。应用CT检查特别是短期随访有重要价值
Objective To study the value of CT and clinical classification in the evaluation of the severity and prognosis of acute pancreatitis (AP) and their relationship. Methods Sixty-five patients with AP were enrolled in this study. The hospitalization time, fever time, local and systemic complications were used as clinical indexes to evaluate the severity and prognosis of AP. The clinical significance of CT and clinical grading in each group were statistically significant. The correlation between the two grading methods and the predictive ability of the whole complication were statistically analyzed. Results The mean score of PSI, Ranson and A PACHE Ⅱ among the three groups in the overall complication group was significantly different. The grading method in addition to CT scan grading method, the average score of the group of local complications was significantly higher than without the group of local complications; the average score of severe group of complications was significantly higher than the mild group. In Ranson severe group, hospitalization time and fever time were significantly longer than those in mild group. PSI and Ranson scores were linearly correlated with fever time, and Ranson score was linearly correlated with hospitalization time. Only PSI and Ranson scores were linearly correlated with CT classification. ROC analysis showed that the area under the curve (Az) of Ranson was the largest. Az combined with the two classification methods did not improve compared with that of Ranson. Conclusion Ranson and PSI are the most valuable in the assessment of the severity and prognosis of patients. The clinical classification method has better predictive ability on systemic complications, and the CT classification method has better predictive ability on local complications. CT combined with clinical classification method can not improve the predictability of the overall complications. CT scan performance and clinical lag. The application of CT examination, especially short-term follow-up has important value