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目的 :探讨不同严重程度急性胰腺炎(AP)CT灌注成像特点。方法 :回顾性分析2014年3月~2016年3月医院就诊的AP患者120例(AP组)和同期医院就诊的非胰腺疾病患者40例(对照组)的病例资料,根据Balrhazar CT分级标准将AP组分为轻度胰腺炎(MAP)组71例和重度急性胰腺炎(SAP)组49例,所有研究对象均于入院72h内行胰腺CT灌注成像检查,并记录增强时间-密度曲线(TDC)形态及CT灌注参数[血流量(BF)、血容量(BV)、平均通过时间(MTT)、毛细血管表面通透性(PS)],测定白介素6(IL-6)、IL-8、IL-10、血浆内皮素-1(ET-1)、血管性假血友病因子(v WF)、血栓调节蛋白(TM)水平。结果 :对照组胰腺TDC形态为速升速降型,MAP组为速升速降型或缓升缓降型,SAP组为缓升平坦型。SAP组BF、BV、PS值低于MAP组和对照组,差异有显著性;MAP组、对照组组间比较差异有显著性,3组MTT比较差异无显著性。SAP组IL-6、IL-8、IL-10、ET-1、v WF、TM明显高于MAP组和对照组,MAP组和对照组上述指标组间比较,差异有显著性。结论 :炎性因子、血管内皮功能障碍在AP病情发展中起重要参与作用,CT灌注成像可通过观察微循环状况评估病情严重程度。
Objective: To investigate the CT perfusion imaging of acute pancreatitis (AP) with different severity. Methods: The clinical data of 120 AP patients (AP group) and 40 non-pancreatic disease patients (control group) from the hospital from March 2014 to March 2016 were retrospectively analyzed. According to the Balrhazar CT grading standards The AP group consisted of 71 patients with mild pancreatitis (MAP) and 49 patients with severe acute pancreatitis (SAP). All subjects underwent resection of pancreatic CT perfusion imaging within 72 hours after admission. The time-density curve (TDC) The levels of IL-6, IL-8, IL and IL-6 were measured by morphological and CT perfusion parameters (BF, BV, MTT and PS) -10, ET-1, v WF, TM. Results: The morphological changes of TDC in the control group were rapid ascending and descending pattern, the MAP group was rapid ascending or descending, and the SAP group was flat. The values of BF, BV and PS in SAP group were lower than those in MAP group and control group, and there was significant difference between MAP group and control group. There was no significant difference between the three groups in MTT. The levels of IL-6, IL-8, IL-10, ET-1, v WF, TM in SAP group were significantly higher than those in MAP group and control group, and there was significant difference between MAP group and control group. Conclusion: Inflammatory factors and vascular endothelial dysfunction play an important role in the development of AP. CT perfusion imaging can assess the severity of the disease by observing microcirculation.