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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (05) : 432 -436. doi: 10.3877/cma.j.issn.2095-2015.2024.05.010

论著

改良CT严重指数联合炎症指标在重症急性胰腺炎患者胰腺感染预测及预后评估中的研究
丛黎1,†(), 马林1, 陈旭1, 李文文1, 张亮亮1, 周华亭1   
  1. 1. 264200　山东省，威海市中医院放射科
  • 收稿日期:2024-01-17 出版日期:2024-10-01
  • 通信作者: 丛黎

MCTSI and detection of serum inflammatory factors in the prediction of pancreatic infection and prognosis evaluation of severe acute pancreatitis

Li Cong1,†(), Lin Ma1, Xu Chen1, Wenwen Li1, Liangliang Zhang1, Huating Zhou1   

  1. 1. Department of Radiology, Weihai Hospital of Traditional Chinese Medicine, Weihai 264200, China
  • Received:2024-01-17 Published:2024-10-01
  • Corresponding author: Li Cong
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丛黎, 马林, 陈旭, 李文文, 张亮亮, 周华亭. 改良CT严重指数联合炎症指标在重症急性胰腺炎患者胰腺感染预测及预后评估中的研究[J]. 中华消化病与影像杂志(电子版), 2024, 14(05): 432-436.

Li Cong, Lin Ma, Xu Chen, Wenwen Li, Liangliang Zhang, Huating Zhou. MCTSI and detection of serum inflammatory factors in the prediction of pancreatic infection and prognosis evaluation of severe acute pancreatitis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 432-436.

目的

探讨改良CT严重指数（MCTSI）联合炎症指标在重症急性胰腺炎（SAP）患者胰腺感染预测及预后评估中的应用价值。

方法

选取威海市中医院2020年5月至2022年12月110例SAP患者，以患者入组时间为起点，观察28 d，依据患者胰腺感染继发情况分为感染组（n=21）和未感染组（n=89）；并依据患者预后生存或死亡情况将患者分为生存组（n=93）和死亡组（n=17）。所有患者均于入院后第1天行增强CT检查与血清炎症细胞学检测，通过受试者工作特征曲线（ROC）评估MCTSI评分与血清炎症指标白介素（IL-6、IL-8、IL-10）联合对患者继发胰腺感染及预后的预测价值。

结果

感染组血清IL-6、IL-8水平高于未感染组，IL-10低于未感染组（P<0.05）；感染组与未感染组入院时MCTSI评分无差异（P>0.05）；SAP患者IL-6、IL-8、IL-10联合检测预测胰腺感染的发生，ROC曲线下面积0.850，大于各项指标单独检测曲线下面积0.750、0.736、0.728（P<0.05）；死亡组入院时IL-6、IL-8水平低于生存组，IL-10高于生存组（P<0.05）；死亡组入院时MCTSI评分高于生存组（P<0.05）；MCTSI评分联合血清炎性指标预测SAP患者预后ROC曲线下面积0.872，大于IL-6、IL-8、IL-10、MCTSI评分各项指标单独检测下曲线面积0.687、0.685、0.667、0.773（P<0.05）。

结论

血清IL-6、IL-8升高、IL-10降低可作为SAP患者胰腺感染的敏感指标；MCTSI评分虽不能有效预测胰腺感染，但与血清炎症指标联合可有效评估患者预后状态。

关键词: 重症急性胰腺炎, 胰腺感染, 增强CT, 炎症细胞因子
Objective

To investigate the application value of modified CT severity index (MCTSI) and detection of serum inflammatory factors in the prediction of pancreatic infection and prognosis evaluation of severe acute pancreatitis (SAP).

Methods

A total of 110 patients with SAP in Weihai Hospital of Traditional Chinese Medicine were enrolled in this study between May 2020 and December 2022. Patients were enrolled at the starting point and observed for 28 days They were divided into infected group (n=21) and uninfected group (n=89) according to the presence or absence of secondary pancreatic infection. Based on the prognosis, the patients were divided into survival group (n=93) and death group (n=17). All patients were subjected to enhanced CT examination and detection of serum inflammatory factors on the first day after admission. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of MCTSI combined with serum inflammatory factors (IL-6/8/10) for secondary pancreatic infection and prognosis.

Results

Serum IL-6 and IL-8 levels in the infected group were higher than those in the uninfected group, and IL-10 level were lower than that in the uninfected group (P<0.05). The MCTSI showed no significant difference between the infected group and the uninfected group at admission (P>0.05). The area under the ROC curve of joint prediction of serum IL-6, IL-8 and IL-10 for pancreatic infection in patients with SAP was 0.850, greater than that of each index single prediction (0.750, 0.736, 0.728) (P<0.05). Serum IL-6 and IL-8 levels in the death group at admission were lower than those in the survival group, and IL-10 level was higher than that in the survival group (P<0.05). The death group had higher MCTSI score than the survival group at admission (P<0.05). The area under the ROC curve of MCTSI combined with serum inflammatory factors for prognosis of patients with SAP was 0.872, greater than that of IL-6, IL-8, IL-10 or MCTSI score alone (0.687, 0.685, 0.667, 0.773) (P<0.05).

Conclusion

The incresde of serum IL-6 and IL-8 and the decrease of IL-10 can be used as sensitive indicators of pancreatic infection in patients with SAP. Although the MCTSI score cannot effectively predict pancreatic infection, it can be used for evaluating prognosis when combined with serum inflammatory factors.

Key words: Severe acute pancreatitis, Pancreatic infection, Enhanced CT, Serum inflammatory factor
表1 感染组与未感染组一般资料比较[例（%）]
组别 例数 性别 年龄 病因 高血压病史 糖尿病史 低氧血症
男 女 <60岁 ≥60岁 胆源性 脂源性 其他
感染组 21 12(57.14) 9(42.86) 9(42.86) 15(71.43) 12(57.14) 5(23.81) 4(19.05) 9(42.86) 5(23.81) 7(33.33)
未感染组 89 49(55.06) 40(44.94) 34(38.20) 55(61.80) 55(61.80) 24(26.97) 10(11.24) 33(37.08) 15(16.85) 24(26.97)
χ2值   0.030 0.681 0.939 0.240 0.553 0.340
P值   0.863 0.409 0.625 0.624 0.457 0.560
表2 感染组与未感染组MCTSI评分与血清炎性指标水平比较（±s）
组别 例数 IL-6(pg/mL) IL-8(pg/mL) IL-10(pg/mL) MCTSI评分
感染组 21 111.79±18.08 167.83±23.97 46.98±7.95 6.35±1.14
未感染组 89 86.73±12.29 136.96±19.44 59.86±8.43 5.98±0.92
t值   7.623 6.251 6.363 1.581
P值   <0.001 <0.001 <0.001 0.117
图1 血清炎性指标水平对胰腺感染的预测价值
表3 血清炎性指标水平对胰腺感染的预测价值
指标 临界值 AUC 95% CI P值 敏感度(%) 特异度(%)
IL-6 94.32 pg/mL 0.750 0.646~0.855 <0.001 81.00 65.20
IL-8 15.73 pg/mL 0.736 0.612~0.860 0.001 61.90 80.90
IL-10 50.93 pg/mL 0.728 0.593~0.864 0.001 66.70 78.70
联合检测 - 0.850 0.765~0.935 <0.001 81.00 74.20
表4 生存组与死亡组MCTSI评分与血清炎性指标水平比较（±s）
组别 例数 IL-6(pg/mL) IL-8(pg/mL) IL-10(pg/mL) MCTSI评分
生存组 93 89.43±10.33 139.92±20.35 58.45±7.41 5.73±1.34
死亡组 17 102.92±19.17 158.90±22.06 51.66±8.06 7.80±1.23
t值   4.242 3.491 3.428 5.926
P值   <0.001 <0.001 <0.001 <0.001
图2 MCTSI评分联合血清炎性指标预测重症急性胰腺炎患者预后效能分析
表5 MCTSI评分联合血清炎性指标水平预测重症急性胰腺炎患者预后效能分析
指标 临界值 AUC 95% CI P值 敏感度(%) 特异度(%)
IL-6 95.87 pg/mL 0.687 0.555~0.819 0.014 70.60 67.70
IL-8 153.06 pg/mL 0.685 0.532~0.838 0.016 64.70 75.30
IL-10 54.01 pg/mL 0.667 0.547~0.788 0.029 76.50 53.80
MCTSI评分 7分 0.773 0.660~0.886 <0.001 76.50 65.60
联合检测 - 0.872 0.800~0.945 <0.001 94.10 74.20
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