New Risk Factors for Infected Pancreatic Necrosis Secondary to Severe Acute Pancreatitis: The Role of Initial Contrast-Enhanced Computed Tomography
New Risk Factors for Infected Pancreatic Necrosis Secondary to Severe Acute Pancreatitis: The Role of Initial Contrast-Enhanced Computed Tomography
复制标题
继发于重症急性胰腺炎的感染性胰腺坏死的新危险因素：初始增强计算机断层扫描的作用
DOI：
10.1007/s10620-018-5359-y
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发表时间：
2019-02-01
影响因子：
3.1
通讯作者：
Lu, Nong-Hua
中科院分区：
文献类型：
--
作者：
Ding, Ling;Yu, Chen;Lu, Nong-Hua
背景和目的胰腺坏死是急性胰腺炎（AP）预后不良的危险因素。然而，最初的胰腺增强计算机断层扫描 (CT) 结果与感染性胰腺坏死 (IPN) 之间的关联尚不清楚。方法这是一项回顾性队列研究。纳入2014年1月至2016年12月南昌大学第一附属医院重症AP（SAP）患者并分为IPN组和非IPN组。依次进行单变量和多变量逻辑回归分析，以评估变量与 IPN 发展之间的关联。对合格的独立危险因素生成受试者工作特征（ROC）曲线。结果将 42 名 IPN 患者与 100 名无 IPN 患者进行比较。 AP 发病后 7 天（范围 3-10）进行增强 CT。多因素逐步Logistic回归分析显示，急性胰周积液（APFC）数量（OR 1.328，P= 0.006）、胰周及胰实质坏死（OR 4.001，P= 0.001）和胃肠道壁增厚（OR 3.353，P= 0.006）是发生胰腺癌的独立危险因素。 IPN 仅次于 SAP。 APFC 数量的 ROC 曲线下面积为 0.714，敏感性为 78.60%，截止值为 4.5，特异性为 57.30%。结论 APFC 数量、胰周及胰实质坏死、胃肠壁增厚是 IPN 的独立危险因素。由于初始增强 CT（AP 发病后约 7 天）在预测 IPN 中发挥着重要作用，因此临床医生考虑胰腺的初始成像非常重要。
Background and AimsPancreatic necrosis is a risk factor for poor prognosis of acute pancreatitis (AP). However, the associations between the findings on initial contrast-enhanced computed tomography (CT) of the pancreas and infected pancreatic necrosis (IPN) are unclear.MethodsThis was a retrospective cohort study. Patients with severe AP (SAP) from January 2014 to December 2016 at the First Affiliated Hospital of Nanchang University were enrolled and assigned to an IPN group and a non-IPN group. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and IPN development. A receiver operating characteristic (ROC) curve was generated for the qualified independent risk factor.ResultsForty-two patients with IPN were compared with 100 patients without IPN. Contrast-enhanced CT was performed 7 (range 3–10) days after AP onset. Multivariate stepwise logistic regression analyses showed that the number of acute peripancreatic fluid collections (APFCs) (OR 1.328,P= 0.006), presence of peripancreatic and pancreatic parenchymal necrosis (OR 4.001,P= 0.001), and gastrointestinal wall thickening (OR 3.353,P= 0.006) were independent risk factors for IPN secondary to SAP. The area under an ROC curve for the number of APFCs was 0.714, the sensitivity was 78.60%, and the specificity was 57.30% at a cutoff value of 4.5.ConclusionsThe number of APFCs, presence of peripancreatic and pancreatic parenchymal necrosis, and gastrointestinal wall thickening were independent risk factors associated with IPN. As initial contrast-enhanced CT (about 7 days from AP onset) plays an important role in predicting IPN, it is important for clinicians to consider initial imaging of the pancreas.