多层螺旋CT灌注成像在急性胰腺炎中的价值

目的:探讨多层螺旋计算机断层扫描(computed tomography,CT)灌注成像在急性胰腺炎(acute pancreatitis,AP)中的应用价值.方法:收集南方医院影像中心60例AP患者的临床资料,按照《中国急性胰腺炎诊治指南规范》分为重症急性胰腺炎(severe acute pancreatitis,SAP)30例(SAP组)和轻型急性胰腺炎(mild acute pancreatitis,MAP)30例(MAP组),选取30例胰腺正常的健康志愿者作为对照组研究对象,所有患者均进行多层螺旋CT灌注扫描,比较3组患者胰腺CT灌注参数:血流速度(blood flow,BF)、血容量(blood volume,BV)、峰值时间(time to peak,TTP)、表面通透性(permeability surface,PS),以及MAP与SAP组患者临床观测指标(腹痛缓解时间及住院总时间).结果:MAP组与SAP组患者BF和BV水平均显著低于正常组[123.79 m L/(100 mg·min)±55.35 m L/(100 mg·min)vs 214.55 m L/(100m g·m i n)±98.41 m L/(100 m g·m i n),63.55m L/(100 mg·min)±36.76 m L/(100 mg·min)vs 214.55 m L/(100 mg·min)±98.41 m L/(100m g·m i n),11.35 m L/100 m g±5.45 m L/100mg vs 18.13 m L/100 mg±14.56 m L/100 mg,7.43 m L/100 mg±2.45 m L/100 mg vs 18.13m L/100 mg±14.56 m L/100 mg],PS水平显著高于正常组[26.84 m L/(100 mg·min)±10.33 m L/(100 m g·m i n)vs 16.48 m L/(100m g·m i n)±8.67 m L/(100 m g·m i n),35.66m L/(100 mg·min)±12.45 m L/(100 mg·min)vs 16.48 m L/(100 mg·min)±8.67 m L/(100m g·m i n)],差异具有统计学意义(P<0.05);S A P组患者B F和B V水平显著低于M A P组[63.55 m L/(100 m g·m i n)±36.76 m L/(100m g·m i n)v s 123.79 m L/(100 m g·m i n)±55.35 m L/(100 m g·m i n),7.43 m L/100 m g±2.45 m L/100 mg vs 11.35 m L/100 mg±5.45 m L/100 mg],PS水平显著高于MAP组,[35.66 m L/(100 m g·m i n)±12.45 m L/(100m g·min)vs 26.84 m L/(100 mg·min)±10.33m L/(100 m g·m i n)],差异具有统计学意义(P<0.05);三组患者TTP水平比较(140.44/0.1s±23.44/0.1 s vs 142.41/0.1 s±13.95/0.1 s vs146.58/0.1 s±29.46/0.1 s),差异无统计学意义(P>0.05);SAP组患者腹痛缓解时间及住院总时间均显著长于MAP组,(64.55 h±21.35 h vs11.55 h±8.76 h,78.35 d±46.45 d vs 20.43 d±8.45 d),差异具有统计学意义(P<0.05).结论:AP患者胰腺血流灌注降低,病情与BF、BV、PS等指标紧密相关,CT灌注成像在急性胰腺炎病情评估中具有重要的临床价值.     

重症急性胰腺炎多层螺旋CT灌注研究

目的 探讨SAP的CT灌注特点,评价其临床价值.方法 使用16排螺旋CT对9例SAP患者、17例MAP患者以及41例胰腺正常者进行CT灌注扫描.应用perfusion 3软件包进行数据处理,计算各组的血流量(BF)、血容量(BV)、平均通过时间(MTT)、毛细血管通透性(IS)等灌注参数,并行独立样本t检验.结果 MAP组的BF、BV平均值为(121.5±55.27)ml·100 mg-1·min-1、(11.7±5.26)ml/100 mg,SAP组平均值为(63.58±36.91)ml·100 mg-1·min-1、(7.13±2.11)ml/100 mg,差异显著(P＜0.01);较正常组的(219.17 4.98.02)ml·100 mg-1·min-1和(18.60±14.75)ml/100 mg,均显著降低(P＜0.01).MAP组和SAP组的PS分别为(25.14±10.7)ml·100 mg-1·min-1和(34.61±11.25)ml·100 mg-1·min-1,均高于正常组的(16.61 ±9.36)ml·100 mg-1·min-1(P＜0.05).结论 CT灌注成像技术判断SAP的严重程度有临床应用价值.     

急性胰腺炎在螺旋CT诊断中的应用

探讨螺旋CT在急性胰腺炎诊断中的价值。回顾分析2002-2004年经临床和螺旋CT确诊的急性胰腺炎52例,其中男37例,女15例。所有病例均经CT平扫,其中增强扫描7例。根据胰腺坏死程度分轻度、中度和重度。轻度为斑片状坏死,中度为段状坏死,重度为整个胰腺坏死。水肿性胰腺炎34例,出血坏死性胰腺炎18例。按Balthazarf分级:A级3例,B级7例,C级16例,D级14例,E级12例。根据胰腺坏死程度分轻度6例,中度9例, 重度11例。螺旋CT检查对急性胰腺炎具有定性诊断价值。CT分级及胰腺坏死程度对急性出血坏死性胰腺炎病情的判断有很大价值。     

多层螺旋CT灌注成像评估急性胰腺炎的价值

目的 探讨CT灌注成像对急性胰腺炎(AP)患者病情严重程度的评估价值.方法 收集2006年8月至2008年1月AP患者82例,入院后2～3 d行多层螺旋CT(MSCT)胰腺灌注成像.另选取30名健康人群行腹部CT检查作对照.采用64层螺旋CT进行动态增强扫描,利用CT自带软件PCT进行处理得到灌注参数,比较血流量(BF)、血容量(BV)、峰值时间(TTP)、表面通透性(PS)变化.结果 AP组平均BF、BV、TTP、PS分别为(110.57±60.04)ml·100 ml-1·min-1、(156.68±65.11)ml/L、(146.58±29.46)0.1 S、(110.73±62.66)0.5 ml·100 ml-1·min-1,与对照组相比BF、BV明显下降(P<0.05),而TTP、PS变化差异无统计学意义(P>0.05).结论 AP患者胰腺血流灌注降低,且与病情严重程度有关,灌注参数BV、BF可用于评估AP病情的严重程度.     

不同辨证分型急性心肌梗死日分布的中医病理节律研究

目的 探索不同中医证型急性心肌梗死(AMI)日发病的时间节律.方法 对155例AMI患者进行问卷调查,并辨证分型,从中医时间医学的角度探究不同中医证型AMI的日发病节律.结果 155例AMI患者中各中医证型的例数由多到少依次为:气虚血瘀证>心血瘀阻证>气阴两虚证>心肾阴虚证>气滞血瘀证>痰阻心脉证>阳气虚衰证>阴寒凝滞证.心血瘀阻证、气虚血瘀证、心肾阴虚证AMI日发病高峰分别在下晡、平旦、日中;气阴两虚证AMI日发病高峰在日中、下晡.结论 2006年12月-2007年4月不同证型AMI发病高峰的五脏主时时段不尽相同,具有明显的中医病理节律.     

老年急性胰腺炎彩色多普勒超声和多层螺旋CT检查的影像学表现及检出率比较

目的比较老年急性胰腺炎(AP)的彩色多普勒超声及多层螺旋CT(MSCT)影像学表现差异及二者对AP的诊断价值。方法对考虑为AP的老年患者分别以彩色多普勒超声及MSCT对患者进行检查,所有病灶经实验室检查或手术病理检查确诊。结果 MSCT增强扫描与MSCT平扫在AP检出率方面差异无统计学意义(91.85%vs 86.67%,P0.05),二者均明显高于彩色多普勒超声,差异有统计学意义(69.93%,均P0.01);MSCT增强扫描检出51例重症AP,检出率为92.72%(51/55),显著高于MSCT平扫[80%(44/55)],差异有统计学意义(P0.05);彩色多普勒超声在重症AP的检出率最低,仅为49.09%(27/55)。彩色多普勒超声、MSCT平扫、MSCT增强扫描诊断AP的敏感性及特异性依次升高,差异均有统计学意义(P0.05)。结论彩色多普勒超声对于老年AP具备一定的临床应用价值,但易受脂肪及气体的干扰而无法确诊,临床需充分结合临床资料及生化指标等进行确诊。MSCT,尤其是增强MSCT对于AP和重症AP的诊断更为准确,可作为临床首选的影像学手段。     

溃疡性结肠炎中医辨证分型与TNF-α的相关性研究

[目的]研究肿瘤坏死因子-α（TNF-α）在溃疡性结肠炎（UC）患者血清中的表达水平及临床意义,并探讨UC患者血清中TNF-α水平与中医证型（大肠湿热证和脾虚湿盛证）的相关性.[方法]收集2011年5月-2013年12月我院和广州市中医医院消化科门诊及病房符合诊断标准的UC患者100例.将100例患者按Mayo UCAI标准分为活动期和缓减期,再将活动期的患者分为轻度活动、中度活动和重度活动,并进行中医辨证分型,检测血清TNF-α水平.[结果]UC活动期患者血清中TNF-α水平与缓解期组比较明显增高,差异有统计学意义（P＜0.05）.UC缓解期患者血清中TNF-α水平与活动期轻度比较,差异无统计学意义,与活动期中、重度比较,差异有统计学意义（P＜0.05）.UC患者不同病情程度血清中TNF-α水平比较,重度组UC患者血清TNF-α水平明显高于轻、中度组患者,而中度组患者又高于轻度组患者,三者比较差异有统计学意义（P＜0.05）.中医辨证分型大肠湿热证UC患者血清中TNF-α水平明显高于脾虚湿盛证患者,二者比较差异有统计学意义（P＜0.05）.[结论]各组血清中TNF-α含量增高与UC严重程度相平行,说明TNF-α对于判断UC患者组织炎症损伤的程度,观察病情发展及变化,有一定的诊断价值.UC患者血清中TNF-α水平与辨证分型有关,测量血清中TNF-α水平,可以协助中医辨证分型,从而为临床上UC的中医辨证提供参考依据,提高本病的临床诊治水平.     

急性胰腺炎多层螺旋CT灌注成像的应用价值

目的:应用多层螺旋CT探讨急性胰腺炎(acute pancreatitis,AP)患者胰腺CT灌注的变化以及CT灌注参数与急性胰腺炎临床常用病情指标的关系,以探讨CT灌注成像在急性胰腺炎中的临床应用价值.方法:2006-08/2008-01 急性胰腺炎患者82例,入院后2-3 d采用德国Siemens somatom Sensation 64层螺旋CT进行动态增强扫描,其中5例因患者移动等致胰腺CT灌注成像失败.30例对照组,其中3例健康志愿者,27例因其他疾病行腹部CT检查患者.利用螺旋CT自带软件PCT进行处理得到灌注参数:BF(血流量)、BV(血容量)、TTP(峰值时间)、PS(表面通透性)等.结果:急性胰腺炎组BF、BV较正常对照组相比下降明显(110.57±60.04 VS 133.55±25.70,156.68±65.11 VS 193.78±27.01,均P＜0.05),TTP、PS变化无统计学意义.重型急性胰腺炎与轻型急性胰腺炎相比,住院时间延长(11.51±8.46 d VS 20.91±8.40 d,P＜0.05),而腹痛缓解时间离散度大,虽有延长趋势,但无统计学意义.急性胰腺炎CT灌注参数BF、BV与腹痛缓解时间、住院总时间、局部并发症间存在相关关系(P＜0.05).结论:急性胰腺炎患者胰腺血流灌注降低,灌注参数Bv、BF与AP临床常用病情指标存在相关关系,CT灌注成像在AP病情评估中具有临床应用价值.     

多层螺旋CT在急性冠状动脉综合征诊断中的应用

急性冠状动脉综合征(ACS)是在动脉粥样硬化的基础上,斑块破裂、表面破损或裂纹引起血栓形成,导致冠状动脉不完全或完全闭塞,使心肌发生缺血或不同程度坏死的一组临床综合征。多层螺旋CT是一种新的无创性影像诊断技术,近年来临床已使用该技术检测冠状动脉狭窄和钙化,多层螺旋CT不仅可以评价冠状动脉狭窄或闭塞,还可以评价冠状动脉斑块的性质和心肌血流灌注情况。本文综述多层螺旋CT在ACS诊断中的作用。     

白细胞介素17表达与急性胰腺炎相关性研究

[目的]观察不同程度的急性胰腺炎（AP）大鼠血清及胰腺组织中白细胞介素（IL）17的表达,探讨IL-17和AP炎症程度的相关性及地塞米松对血清IL-17表达的影响。[方法]将54只SD大鼠随机分为3组：重症AP（SAP）组、轻型AP（MAP）组和假手术（SO）组。造模成功后3、6和12h分批处死各组大鼠,解剖观察各组大鼠胰腺组织及有无胸腹水,取胰腺组织行病理学评估;用酶联免疫吸附试验（ELISA）法检测各组大鼠血清和胰腺组织中IL-17的表达水平。另取SD大鼠36只建立SAP模型后,随机分为2组：地塞米松（治疗）组和0.85%氯化钠（对照）组。3、6和12h分批处死大鼠,ELISA法检测各组鼠血清和胰腺组织IL-17表达水平。[结果]①MAP组和SAP组血清及胰腺组织中IL-17表达水平均高于SO组（P〈0.01）;并且SAP大鼠血清及胰腺组织中IL-17表达水平均低于MAP（P〈0.01）。②地塞米松治疗组大鼠血清及组织IL-17表达水平均低于对照组（P〈0.01）。[结论]IL-17的表达水平与AP的严重程度密切相关;地塞米松可以抑制IL-17表达,改善AP的严重程度。     

Persistent SIRS and acute fluid collections are associated with increased CT scanning in acute interstitial pancreatitis

Background: The use of computed tomography (CT) in acute pancreatitis (AP) continues to increase in parallel with the increasing use of diagnostic imaging in clinical medicine.

Aim: To determine the factors associated with obtaining >1 CT scan in acute interstitial pancreatitis (AIP).

Methods: Demographic and clinical data of all adult patients admitted between 1/2010 and 1/2015 with AP (AP) were evaluated. Only patients with a CT severity index (CTSI)?≤?3 on a CT obtained within 48?h of presentation were included.

Results: A total of 229 patients were included, of whom 206 (90%) had a single CT and 23 (10%) had >1 CT during the first week of hospitalization. Patients undergoing >1 CT had significantly higher rates of acute fluid collection (AFC), persistent SIRS, opioid use ≥4 days, and persistent organ failure compared to those undergoing 1 CT (p?p?=?.01) and an AFC on initial CT (OR?=?3.5, 95% CI 1.4–9, p?=?.009) were independently associated with obtaining >1 CT.

Conclusion: An AFC on initial CT and persistent SIRS are associated with increased CT imaging in AIP patients. However, these additional CT scans did not change clinical management.     

急性胰腺炎CT检查时机选择

目的探讨急性胰腺炎患者最佳CT检查时间。方法本研究选择2008年1月~2010年3月对确诊的172例急性胰腺炎的患者,随机分为3组,分别在发病≤12 h、12~24 h、48~72 h行CT检查。为观察病情变化,在发病≤12 h行CT检查的患者在72~120 h期间行第二次CT检查,分析不同时间段的CT检出率和Balthazar分级情况,以确定最佳CT检查时间。结果随着时间的推移,CT检查发现胰腺炎的阳性率逐渐增高,88.7%的患者12~24 h CT检查阳性率明显高于在发病12 h之内行CT检查的阳性率,差异显著（P〈0.05）,但与在发病48~72 h和72~120 h行CT相比,无显著差异（P〉0.05）。按照Balthazar CT分级标准,对确诊的胰腺炎患者不同时间段分级进行研究发现：随着时间的延长,患者D级、E级检出率逐渐增多,48~72 h D级、E级检出率明显高于12 h之内和12~24 h之间检出率（P〈0.05）;但与72~120 h相比,无显著性差异（P〉0.05）。结论对于疑诊胰腺炎的患者在发病12~24 h行CT检查可较早检测到胰腺炎的变化;在48~72 h行CT检查可较早检测到胰腺炎的严重程度。     

GC-MS based metabolomics strategy to distinguish three types of acute pancreatitis

Acute pancreatitis (AP) is a progressive systemic inflammatory response with high morbidity and high mortality, which is mainly caused by alcohol, bulimia, gallstones and hyperlipidemia. The early diagnosis of different types of AP and further explore potential pathophysiological mechanism of each type of AP is beneficial for optimized treatment strategies and better patient's care. In this study, a metabolomics approach based on gas chromatography-mass spectrometry (GC-MS), and random forests algorithm was established to distinguish biliary acute pancreatitis (BAP), Hyperlipidemia acute pancreatitis (HLAP), and alcoholic acute pancreatitis (AAP), from healthy controls. The classification accuracies for BAP, HLAP, and AAP patients compared with healthy control, were 0.886, 0.906 and 0.857, respectively, by using 5-fold cross-validation method. And some special metabolites for each type of AP were discovered, such as l-Lactic acid, (R)-3-Hydroxybutyric acid, Phosphoric acid, Glycine, Erythronic acid, l-Phenylalanine, d-Galactose, l-Tyrosine, Arachidonic acid, Glycerol 1-hexadecanoate. Furthermore, associations between these metabolites with the metabolism of amino acids, fatty acids were identified. Our studies have illuminated the biomarkers and physiological mechanism of disease in a clinical setting, which suggested that metabolomics is a valuable tool for identifying the molecular mechanisms that are involved in the etiology of BAP, AAP, HLAP and thus novel therapeutic targets.     

Diagnosing acute pancreatitis and assessing its severity by enhanced computed tomography: Correlations with Ranson’s assessment method

Using the criteria of the Japanese Ministry of Health and Welfare for evaluation of the severity of acute pancreatitis based on computed tomography (CT), we assessed the CT grade of 104 patients with acute pancreatitis. The CT assessments were compared with the status of acute pancreatitis in these patients, assessed using Ranson’s system of objective prognostic signs by which acute pancreatitis is classified as “mild”, “moderate”, or “severe.” A CT grade of I corresponded to Ranson’s mild category; CT grades II and III corresponded to moderate, and CT grades IV and V corresponded to servere. Some patients with a CT grade of IV or V died, whereas none of the patients with CT grades of I, II, or III succumbed to the condition. This study confirmed that enhanced CT provides an accurate CT grading of acute pancreatitis. We emphasize the necessity of using enhanced CT for determining the severity of acute pancreatitis, not only on admission but also during hospitalization if the patient’s condition should become exacerbated.     

Effect of microcirculatory perfusion on distribution of trypsinogen activation peptides in acute experimental pancreatitis

Extraintestinal trypsinogen activation peptides (TAP) have been shown to correlate with severity of acute pancreatitis in humans as well as in various animal models. Ischemia superimposed on experimental pancreatitis, however, increases acinar cell injury without increasing TAP in plasma. We speculated that TAP generated in the pancreas might not reach the circulation in necrotizing pancreatitis due to decreased pancreatic perfusion. To test the hypothesis that generation of TAP in plasma is related to pancreatic perfusion and that plasma TAP may therefore underestimate acinar cell injury in necrotizing disease, we correlated TAP in pancreatic tissue and body fluids with capillary pancreatic blood flow in necrotizing and edematous pancreatitis. The ratio between necrosis and TAP in tissue was similar in both models; the ratio between TAP in plasma and tissue, however, was significantly lower in necrotizing pancreatitis, indicating that a certain amount of TAP generated in the pancreas did not reach the circulation. Decreased pancreatic perfusion found in necrotizing pancreatitis was consistent with this finding. Our data suggest that TAP in tissue is most reliable to indicate severity of acute pancreatitis, whereas plasma TAP may underestimate pancreatic injury in necrotizing disease due to decreased pancreatic perfusion.     

急性胰腺炎患者血淀粉酶变化和CT诊断的比较

目的探讨血淀粉酶的变化规律及其机制。方法本研究对确诊的172例急性胰腺炎(AP)患者随机分为3组,分别在发病≤12 h、12～24 h、48～72 h行CT和血淀粉酶检查。分析不同时间段CT和血淀粉酶检出率。结果 87.5%患者血淀粉酶在6～12 h升高;100%患者血淀粉酶在12 h以上升高。91.3%的患者在12～24 h之间CT检查发现胰腺炎症变化,但与发病大于48 h相比,无显著差异。12 h之内,血淀粉酶升高的阳性率高于CT诊断的阳性率(χ2=22.04,P<0.01)。48～72 h D级、E级检出率明显高于12 h之内和12～24 h之间的检出率。血淀粉酶随着轻症急性胰腺炎分级水平有上升趋势;随着重症急性胰腺炎分级水平有下降趋势。结论血淀粉酶升高的水平与胰腺炎的病情程度无明显相关性,推测其机制可能与胰腺微循环受损程度有关。