探究急性坏死性积聚转归的影响因素

闫威; 靳二虎; 魏玮; 杨洋; 刘超; 董力宁; 张娟; 韩雪

doi:10.15953/j.ctta.2024.295

探究急性坏死性积聚转归的影响因素

闫威^1a,,
靳二虎²,
魏玮^1b,
杨洋^1b,
刘超^1a,
董力宁²,
张娟^1a,
韩雪^1a, ,

1a.
中国中医科学院望京医院中国中医科学院望京医院
1b.
中国中医科学院望京医院脾胃科，北京，100102
2.
首都医科大学附属北京友谊医院放射科，北京，100050

基金项目: 国家中医药传承创新团队项目（ZYYCXTD-C-202210）。

详细信息

作者简介:
闫威（1984-），女，北京人，硕士，副主任医师。研究方向为腹部影像诊断。E-mail：yw285858404@sina.com

通讯作者:
韩雪✉，中国中医科学院望京医院放射科，主要从事医学影像诊断相关的临床、教学和科研工作。E-mail：hxmmc@126.com。

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出版历程
- 收稿日期: 2024-12-10
- 修回日期: 2025-02-13
- 录用日期: 2025-02-23
- 网络出版日期: 2025-03-22

Exploring the Influencing Factors of Acute Necrotic Accumulation Outcome

YAN Wei^1a,,
JIN Erhu²,
WEI Wei^1b,
YANG Yang^1b,
LIU Chao^1a,
DONG Lining²,
ZHANG Juan^1a,
HAN Xue^1a, ,

1a.
Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing 100102, China Department of Radiology
1b.
Wangjing Hospital, Chinese Academy of Traditional Chinese Medicine, Beijing 100102, China Spleen and Stomach Department
2.
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

摘要

摘要:
目的：探究急性坏死性积聚（ANC）转归为包裹性坏死（WON）的独立危险因素及预测效能。方法：回顾性分析53例ANC的CT/MRI特征，根据ANC形成4周后的转归分为WON组与吸收组，采用卡方检验或t检验比较两组在病因、实验室检查方面差异的统计学意义。采用回归法分析影响ANC转归的独立危险因素，并绘制受试者工作特征（ROC）曲线，获得曲线下面积（AUC），评价各危险因素对ANC转归为WON的预测效能。结果：Logistic回归分析显示，坏死体积≥30%与MCTSI＞6分的P值均＜0.05，OR值分别为9.21、16.04。ROC曲线分析显示，坏死体积≥30%与MCTSI＞6分的P值均＜0.05，AUC值分别为0.86、0.88。结论：坏死体积≥30%与MCTSI＞6分为ANC演变为WON的独立危险因素，且二者预测效能均较显著。
- 急性坏死性积聚 /
- 转归 /
- 包裹性坏死 /
- CT /
- MRI
Abstract:
Objective
To explore the independent risk factors and predictive efficacy of ANC conversion to encapsulated necrosis (WON). Methods: A Retrospective analysis of CT/MRI features in 53 cases of ANC, divided into the WON and absorption groups, based on the outcome after 4 weeks of ANC formation. The chi square test or t-test were used to compare the statistical significance of differences in etiology and laboratory tests between the two groups. Regression analysis was used to identify independent risk factors affecting the outcome of ANC. Receiver operating characteristic (ROC) curves were used to obtain the area under the curve (AUC) and evaluate the predictive efficacy of each risk factor for the outcome of ANC to WON.
Results
Logistic regression analysis showed that the P-values for necrotic volume ≥ 30% and MCTSI score > 6 were both < 0.05, with OR values of 9.21 and 16.04, respectively. ROC curve analysis showed that the P-values for necrotic volume ≥ 30% and MCTSI score> 6 were both < 0.05, with AUC values of 0.86 and 0.88, respectively.
Conclusion
Necrosis volume ≥ 30% and MCTSI score > 6 points are independent risk factors for the progression of ANC into WON, and the predictive performance of both is significant.
- acute necrotic accumulation /
- reversion /
- encapsulated necrosis /
- CT /
- MRI

HTML全文

图 1 男，55岁，急性坏死性胰腺炎及4周后ANC转归

注：（a）发病后第11天轴面增强CT检查，坏死体积＞30%（箭），MCTSI评分8分；（b）发病后3个月第11天轴面CT平扫检查，ANC演变为WON（箭）。

Figure 1. Male,55 years old; Acute necrotizing pancreatitis and ANC outcome after 4 weeks

下载: 全尺寸图片幻灯片

图 2 女，63岁，急性坏死性胰腺炎4周后ANC转归

注：发病后第73天，MRI检查轴面增强T1 WI静脉期显示WON的囊壁连续且清晰（箭）。

Figure 2. Female,63 years old; ANC outcome after 4 weeks of acute necrotizing pancreatitis

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图 3 坏死体积≥30%与MCTSI评分＞6分预测ANC演变为WON的ROC曲线

Figure 3. ROC curve predicting ANC evolution to WON with necrotic volume ≥ 30% and MCTSI score > 6

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表 1 WON组与吸收组的影像与临床资料比较

Table 1 Comparison of Imaging and Clinical Data between WON Group and Absorption Group

影响因素		分组		统计检验
影响因素		WON组（n=33）	吸收组（n=20）	$\chi^2/t $值	P
病因	胆石症	17	12	0.36	0.55
	酗酒	4	3	0.09	0.76
	高脂血症	11	3	1.31	0.25
实验室检查	总淀粉酶（U/L）	1096.69	1511.36	−0.75	0.46
	脂肪酶（U/L）	1094.87	1769.09	−0.10	0.33
	CRP（mg/L）	239.06	160.27	2.63	0.01

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表 2 ANC转归为WON影响因素的多因素Logistic逐步回归分析结果

Table 2 Results of Multi factor Logistic Stepwise Regression Analysis on Factors Influencing the Conversion of ANC to WON

因素	β值	SE值	Wald值	OR值	95%CI	P值
坏死累及胰腺	19.99	1636.82	0.00	48160.41	0.00~	0.99
坏死累及胰头颈和/或胰体	−0.76	1.73	0.20	0.47	0.02~13.79	0.66
坏死体积	2.22	1.15	3.76	9.21	0.98~86.88	0.05
MCTSI评分	2.78	1.16	5.75	16.04	1.66~154.92	0.02
CRP（mg/L）	0.00	0.01	0.07	1.00	0.99~1.02	0.79

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表 3 坏死体积≥30%与MCTSI评分＞6分的预测效能

Table 3 Predictive efficacy of necrotic volume ≥ 30% and MCTSI score > 6 points

因素	AUC	P值	95%置信区间	敏感性（%）	特异性（%）	折点（%/分）
坏死体积≥30%	0.86	0.00	0.77~0.99	81.82	90	30
MCTSI评分＞6分	0.88	0.00	0.75~0.97	90.97	85	8

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