| OBJECTIVE This study aimed to evaluate the severity of pancreatits,discuss the possibility of pancreas infection and look for the optimal timing of performing contrast-enhanced computed tomography(CECT)of the pancreas in severe acute pancreatitis(SAP)through assessing acute peripancreatic fluid collection(APFC),acute necrotic collection(ANC),pleural effusion(PF)and changes,MCTSI grade on CECT.METHODS Between February 2002 and July 2016,309 patients with SAP and available clinical and abdomen CT imaging data about APFC,ANC,PF and changes were enrolled in a study at the First Affiliated Hospital of Guangxi Medical University,which the diagnosis of SAP was consistent with the diagnostic criteria for acute pancreatitis in Atlanta in 2012.APFC areas include ? the area between the posterior wall of the stomach and small omental bursa and pancreas;?the left anterior kidney area;?right kidney front area;? the upper abdominal cavity which was around the paracolic gutters and the perihepatic,perisplenic and intestinal areas.Division classification was level I-1 areas,level II-2 areas,level III-3 areas and level IV-4 areas.ANC area:(1)?30% of the pancreas;(2)>30% of the pancreas.Through evaluating CECT of 309 SAP patients including the infection group(108 cases),in which there were 30 cases pancreas infection patients,and non-infection group(201 cases)within ?3 days,4~7 days,2 weeks,3 weeks,4 weeks,>4weeks of onset,we determined APFC,ANC,PF,their changes and grade of modified CT severity index(MCTSI).The P value compared between infection group and non-infection group was <0.05,said there was statistical significance.RESULTS 1.APFC on CECT of SAP was generally observed in four regions in all SAP and both infection group and non-infection group within 1week to 4 weeks or more time,in which the 4 regions of pancreatic infection patients accounted for 66.7%(20/30 cases)that was that the highest rate was found in all SAP,indicating the most severe inflammation of pancreatic infection.Within 4 weeks,percent of the infected group and the non-infected group in IV grade of APFC were 55.6%(15/27cases),25%(4/16cases),repectively.The APFC between the two groups were not significantly different(P>.05).The volume of APFCs,as detected by CT,was compared with privious CT in all SAP and the two groups.Specifically,the APFC volume increased within 4-7 days of onset and decreased within 2 weeks and 2 weeks or more through assessing using a prevous CT as the baseline.2.The occurrence of ANC in all SAP and both infection group and non-infection group within 1 week to 4 weeks or more of onset was ?30%,and the differences between the two groups were significantly different within ?3days and 4 weeks(P=.024,P=.047,respectively).Compared with the initial CT,ANCs were mainly increased within 4-7 days of onset and 4 weeks or more;however,no changes were observed within 2 weeks to 4 weeks of onset in all SAP.ANCs were mainly increased within 4-21 days and 4 weeks or more of onset and no change within 4 weeks in the infection group.ANCs were mainly increased within 4-7 days of onset and no change within 2 weeks or more in the non-infection group.Comparisons of necrosis between the infection and non-infection groups showed significant differences within 4 weeks(P=.027).3.PF was also mainly in all SAP and both groups on within 1week to 4 weeks or more of onset,in which the percent was most within 4-7days and highest in the patients of pancreatic infection.Exudation of PF in both the infection and non-infection groups was increased within 4-7 days of onset compared with the previous CT and was reduced at within 4weeks and thereafter.4.The MCTSI classification of the SAP patients in all SAP and both groups within 1week to 4 weeks or more of onset was primarily grade III.At 4 weeks compared both the infection and non-infected groups,there were significantly different with grade III of MCTSI(P=.016).The grade III of MCTSI was 83.3 %(25/30 cases)in patients with pancreatic infection of SAP.5.Only four of 309 cases(4/30 cases,13.3%)in SAP were diagnosed accordance rate with pancreatic infection as detected by indications of bubbles on the CT scans.CONCLUSIONS 1.The severity of pancreatic inflammation in SAP can be assessed on CECT through APFC,ANC,PF and their changes and MCTSI grade,but the possibility of pancreatic infection cannot be predicted.2.The optimal timing of preforming pancreatic CECT in SAP is within 1 week because pancreatic fluid accumulation improved and necrosis was no changed mainly at 2 weeks and 2 weeks or more.We can reduce the number of CT unless there is evidence of suspected pancreatic infection,can increase the number of CT appropriately.OBJECTIVE Aim to look for the relationship between C-reactive protein(CRP)and the severity and infection of pancreatitis on early stage of SAP in the patients of systemic inflammatory response syndrome(SIRS)of severe acute pancreatitis(SAP),predict the possibility of pancreas infection.METHODS A total of 309 cases SAP were enrolled in the study at the First Affiliated Hospital of Guangxi Medical University from February 2002 to July 2016.We performed a comprehensive analysis of the patients with SIRS.A total of 211 SIRS patients were selected from 309 cases SAP patients,in which the patients of infection and non-infection groups were 77 cases and 134 cases,respectively.The patients' CRP levels and APFC,ANC,PF and MCTSI on CECT were evaluated in 211 cases.RESULTS 1.SIRS in 309 SAP patients accounted for 68.3 %(211/ 309cases).In the infection and non-infection groups,there were 36.5%(77/211 cases)and 63.5% (134/211 cases)of SIRS,respectively.The difference in the number of SIRS cases did not reach the level of statistical significance(P>0.05).In the infection and non-infection groups with SIRS,the mortality rates were 18.2%(14/77 cases)and 8.2%(11/134 cases),respectively.In the infection group and non-infection group,the durations of SIRS were 11.6±12 days and 6.4±4.1 days,respectively.The following statistically significant between-group differences were observed: SIRS duration between two groups was statistically significant(P=.00).2.In SAP patients with SIRS,the average CRP was mainly more than 150 mg/L within ?3days,4-7days.But there was no significant difference between infection group and non-infection group(P > 0.05)about CRP level,in which the percent was highest within 4-7days.3.In the case of SIRS,the pantients of SAP on CECT were primarily APFC of mostly 3-4 areas,ANC,PF and grade III of MCTSI within ?3days,4-7days.The SIRS patients percent of SAP about APFC of mostly 3-4 areas,ANC,PF and grade III of MCTSI were mostly within 4-7days.But,the difference between infection group and non-infection group about APFC of mostly 3-4 areas,ANC,PF and grade III of MCTSI was not statistical significance(P>0.05).CONCLUSIONS 1.The mortality rate of SIRS patients was the higher in SAP.2.In case of SIRS of SAP,there was a correlation between having a CRP level>150 mg/L and APFC?ANC?PF and MCTSI grade,and this correlation was consistent with the severity of pancreatitis,especially 4-7 days.3.CRP could not predict pancreatic infection in SAP patients. |
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