| Objective: This study was to evaluate the relationship between the severity of acute pancreatitis(according to MRSI scoring system) and clinical features and biochemical indicators.Methods: 207 patients admitted in our hospital between Jan 2012 and Dec 2014 had been diagnosed with acute pancreatitis were retrospectively studied. According to MRSI, patients were divided into 3 groups: mild AP(0-3points), moderate AP(4-6points) and severe AP(7-10points). Non-parametric test and ANOVA analysis were used to assess the differences of clinical features and biochemical indicators among three different severities of AP, spearman correlation was used to evaluate their relationship. Two independent samples t-test and pearson correlation were used to evaluate the differences and connection between MRSI and APACHE Ⅱ scoring system.Result: Of 207 cases, 67 cases were mild AP(32.40%), 119 cases were moderate AP(57.50%), 21 cases were severe AP(10.10%). Comparing clinical features and biochemical markers with 3 different severities of AP, it turned out that hospitalization time, CRP, TCA had significant differences among three groups(P<0.05), while HCT, TG, APTT, PT had no difference(P>0.05); hospitalization time, CRP, TCA were correlated with MRSI(r=0.16, 0.25,-0.31 respectively and P<0.05), while other biochemical indicators had no correlation with MRSI(P>0.05). Although there was difference between MRSI and APACHE Ⅱ scoring system, they had weak positive correlation(r=0.41, r2=0.16, P=0.00).Conclusions:CRP, TCA can quickly determine the severity of AP, although there is difference between MRSI and APACHE Ⅱ scoring system, they are associated with each other.AbstractObjective: The purpose of this study was to identify the risks of acute recurrent pancreatitis from radiographic and clinical characteristics.Methods: From Jan 2010 to Dec 2012, 440 patients with acute pancreatitis had admitted in our institution and successfully underwent MRCP and abdominal MRI. These patients had been enrolled in a follow-up protocol until Dec 2014. According to exclusion criteria finally 249 patients were enrolled. During follow-up, acute pancreatitis with at least one recurrence constitute experimental group(n=40) while acute pancreatitis without recurrence served as control group(n=209). The assessment included the configuration of CBD and MPD when draining into duodenum, three different forms, that were B-P type and non-B-P type(V type, P-B type), and the angle of pancreaticobiliary junction when MPD draining into major papilla, MPD disconnection, the diameter of MPD, visualized MPD segments. Chi-Square test and Mann-Whitney u test were performed to compare the differences of these indicators between two groups, and ROC curve was used to evaluate the value when predicting ARP with the angle of pancreaticobiliary junction and the diameter of MPD. The severity of AP overall patients was graded by MRSI and APACHE Ⅱ scoring system. Determine the distinction of the incidence of AP relapsing among different severities of AP, whether pancreas and(or) peripancreatic adipose tissue hemorrhaged or putrefied. T-test and Chi-Square test were used to identify the distinction between two groups. Stepwise logistic regression was used to screen out the most significant risk and protective factors.Result: The average age of experimental group was younger than control group(P<0.05). Males accounted for 70%(28/40) of experimental group, which was higher than control group(P<0.05). The ratio of AP relapsing was higher when MPD drained into minor papilla than drained into major papilla(P<0.05). When MPD import major papilla together with CBD, the portion of ARP of B-P type was significantly higher than non-B-P type(P<0.05). The median angle of pancreaticobiliary junction in experimental group was larger than that of control group, and the median diameter of MPD was smaller in experimental group(P<0.05), however, these indicators had low accuracy in diagnosis of ARP(AUC=0.62, 0.61). The regression equation was Y(ARP) =-0.804-0.037(age) + 0.847(male) + 0.955(B-P type) + 1.557(MPD draining into minor papilla) + 1.395(MPD disruption), resulting from stepwise logistic regression, which meaned male, MPD draining into minor papilla, B-P type when MPD draining into major papilla with CBD, MPD disruption were risk factors while increasing age was a protective factor. For the part of visualized MPD segments, there was no significant difference between experimental and control groups(P>0.05). The incidence of AP relapsing among different severity of AP had no difference according to either MRSI or APACHE Ⅱ scoring system(P<0.05). Hemorrhage and necrosis of pancreas and(or) peripancreatic adipose tissue would not enhance the risk of ARP(P>0.05).Conclusions: Younger male patients with acute pancreatitis were more likely to relapse. Pancreatitis with MPD importing duodenum through minor papilla had higher chance of recurrence(P<0.05). When MPD drains into major papilla together with CBD, B-P type will greatly enhance the risk of ARP. Additionally, the larger angle of the pancreaticobiliary junction(>35°) and the smaller the diameter of MPD(≤2.29mm) were, the higher ratio of ARP will be, however these two indicators had low accuracy forecasting the recurrence of AP. When first occurrence AP accompanied by MPD disconnection, the incidence of recurrence will be largely increased. |
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