| Objective: As the incidence of acute pancreatitis(AP) increased in the recent years, early judging the severity of acute pancreastitis and whether there is amalgamative infection are very important for treatment and improving prognosis. Almost all of the literature stressed on the significance of the increases of white blood cell(WBC), rarely concentrated on the role of neutrophil rate(NR). However, recent studies showed that the sensitivity of WBC decreased, which could not meet the clinical needs. While there was few research on NR, a traditional indicator for infection, which was applied in a wide range of clinical, its value might be underestimated. This study will investigate the role of NR in patients with AP and the severity of SAP and the relationship between NR and severe acute pancreatitis to evaluate the clinical value of NR objectively.Methods: 1568 patients with AP admitted in Chongzhou People’s Hospital were studied from September 2010 to October 2014. The standard of AP diagnosis was based on the guideline published in 2003 by the Pancreatic Disease Branch of Chinese Medical Association. All the patients were classified into three groups: mild acute pancreatitis(MAP), severe acute pancreatitis(SAP) and acute pancreatitis on chronic pancreatitis(AP-on-CP). All clinical data were collected, including general data(age and sex), laboratory data(WBC,NR and et al) and imaging data(abdominal ultrasound imaging data and abdominal CT). The whole clinical and laboratory data were collected from the managing system of Chongzhou Hospital and imaging data from PACS. NR and the WBC expression in patients with different types of AP were investigated, and positive rate, sensitivity and specificity were recorded. SPSS19.0 was used to run statistical data analysis. Categorical data were shown in percentage, comparisons between groups were examined by chi-square test;measurement data were shown in x±s, comparisons between groups were estimated by one-way ANOVA. The difference was statistically significant if P had been less than 0.05.Results: 1568 patients were collected, among which the number of male was 777. The age ranged from 7 to 93(51.8±16.1).Patients with MAP, SAP and AP-on-CP were 74.81%, 18.56% and 6.63% respectively. The sex among these groups had no statistically significant difference(P>0.05). The age of onset in AP-on-CP was elder than that in MAP and SAP(P<0.001). The positive rate of WBC was lower than that of NR in patients with MAP, SAP and AP-on-CP(P<0.001). The sensitivity of WBC and NR were highest in SAP, then MAP,and lowest in AP-on-CP(P<0.05). In patients with SAP, the positive rate of WBC>16×109/L is only 30.93%, while regarding the positive rate of NR>0.85 as positive standard it was 70.79%(P<0.001). The area under the ROC curve confirm that NR > 0.85 was the best point.Conclusions:(1) The clinical significance of NR elevation which isindicator of antibiotic use as well as judging the severity of SAP value is higher than the WBC in patients with SAP.(2) There is a suggestion that NR > 0.85 as one of the important indicators of diagnosis and judging the severity of SAP.(3)The onset age of AP-on-CP is older than MAP and SAP, which indicates AP-on-CP may be secondary to AP.Objective: As the incidence of acute pancreatitis(AP) increased in the recent years, it is very important for early diagnosis of AP to prognosis amd treatment. As one of the most significant test, CT scan is also recommended by the guideline, which is widely utilized. There are quite a few research on dynamic analysis of CT scanning in patients with SAP. To evaluate the severity of pancreatic trends and changes in the incidence of complications,dynamic analysis of CT scanning in different year of SAP onset were done.Methods: 295 patients which were diagnosed as SAP and admitted to Chongzhou People’s Hospital were studied from January 2012 to December2014. Abdominal CT image within 3 days were collected via medical imaging management system. The situation of pancreas and other complications were recorded, including CT classification, pleural effusion, fat liver, splenomegaly,gastric retention, gastrointestinal wall thickening, calcification of the pancreas,pancreatic duct dilatation, gallstones(also effusion in gall) or absent gallbladder and intrahepatic bile duct stones. SPSS 19.0 was used to run statistical data analysis. Categorical data were shown in percentage, comparisons between groups were examined by chi-square test; measurement data were shown in x±s, comparisons between groups were estimated by one-way ANOVA. The difference was statistically significant if P had been less than 0.05. Results: In295 patients with SAP from January 2012 to 2014 in December,cholecystectomy /cholecystitis as inducing factor accounted for a higher proportion of patients(73.84%-83.05%), and there was an upward trend. The Balthazar CT classification of SAP decreased, which was that the rate of grade D descended(76.92% down to 18.18%), while that of grade C increased(12.31% rise to 67.77%), and there was a significant difference(P<0.05). The incidence of pancreatic duct enlargement and calcification of pancreas among SAP increased(6.15% to 18.18%, 3.08% to 6.61% respectively), suggesting that patients with chronic pancreatitis constituent ratio in SAP was significantly increased(P <0.05). As for the complications, the incidence of gastrointestinal wall thickening increased(15.38% to 82.18%), while the incidence of gastric retention and pleural effusion descended(60% to 23.96%, 75.38% to 32.23%respectively), and there were statistical significance. The rate of fat liver and splenomegaly in patients with SAP increased. The former raised from 60% to82.18%, and the latter raised from 63.08% to 83.17%(P<0.05). The study found that at the same time, patients with splenomegaly did not show thrombocytopenia.Conclusions:(1) The Balthazar CT grade in patients with SAP descendes, which grade D lowers, while that of grade C higher.(2) The cause of SAP is mainly biliary(including cholecystectomy and cholecystitis),the rate of which still gradually increased.(3) Among all SAP, the proportion of chronic pancreatitis is higher, which may lead to reduction of the severity of SAP.(4) As for the complications, the incidence of gastrointestinal wallthickening increases, while that of gastric retention and pleural effusion descendes.(5) It indicates that fat liver disease and splenomegaly in patients with SAP increase gradually. |
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