Abstract
Relevance. Early detection of severe forms of acute pancreatitis remains an unsolved problem of urgent surgery.Objective of the study: early detection of prognostically unfavorable forms of the disease based on the constitutional characteristics of the patient.Materials and methods. A comparative prospective analysis of the clinical course of acute pancreatitis in 270 patients with an assessment of the prognostic significance of clinical, instrumental and anthropological data in the early diagnosis of severe forms of acute pancreatitis was carried out. In 179 patients there was a moderate and severe form of the disease, in 91 patients the disease was mild.Results and discussion. ROC analysis of the studied criteria showed that clinical and laboratory data on the first day of the disease are not reliable predictors of the risk of death. The somatotype and the amount of adipose tissue in the body (type of nutrition) showed a significant predictive value of AUC (0.768 and 0.655, p < 0.01 and p < 0.05, respectively). At the same time, only the body type AUC (0.658, p < 0.0001) showed statistical reliability as a significant prognostic factor for the progress severity of the patient's condition. The criti cal boundary calculated value of the somatotype is 20 nominal units. The risk group includes persons with a body type close to brachymorphic.Conclusion. Carrying out somatotyping with the calculation of its numerical values, attributing the patient to a particular type of physique in the group of patients with acute pancreatitis in the early stages from the moment of the disease, is an additional criterion for early prediction of the course of acute pancreatitis and will allow to determine the competent treatment to avoid manifestation of severe form of disease.
Highlights
Early detection of severe forms of acute pancreatitis remains an unsolved problem of urgent surgery
early detection of prognostically unfavorable forms of the disease based on the constitutional characteristics of the patient
Определение при остром панкреатите того или иного типа телосложения и типа питания служит дополнительным фактором в комплексной оценке состояния пациента, определяющим риск неблагоприятного исхода и развития более тяжёлой формы заболевания, и позволяет индивидуализировать подход к лечению конкретного пациента
Summary
1) видно, что такие показатели как уровень альфа-амилазы крови, возраст пациента (оранжевая и коричневая пунктирные линии) являются абсолютно недостоверными факторами раннего прогноза тяжести острого панкреатита, поскольку значения располагаются ниже биссектрисы угла начала координат. Графики значений остальных факторов (соматотип, тип питания, индекс массы тела и количество критериев по шкале Ranson) располагаются выше биссектрисы, говорить однозначно о их достоверности возможно только после оценки основных критериев ROC-анализа (чувствительности, специфичности и уровня p < 0,05). 1, демонстрирует, что из изучаемых показателей наибольшую достоверность проявляют соматотип и тип питания, определенные по применяемой методике (отмечается наибольшая площадь под кривыми AUC), кроме того прогностическую значимость имеет такой показатель, как индекс массы тела.
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