80岁以上老年急性胰腺炎患者的临床特征分析

徐劲; 蒋鑫; 严永峰; 钟瑞; 彭燕; 汤小伟; 唐川康

doi:10.3969/j.issn.1001-5256.2021.01.028

80岁以上老年急性胰腺炎患者的临床特征分析

DOI: 10.3969/j.issn.1001-5256.2021.01.028

西南医科大学附属医院消化内科，四川泸州 646000

基金项目:

泸州市科技局基金 (17246);

泸州市三方联合基金 (Z1437);

西南医科大学附属医院科研基金 (07037);

西南医科大学附属医院博士启动基金 (16229)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突，特此声明。

作者贡献声明：徐劲、蒋鑫负责课题设计，资料分析，撰写论文; 严永峰、钟瑞参与收集数据; 彭燕、汤小伟修改论文; 唐川康负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

作者简介:
徐劲(1989—)，女，主要从事胰腺病方面的研究

通信作者:
唐川康，732008116@qq.com

中图分类号: R576
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出版历程
- 收稿日期: 2020-07-14
- 录用日期: 2020-08-08
- 出版日期: 2021-01-20

Clinical features of elderly patients with acute pancreatitis aged ≥80 years

Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China

摘要

摘要: 目的探讨≥80岁老年急性胰腺炎(AP)患者的临床特征。方法回顾性分析2013年1月—2019年12月西南医科大学附属医院消化内科收治的3642例AP患者，分为青年组(＜65岁，n=2955)、中老年组(65~79岁, n=558)、老年组(≥80岁, n=129例)。收集并统计分析3组患者的资料信息，包括性别、年龄、病因、诱因、既往病史、病情严重程度、并发症和临床转归等。符合正态分布的计量资料3组间比较采用one-way ANOVA检验，进一步两两比较采用LSD-t检验; 不符合正态分布的计量资料3组间比较采用Mann-Whitney U检验; 计数资料3组间比较采用χ²检验或Fisher精确概率法，有序多分类变量比较采用Kruskal-Wallis H检验。结果中老年组和老年组女性比例均高于青年组(P值均＜0.05);老年组并发高血压比例均高于中老年组和青年组(P值均＜0.05);老年组并发高脂血症比例低于青年组(P＜0.05)。3组AP患者均以高脂饮食为主要诱因，老年组因酒精、高脂饮食+酒精诱发AP比例均低于青年组(P值均＜0.05);老年组以胆道疾病为病因的比例高于中老年、青年组(P值均＜0.05)，而高脂血症、酒精、胆道疾病+高脂血症比例均低于青年组(P值均＜0.05)。老年组中发生轻症急性胰腺炎83例(64.3%)，中度重症急性胰腺炎23例(17.8%)，重症急性胰腺炎23例(17.8%)，与中老年组及青年组相比，病情严重程度构成比例差异均有统计学意义(P值均＜0.05);老年、中老年组复发比例均低于青年组(P值均＜0.05)。在全身并发症方面，老年组发生肺炎、急性肾损伤、多器官功能障碍综合征的比例均高于青年组(P值均＜0.05)。老年组治愈病例比例均低于中老年组和青年组(P值均＜0.05)，好转病例比例均高于中老年组和青年组(P值均＜0.05)。老年组和中老年组放弃治疗比例均高于青年组(P值均＜0.05)。老年组死亡1例(0.8%)，中老年组死亡9例(1.6%)、青年组死亡16例(0.5%)，3组间比较差异无统计学意义(P＞0.05)。3组患者住院天数及住院费用比较差异均无统计学意义(P值均＞0.05)。结论 ≥80岁AP患者以女性为主，多由胆源性因素引起，易并发肺炎、急性肾损伤、多器官功能障碍综合征。
- 胰腺炎 /
- 老年人 /
- 疾病特征
Abstract: Objective To investigate the clinical features of elderly patients with acute pancreatitis (AP) aged ≥80 years. Methods A retrospective analysis was performed for 3642 patients with pancreatitis who were admitted to Department of Gastroenterology in The Affiliated Hospital of Southwest Medical University from January 2013 to December 2019, and according to age, they were divided into young group (aged < 65 years) with 2955 patients, middle-aged group (aged 65-79 years) with 558 patients, and elderly group (aged ≥80 years) with 129 patients. Related clinical data were collected and analyzed, including sex, age, etiology, predisposing factors, past medical history, disease severity, complication, and clinical outcome. The independent samples one-way ANOVA-test was used for comparison of normally distributed continuous data between groups and the least significant difference t-test was used for comparison within each group; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between groups; the Kruskal-Wallis H test was used for comparison of ordinal categorical variables. Results In the young group, there were 1721 male patients and 1234 female patients; in the middle-aged group, there were 214 male patients and 334 female patients; in the elderly group, there were 48 male patients and 81 female patients; the middle-aged group and the elderly group had a significantly higher proportion of female patients than the young group (62.8% vs 61.6% vs 41.8%, P < 0.05). High-fat diet was the main predisposing factor for all three groups, and compared with the young group, the elderly group had a significantly lower proportion of patients with AP induced by alcohol or high-fat diet+alcohol (P < 0.05). The elderly group had a significantly higher proportion of patients with the etiology of biliary diseases than the middle-aged group and the young group (79.8% vs 69.2% vs 41.4%, χ²=204.127, P < 0.05), as well as a significantly lower proportion of patients with the etiology of hyperlipidemia, alcohol, or biliary diseases+hyperlipidemia (all P < 0.05). Among the 129 patients in the elderly group, 83 (64.3%) had mild AP, 23 (17.8%) had moderate-severe AP, and 23 (17.8%) had severe AP; there was a significant difference in the constituent ratio of disease severity between the elderly group and the middle-aged/young groups (H=1972.5, P < 0.05). The elderly group and the middle-aged group had a significantly lower proportion of patients with recurrence than the young group (both P < 0.05). There were no significant differences in local complications between the three groups (all P > 0.05), and as for systemic complications, compared with the young group, the elderly group had a significantly higher proportion of patients with pneumonia (3.9% vs 2.2%, P < 0.05), acute kidney injury (AKI) (6.2% vs 2.5%, P < 0.05), or multiple organ dysfunction syndrome (MODS) (7.8% vs 4.0%, P < 0.05). Compared with the middle-aged group and the young group, the elderly group had a significantly lower proportion of cured patients (67.4% vs 76.3% vs 82.0%, P < 0.05) and a significantly higher proportion of patients with improvement (23.3% vs 14.7%/12.7%, P < 0.05). The elderly group and the middle-aged group had a significantly higher proportion of patients withdrawn from treatment than the young group (8.5%/5.9% vs 3.4%, P < 0.05). There was 1 death in the elderly group (0.8%), 9 deaths in the middle-aged group (1.6%), and 16 deaths in the young group (0.5%), and there was no significant difference between the three groups (P > 0.05). There were no significant differences in length of hospital stay and hospital costs between the three groups (P > 0.05). Conclusion AP patients aged ≥80 years are mainly female and are often caused by biliary factors, and they are likely to develop the complications such as pneumonia, AKI, and MODS.
- Pancreatitis /
- Aged /
- Disease Attributes

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表 1 3组患者一般资料比较

项目	青年组(n=2955)	中老年组(n=558)	老年组(n=129)	统计值	P值
年龄(岁)	45.1±10.5	71.2±4.2¹⁾	83.5±3.5¹⁾²⁾	F=2 494.070	＜0.001
性别[例(%)]				χ²=90.884	＜0.001
男	1721(58.2)	214(38.4)¹⁾	48(37.2)¹⁾
女	1234(41.8)	344(61.6)	81(62.8)
既往疾病史[例(%)]
胆道疾病	261(8.8)	45(8.1%)	11(8.5)	χ²=0.367	0.832
高脂血症	109(3.7)	2(0.4)¹⁾	0¹⁾	χ²=21.858	＜0.001
糖尿病	166(5.6)	19(3.4)¹⁾	3(2.3)	χ²=6.924	0.030
高血压	238(8.1)	100(17.9)¹⁾	34(26.4)¹⁾²⁾	χ²=87.613	＜0.001
混合因素	274(9.3)	70(12.5)¹⁾	17(13.2)	χ²=7.162	0.028
既往手术史[例(%)]
胆囊或胆道手术	223(7.5)	41(7.3)	15(11.6)	χ²=3.009	0.222
ERCP	2(0.1)	2(0.4)	0	χ²=3.754	0.153
胃部手术	6(0.2)	1(0.2)	1(0.8)	χ²=1.897	0.387
注：1)与青年组比较，P＜0.05;2)与中老年组比较，P＜0.05。ERCP，经内镜逆行胰胆管造影。

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表 2 3组患者诱因与病因的差异性比较

项目	青年组(n=2955)	中老年组(n=558)	老年组(n=129)	χ²值	P值
诱因[例(%)]
高脂饮食	869(29.4)	136(24.3)¹⁾	31(24.0)	7.234	0.027
酒精	239(8.0)	31(5.5)¹⁾	4(3.1)¹⁾	8.125	0.017
高脂饮食+酒精	155(5.2)	2(0.4)¹⁾	0¹⁾	33.253	＜0.001
其他因素	10(0.3)	2(0.4)	2(1.6)	4.755	0.093
病因[例(%)]
胆道疾病	1223(41.4)	387(69.2)¹⁾	103(79.8)¹⁾²⁾	204.127	＜0.001
高脂血症	1002(33.9)	62(11.1)¹⁾	12(9.3)¹⁾	143.900	＜0.001
胆道疾病+高脂血症	148(5.0)	7(1.3)	1(0.8)	20.194	＜0.001
酒精	320(10.8)	35(6.3)¹⁾	4(3.1)¹⁾	17.908	＜0.001
药物	11(0.4)	5(0.9)	0	3.522	0.172
特发及其他	251(8.5)	63(11.3)¹⁾	8(6.2)	5.650	0.059
注：1)与青年组比较，P＜0.05;2)与中年组比较，P＜0.05。

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表 3 3组患者病情及复发差异性比较

项目	青年组(n=2955)	中老年组(n=558)	老年组(n=129)	统计值	P值
分型[例(%)]				H=1 972.50	＜0.001
MAP	1898(64.23)	365(65.4)¹⁾	83(64.3)¹⁾²⁾
MSAP	545(18.44)	82(14.6)	23(17.8)
SAP	512(17.33)	111(19.8)	23(17.8)
复发[例(%)]
是	740(25.0)	74(13.3)¹⁾	16(12.4)¹⁾	χ²=45.22	＜0.001
否	2215(75.0)	484(86.7)	113(87.6)
注：1)与青年组比较，P＜0.05;2)与中老年组比较，P＜0.05。MAP，轻症急性胰腺炎; MSAP，中度重症急性胰腺炎。

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表 4 3组患者并发症比较

项目	青年组(n=2955)	中老年组(n=558)	老年组(n=129)	χ²值	P值
局部并发症[例(%)]
急性液体积聚	1111(37.6)	197(35.3)	50(38.8)	1.179	0.555
假性囊肿	92(3.1)	23(4.1)	4(3.1)	1.522	0.467
急性坏死物积聚	506(17.1)	125(18.8)	22(17.1)	0.948	0.623
包裹性坏死	97(3.3)	15(2.7)	3(2.3)	0.845	0.655
感染性胰腺坏死	44(1.5)	13(2.3)	0	4.280	0.118
腹腔出血	8(0.3)	1(0.2)	0		0.664
区域性门静脉高压	38(1.3)	4(0.7)	1(0.8)	1.491	0.474
消化道瘘	4(0.1)	0	0		0.433
胃流出道梗阻	2(0.1)	1(0.2)	0		0.681
全身并发症[例(%)]
肺炎	28(0.9)	12(2.2)¹⁾	5(3.9)¹⁾	13.207	0.001
SIRS	829(28.1)	145(26.0)	34(26.4)	1.120	0.571
ARDS	194(6.6)	39(7.0)	5(3.9)	1.686	0.430
AKI	75(2.5)	17(3.0)	8(6.2)¹⁾	6.436	0.040
胰性脑病	1(0)	1(0.2)	1(0.8)	9.005	0.011
脓毒症	30(1.0)	5(0.9)	1(0.8)	0.130	0.937
MODS	118(4.0)	36(6.5)¹⁾	10(7.8)¹⁾	9.879	0.007
注：1)与青年组比较，P＜0.05;2)与中老年组比较，P＜0.05。SIRS，全身反应炎症综合征; ARDS，急性呼吸窘迫综合征; AKI，急性肾损伤; MODS，多器官功能障碍综合征。

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表 5 3组患者临床转归、住院天数、住院费用比较

项目	青年组(n=2955)	中老年组(n=558)	老年组(n=129)	统计值	P值
临床转归[例(%)]
治愈	2423(82.0)	426(76.3)¹⁾	87(67.4)¹⁾²⁾	χ²=24.448	＜0.001
好转	375(12.7)	82(14.7)	30(23.3)¹⁾²⁾	χ²=12.908	0.002
转外科	40(1.4)	8(1.4)	0	χ²=1.809	0.405
放弃	101(3.4)	33(5.9)¹⁾	11(8.5)¹⁾	χ²=14.879	＜0.001
死亡	16(0.5)	9(1.6)¹⁾	1(0.8)	χ²=7.609	0.022
住院费用(元)	20 272.6 (14 619.9~33 548.8)	23 321.2 (14 905.2~33 780.9)¹⁾	19 050.7 (12 570.6~32 938.5)	H=1.055	0.348
住院天数(d)	12.38±7.64	12.86±8.23	12.07±8.39	F=7.059	0.290
注：1)与青年组比较，P＜0.05;2)与中老年组比较，P＜0.05。

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