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经皮胆道支架植入术后高淀粉酶血症和胰腺炎的发生率及危险因素分析
DOI: 10.3969/j.issn.1001-5256.2021.04.031
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。
作者贡献声明：许晨、周卫忠负责课题设计，资料分析，撰写论文；许晨、杨魏、顾杰参与收集数据，修改论文；周卫忠、施海彬负责拟定写作思路，指导撰写文章并最后定稿。
Incidence rates of hyperamylasemia and acute pancreatitis after percutaneous transhepatic biliary stenting and related risk factors
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摘要:
目的 分析经皮肝穿刺胆道支架植入(PTBS)术后高淀粉酶血症和急性胰腺炎的临床特征，探讨其相关危险因素。 方法 回顾性收集2016年3月—2020年2月于南京医科大学第一附属医院介入放射科收治且接受PTBS治疗的249例恶性胆道梗阻患者的临床资料。根据术后患者有无高淀粉酶血症或急性胰腺炎，将所有患者分为高淀粉酶血症和胰腺炎组(n=55)、无高淀粉酶血症和胰腺炎组(n=194)，并分析其发生率、严重程度及相关危险因素。计量资料两组间比较采用t检验或Mann-Whitney U检验。计数资料两组间比较采用χ2检验。将上述单因素分析中P < 0.1的因素纳入多因素logistic回归分析，探究PTBS术后高淀粉酶血症和急性胰腺炎的独立危险因素。 结果 PTBS术后，共55例(22.1%)发生血清淀粉酶异常升高，其中26例(10.4%)诊断为高淀粉酶血症，29例(11.7%)诊断为急性胰腺炎。所有胰腺炎均表现为轻度。多因素logistic回归分析发现，年龄(≤60岁)(OR=2.2，95%CI：1.07~4.52，P=0.033)、碘-125粒子条植入(OR=2.8，95%CI：1.21~6.45，P=0.016)、胆道支架跨乳头释放(OR=6.3，95%CI：2.85~14.05，P < 0.001) 及术中胰管显影(OR=13.9，95%CI：5.64~34.03，P < 0.001)是PTBS术后高淀粉酶血症和急性胰腺炎的危险因素。 结论 高淀粉酶血症和急性胰腺炎是PTBS术后相对常见的并发症。年龄≤60岁、同期碘粒子条植入、胆道支架跨乳头释放及术中胰管显影是PTBS术后发生高淀粉酶血症和胰腺炎的独立风险因素。 Abstract:Objective To investigate the clinical characteristics and risk factors of hyperamylasemia and acute pancreatitis after percutaneous transhepatic biliary stenting (PTBS). Methods A retrospective analysis was performed for the clinical data of 249 patients with malignant biliary obstruction who were admitted to Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, and underwent PTBS from March 2016 to February 2020, and according to the presence or absence of postoperative hyperamylasemia or acute pancreatitis, the patients were divided into two groups to analyze incidence rate, severity, and related risk factors. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for the factors with P < 0.1 in the univariate analysis to investigate independent risk factors for hyperamylasemia and acute pancreatitis after PTBS. Results After PTBS, 55 patients (22.1%) patients had abnormally elevated serum amylase, among whom 26 (10.4%) were diagnosed with hyperamylasemia and 29 (11.7%) were diagnosed with acute pancreatitis. All patients with acute pancreatitis had mild manifestations. The multivariate logistic regression analysis showed that age ≤60 years (odds ratio [OR]=2.2, 95% confidence interval [CI]: 1.07-4.52, P=0.033), iodine-125 seed strand implantation (OR=2.8, 95%CI: 1.21-6.45, P=0.016), biliary stent placement across the papilla (OR=6.3, 95%CI: 2.85-14.05, P < 0.001), and visualization of the pancreatic duct during surgery (OR=13.9, 95%CI: 5.64-34.03, P < 0.001) were risk factors for hyperamylasemia and acute pancreatitis after PTBS. Conclusion Hyperamylasemia and acute pancreatitis are relatively common complications after PTBS. Age ≤60 years, iodine-125 seed strand implantation, biliary stent placement across the papilla, and visualization of the pancreatic duct during surgery are independence risk factors for hyperamylasemia and acute pancreatitis after PTBS. -
Key words:
- Hyperamylasemia /
- Pancreatitis /
- Risk Factors
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表 1 患者基线特征
基本特征 数值 男/女(例) 131/118 年龄(岁) 64.6±9.9 肿瘤类型[例(%)] 胰腺癌 33(13.3) 胆囊癌 23(9.2) 胆管细胞癌 108(43.4) 肝细胞癌 57(22.9) 其他恶性肿瘤 28(11.2) 基础疾病[例(%)] 高血压 96(38.6) 糖尿病 37(14.9) 冠心病 22(8.8) 术前肝功能 ALT(U/L) 73.1(42.7~127.4) AST(U/L) 88.8(56.2~144.8) TBil(μmol/L) 190.7(113.2~311.3) 术前感染[例(%)] 68(27.3) 既往胆道引流手术史[例(%)] 103(41.4) 手术时长[例(%)] ≤60 min 194(77.9) >60 min 55(22.1) 支架数量[例(%)] 1个 164(65.9) 2个 76(30.5) ≥3个 9(3.6) 支架类型[例(%)] Cordis 136(54.6) Bard 72(28.9) Cook 41(16.5) 支架释放位置[例(%)] 乳头上方 140(56.2) 跨乳头 109(43.8) 胰管显影[例(%)] 39(15.7) 碘-125粒子条植入[例(%)] 51 (20.5) 
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表 2 PTBS术后高淀粉酶血症和胰腺炎的单因素分析
因素 高淀粉酶血症和胰腺炎组(n=55) 无高淀粉酶血症和胰腺炎组(n=194) 统计值 P值 性别(例) χ2=0.082 0.775 男 28 103 女 27 91 年龄(例) χ2=3.135 0.077 ≤60岁 28 73 >60岁 27 121 肿瘤类型(例) χ2=2.914 0.088 胰腺癌 3 30 非胰腺癌 52 164 高血压(例) χ2=0.004 0.949 是 21 75 否 34 119 糖尿病(例) χ2=0.616 0.433 是 10 27 否 45 167 冠心病(例) χ2=0.377 0.539 是 6 16 否 49 178 术前肝功能 ALT(U/L) 73.0(44.4~134.0) 75.3(41.4~116.0) Z=-0.433 0.433 AST(U/L) 92.2(57.2~144.4) 82.5(48.2~173.6) Z=-0.387 0.699 TBil(μmol/L) 185.4(116.8~310.6) 191.6(90.7~306.3) Z=-0.364 0.716 术前感染(例) χ2=1.044 0.307 是 18 50 否 37 144 既往胆道引流手术史(例) χ2=0.295 0.587 是 21 82 否 34 112 手术时长(例) χ2=0.003 0.956 ≤60 min 43 151 >60 min 12 43 支架数量(例) χ2=0.156 0.693 1个 35 129 ≥2个 20 65 支架类型(例) χ2=0.401 0.818 Cordis 28 108 Bard 17 55 Cook 10 31 支架释放位置(例) χ2=18.382 < 0.001 乳头上方 17 123 跨乳头 38 71 胰管显影(例) χ2=41.819 < 0.001 是 24 15 否 31 179 碘-125粒子条植入(例) χ2=3.212 0.073 是 16 35 否 39 159
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表 3 多因素logistic回归分析结果
因素 B值 P值 OR 95%CI 胰腺癌 -0.893 0.174 0.4 0.11~1.49 年龄(≤ 60岁) 0.786 0.033 2.2 1.07~4.52 碘-125粒子条植入 1.026 0.016 2.8 1.21~6.45 支架跨乳头释放 1.845 < 0.001 6.3 2.85~14.05 胰管显影 2.628 < 0.001 13.9 5.64~34.03
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