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妊娠期急性胰腺炎的临床特征及危险因素分析

吴迪 代大华 梁文美 付豹 傅小云

引用本文:
Citation:

妊娠期急性胰腺炎的临床特征及危险因素分析

DOI: 10.12449/JCH240522
基金项目: 

贵州省卫生健康委科学基金项目 (gzwk2022-015)

医学伦理声明本研究方案于2023年4月11日经由遵义医科大学附属医院伦理委员会审批,批号:KLL-2023-491。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:吴迪负责病例资料采集、分析以及论文的撰写;代大华负责病例筛选,数据评分;梁文美负责病例采集,统计数据;付豹负责监督研究过程,修改稿件;傅小云负责拟定研究方向,研究设计。
详细信息
    通信作者:

    傅小云, zyyxyfxy@163.com (ORCID: 0009-0000-8967-0518)

Clinical features of acute pancreatitis in pregnancy and related risk factors

Research funding: 

Guizhou Provincial Health Commission Scientific Research Fund Project (gzwk2022-015)

More Information
    Corresponding author: FU Xiaoyun, zyyxyfxy@163.com (ORCID: 0009-0000-8967-0518)
  • 摘要:   目的  分析妊娠期急性胰腺炎(APIP)的临床特征及母婴结局,探讨病情加重的危险因素并试图建立预测模型。  方法  选取2017年1月—2022年12月遵义医科大学附属医院收治的52例APIP患者,按病情严重程度分为轻型急性胰腺炎(MAP,n=32)、中度重症胰腺炎(MSAP,n=8)和重症胰腺炎(SAP,n=12),并进行回顾性分析。对各组临床资料进行Logistic回归分析,绘制受试者工作特征曲线(ROC曲线)评估危险因素对APIP病情严重程度的预测价值。符合正态分布计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Wilcoxon检验。计数资料组间比较采用χ2检验。  结果  52例APIP患者按病因分组:26例(50.0%)患者为高脂性胰腺炎、20例(38.5%)患者为胆源性胰腺炎、6例(11.5%)患者为特发性胰腺炎。依据孕周分组:1例(1.9%)患者处在妊娠早期、25例(48.1%)患者处在妊娠中期、26例(50.0%)患者处在妊娠晚期。10例(19.2%)患者并发急性呼吸窘迫综合征(ARDS),其中9例(90%)使用了呼吸机支持。不同严重程度APIP患者间AST、ALT、尿素氮、血糖、CRP、INR、是否肺炎、是否ARDS、是否脓毒症、是否肝功能不全和是否凝血功能不全的组间差异均有统计学意义(P值均<0.05)。单因素分析显示,APIP严重程度与血糖、尿素氮、CRP和肺炎有相关性(P值均<0.05),肺炎是APIP病情加重的危险因素(OR=18.938,95%CI:1.020~351.747,P=0.048)。CRP、血糖、尿素氮、INR联合预测APIP严重程度的ROC曲线下面积(0.954)高于CRP、血糖、尿素氮、INR的单独检测值(0.778、0.796、0.721、0.801)。  结论  肺炎是APIP病情加重的危险因素,CRP、血糖、尿素氮、INR可联合预测APIP严重程度。

     

  • 图  1  CRP、血糖、尿素氮、INR和联合指标预测APIP严重程度的ROC曲线

    Figure  1.  The ROC curve of CRP, Glu, BUN, INR, and combined indicators predicting the severity of APIP

    表  1  不同严重程度APIP患者的基线特征

    Table  1.   Baseline characteristics of APIP patients with different severity

    项目 MAP(n=32) MSAP(n=8) SAP(n=12) 统计值 P
    年龄(岁) 29.00±5.84 27.00±5.95 31.08±4.80 F=1.299 0.282
    初产妇[例(%)] 23(71.8) 4(50.0) 8(66.7) χ2=1.507 0.534
    发病孕期[例(%)] χ2=1.783 0.434
    早期 0(0.0) 0(0.0) 1(8.3)
    中期 18(56.3) 3(37.5) 4(33.3)
    晚期 14(43.8) 5(62.5) 7(58.3)
    病因[例(%)]
    胆源性 13(40.6) 5(62.5) 2(16.7) χ2=8.159 0.059
    高脂性 16(50.0) 1(12.5) 9(75.0)
    特发性 3(9.4) 2(25.0) 1(8.3)
    水肿型[例(%)] 27(84.4)1) 7(87.5)1) 3(25.0) χ2=14.302 0.001
    入住ICU[例(%)] 3(9.4)1) 5(62.5)1) 12(100.0) χ2=34.993 <0.001
    ICU停留时间(天) 0.00(0.00~0.00)1) 3.00(0.00~5.00)1) 9.50(7.00~11.75) H=7.955 0.019
    住院时间(天) 5.00(3.25~6.75) 14.00(8.00~17.75)2) 14.50(12.25~45.25)2) H=23.095 <0.001
    治疗费用(元) 3 988.34 (1 573.14~10 175.92)1) 44 933.84 (9 547.35~71 369.44)2) 75 828.25 (48 981.25~192 749.73) H=28.702 <0.001
    注:与SAP组比较,1)P<0.05;与MAP组比较,2)P<0.05。
    下载: 导出CSV

    表  2  不同严重程度APIP患者的生化指标比较

    Table  2.   Comparison of biochemical indices in patients with APIP of different severities

    指标 MAP(n=32) MSAP(n=8) SAP(n=12) 统计值 P
    ALT(U/L) 18.00(9.50~25.50) 69.00(16.25~131.75)1) 10.50(5.50~25.00) H=7.102 0.029
    AST(U/L) 30.00(21.00~40.00) 79.00(34.00~143.25) 1) 26.00(17.75~66.50) H=6.366 0.041
    尿素氮(mmol/L) 2.53(1.93~3.49) 1) 3.75(2.43~6.26) 3.55(2.56~6.39) H=7.077 0.029
    血糖(mmol/L) 4.25(3.42~5.29) 1) 5.54(5.10~6.94) 7.01(5.67~7.88) H=9.935 0.007
    CRP(mg/L) 35.74(3.38~128.45) 1) 127.72(29.99~173.53) 154.20(59.22~175.22) H=7.288 0.026
    INR 0.84(0.78~0.92) 1) 0.89(0.83~0.95) 1.00(0.90~1.20) H=10.081 0.006
    NLR 9.00(4.00~17.50) 1) 17.50(10.00~24.50) 16.00(8.25~21.00) H=6.236 0.044
    血淀粉酶(U/L) 254.00(127.00~960.00) 414.00(142.00~1 040.50) 225.00(77.00~677.00) H=1.036 0.596
    尿淀粉酶(U/L) 2 720.00 (1 477.00~7 041.00) 1 285.00 (374.00~3 664.00) 535.00 (397.00~7 336.75) H=2.172 0.338
    白细胞计数(×109/L) 12.94(9.03~16.94) 15.00(14.12~16.03) 16.12(10.89~20.37) H=4.140 0.126
    白蛋白(g/L) 32.61±4.58 32.88±5.99 32.78±6.32 F=0.056 0.946
    肌酐(μmol/L) 47.72±16.06 54.88±16.88 54.83±27.77 F=0.830 0.442
    甘油三酯(mmol/L) 12.71(2.50~17.23) 3.32(2.65~4.89) 11.96(4.79~17.48) H=2.469 0.291
    PT(s) 14.45±21.17 10.66±0.91 12.70±2.59 F=0.177 0.839
    注:与SAP组比较,1)P<0.05。
    下载: 导出CSV

    表  3  不同严重程度APIP患者的并发症及预后比较

    Table  3.   Complications and prognosis of APIP with different severity

    项目 MAP(n=32) MSAP(n=8) SAP(n=12) 统计值 P
    并发症[例(%)]
    肺炎 3(9.4)1) 3(37.5) 10(83.3) χ2=21.828 <0.001
    肝功能不全 0(0.0) 4(50.0)1)2) 1(8.3) χ2=13.206 0.001
    腹腔感染 1(3.1)1) 1(12.5) 5(41.7) χ2=9.529 0.004
    凝血功能不全 0(0.0)1) 0(0.0) 2(16.7) χ2=6.933 0.031
    ARDS 0(0.0)1) 2(25.0)2) 8(66.7) χ2=23.865 <0.001
    脓毒症 0(0.0)1) 0(0.0)1) 6(50.0) χ2=16.810 <0.001
    评分
    APACHEⅡ评分 9.67±1.531) 12.20±3.901) 14.50±4.40 F=6.068 0.010
    Ranson评分 2.0(2.0~2.0) 3.0(2.5~3.5) 3.0(2.5~4.0) H= 4.871 0.088
    结局[例(%)]
    胎儿存活 29(90.6) 6(75.0) 9(75.0) χ2=2.308 0.315
    注:与SAP组比较,1)P<0.05;与MAP组比较,2)P<0.05。
    下载: 导出CSV

    表  4  APIP严重程度危险因素分析

    Table  4.   Analysis of risk factors of APIP severity

    指标 单因素分析 多因素分析
    OR P 95%CI OR P 95% CI
    血糖 1.671 0.014 1.109~2.519 2.825 0.155 0.675~11.820
    尿素氮 1.638 0.022 1.075~2.496 1.897 0.205 0.704~5.108
    CRP 1.015 0.019 1.002~1.027 1.000 0.975 0.979~1.022
    肺炎 48.333 0.001 7.028~332.383 18.938 0.048 1.020~351.747
    下载: 导出CSV

    表  5  不同指标对APIP严重程度预测值

    Table  5.   Predicted values of APIP severity by different indicators

    指标 AUC 敏感度(%) 特异度(%) 准确度(%) P
    CRP 0.778 66.70 83.30 50.00 0.011
    血糖 0.796 71.00 83.30 54.30 0.030
    尿素氮 0.721 46.90 91.70 38.60 0.025
    INR 0.801 67.70 83.30 51.00 0.002
    联合检测 0.954 83.30 100.00 83.30 <0.001
    下载: 导出CSV
  • [1] DATE RS, KAUSHAL M, RAMESH A. A review of the management of gallstone disease and its complications in pregnancy[J]. Am J Surg, 2008, 196( 4): 599- 608. DOI: 10.1016/j.amjsurg.2008.01.015.
    [2] HUANG CL, LIU J, LU YY, et al. Clinical features and treatment of hypertriglyceridemia-induced acute pancreatitis during pregnancy: A retrospective study[J]. J Clin Apher, 2016, 31( 6): 571- 578. DOI: 10.1002/jca.21453.
    [3] BANKS PA, BOLLEN TL, DERVENIS C, et al. Classification of acute pancreatitis: 2012: Revision of the Atlanta classification and definitions by international consensus[J]. Gut, 2013, 62( 1): 102- 111. DOI: 10.1136/gutjnl-2012-302779.
    [4] WEI P, ZHAO XL, HOU WH, et al. Clinical characteristics and maternal and fetal outcomes of 166 patients with acute pancreatitis in pregnancy[J]. Chin J Pract Gynecol Obstet, 2022, 38( 7): 756- 759. DOI: 10.19538/j.fk2022070119.

    魏鹏, 赵先兰, 侯文汇, 等. 妊娠合并急性胰腺炎166例临床特征及母儿结局分析[J]. 中国实用妇科与产科杂志, 2022, 38( 7): 756- 759. DOI: 10.19538/j.fk2022070119.
    [5] DUCARME G, MAIRE F, CHATEL P, et al. Acute pancreatitis during pregnancy: A review[J]. J Perinatol, 2014, 34( 2): 87- 94. DOI: 10.1038/jp.2013.161.
    [6] TSUANG W, NAVANEETHAN U, RUIZ L, et al. Hypertriglyceridemic pancreatitis: Presentation and management[J]. Am J Gastroenterol, 2009, 104( 4): 984- 991. DOI: 10.1038/ajg.2009.27.
    [7] JIANG X, YAN YF, ZHONG R, et al. Clinical features of biliary acute pancreatitis versus hypertriglyceridemic acute pancreatitis[J]. J Clin Hepatol, 2020, 36( 9): 2050- 2055. DOI: 10.3969/j.issn.1001-5256.2020.09.028.

    蒋鑫, 严永峰, 钟瑞, 等. 胆源性急性胰腺炎与高甘油三酯血症性急性胰腺炎临床特点对比分析[J]. 临床肝胆病杂志, 2020, 36( 9): 2050- 2055. DOI: 10.3969/j.issn.1001-5256.2020.09.028.
    [8] ONG Y, SHELAT VG. Ranson score to stratify severity in acute pancreatitis remains valid-old is gold[J]. Expert Rev Gastroenterol Hepatol, 2021, 15( 8): 865- 877. DOI: 10.1080/17474124.2021.1924058.
    [9] Chinese Society for Emergency Medicine, Beijing-Tianjin-Hebei Alliance of Emergency Treatment and First Aid, Emergency Medicine Branch, Beijing Medical Association, et al. Expert consensus on emergency diagnosis and treatment of acute pancreatitis[J]. J Clin Hepatol, 2021, 37( 5): 1034- 1041. DOI: 10.3969/j.issn.1001-5256.2021.05.012.

    中华医学会急诊分会, 京津冀急诊急救联盟, 北京医学会急诊分会, 等. 急性胰腺炎急诊诊断及治疗专家共识[J]. 临床肝胆病杂志, 2021, 37( 5): 1034- 1041. DOI: 10.3969/j.issn.1001-5256.2021.05.012.
    [10] PITCHUMONI CS, YEGNESWARAN B. Acute pancreatitis in pregnancy[J]. World J Gastroenterol, 2009, 15( 45): 5641. DOI: 10.3748/wjg.15.5641.
    [11] GARG PK, SINGH VP. Organ failure due to systemic injury in acute pancreatitis[J]. Gastroenterology, 2019, 156( 7): 2008- 2023. DOI: 10.1053/j.gastro.2018.12.041.
    [12] SZATMARY P, GRAMMATIKOPOULOS T, CAI WH, et al. Acute pancreatitis: Diagnosis and treatment[J]. Drugs, 2022, 82( 12): 1251- 1276. DOI: 10.1007/s40265-022-01766-4.
    [13] TANG SJ, RODRIGUEZ-FRIAS E, SINGH S, et al. Acute pancreatitis during pregnancy[J]. Clin Gastroenterol Hepatol, 2010, 8( 1): 85- 90. DOI: 10.1016/j.cgh.2009.08.035.
    [14] KMN V, SHEELA CN, BANKA S, et al. Maternal and perinatal outcome of acute pancreatitis during pregnancy: A 5 year experience at a tertiary care centre[J]. Int J Reprod Contracept Obstet Gynecol, 2016: 4041- 4045. DOI: 10.18203/2320-1770.ijrcog20163886.
    [15] GENG YX, LI WQ, SUN LQ, et al. Severe acute pancreatitis during pregnancy: Eleven years experience from a surgical intensive care unit[J]. Dig Dis Sci, 2011, 56( 12): 3672- 3677. DOI: 10.1007/s10620-011-1809-5.
    [16] PAPADAKIS EP, SARIGIANNI M, MIKHAILIDIS DP, et al. Acute pancreatitis in pregnancy: An overview[J]. Eur J Obstet Gynecol Reprod Biol, 2011, 159( 2): 261- 266. DOI: 10.1016/j.ejogrb.2011.07.037.
    [17] ZHANG TT, WANG GX, CAO Z, et al. Acute pancreatitis in pregnancy: A 10-year, multi-center, retrospective study in Beijing[J]. BMC Pregnancy Childbirth, 2022, 22( 1): 414. DOI: 10.1186/s12884-022-04742-8.
    [18] YANG ZY, GUO GY, LI H. Predicting fetal loss in severe acute pancreatitis during pregnancy: A 5-year single-tertiary-center retrospective analysis[J]. Postgrad Med, 2020, 132( 5): 473- 478. DOI: 10.1080/00325481.2020.1752010.
    [19] RAUSCHERT S, GÁZQUEZ A, UHL O, et al. Phospholipids in lipoproteins: Compositional differences across VLDL, LDL, and HDL in pregnant women[J]. Lipids Health Dis, 2019, 18( 1): 20. DOI: 10.1186/s12944-019-0957-z.
    [20] RUSSI G. Severe dyslipidemia in pregnancy: The role of therapeutic apheresis[J]. Transfus Apher Sci, 2015, 53( 3): 283- 287. DOI: 10.1016/j.transci.2015.11.008.
    [21] PENG R, ZHANG XM, ZHANG L, et al. CT findings of acute pancreatitis with pneumonia and its clinical correlation analysis[J]. Radiol Pract, 2020, 35( 1): 68- 73. DOI: 10.13609/j.cnki.1000-0313.2020.01.013.

    彭容, 张小明, 张凌, 等. 急性胰腺炎伴肺炎的CT表现及其与临床相关性分析[J]. 放射学实践, 2020, 35( 1): 68- 73. DOI: 10.13609/j.cnki.1000-0313.2020.01.013.
    [22] SHEN HN, CHANG YH, CHEN HF, et al. Increased risk of severe acute pancreatitis in patients with diabetes[J]. Diabet Med, 2012, 29( 11): 1419- 1424. DOI: 10.1111/j.1464-5491.2012.03680.x.
    [23] URUSHIHARA H, TAKETSUNA M, LIU Y, et al. Increased risk of acute pancreatitis in patients with type 2 diabetes: An observational study using a Japanese hospital database[J]. PLoS One, 2012, 7( 12): e53224. DOI: 10.1371/journal.pone.0053224.
    [24] SCHÜTTE K, MALFERTHEINER P. Markers for predicting severity and progression of acute pancreatitis[J]. Best Pract Res Clin Gastroenterol, 2008, 22( 1): 75- 90. DOI: 10.1016/j.bpg.2007.10.013.
    [25] ZHOU HJ, MEI X, HE XH, et al. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase: A retrospective study[J]. Medicine(Baltimore), 2019, 98( 16): e15275. DOI: 10.1097/MD.0000000000015275.
    [26] KONG WH, HE YY, BAO HR, et al. Diagnostic value of neutrophil-lymphocyte ratio for predicting the severity of acute pancreatitis: A meta-analysis[J]. Dis Markers, 2020, 2020: 9731854. DOI: 10.1155/2020/9731854.
    [27] LIU DL, WEN LL, WANG ZD, et al. The mechanism of lung and intestinal injury in acute pancreatitis: A review[J]. Front Med(Lausanne), 2022, 9: 904078. DOI: 10.3389/fmed.2022.904078.
    [28] GE JH. Risk factors for development of acute respiratory distress syndrome in septic patients[J]. Zhejiang Med J, 2017, 39( 20): 1789- 1792. DOI: 10.12056/j.issn.1006-2785.2017.39.20.2017-1141.

    葛建辉. 脓毒症患者并发ARDS的早期危险因素分析[J]. 浙江医学, 2017, 39( 20): 1789- 1792. DOI: 10.12056/j.issn.1006-2785.2017.39.20.2017-1141.
    [29] CASQUEIRO J, CASQUEIRO J, ALVES C. Infections in patients with diabetes mellitus: A review of pathogenesis[J]. Indian J Endocrinol Metab, 2012, 16( Suppl1): S27- S36. DOI: 10.4103/2230-8210.94253.
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