急性胰腺炎患者的临床特征分析

Clinical characteristics analysis of acute pancreatitis

目的分析急性胰腺炎患者的临床特征。方法采用回顾性病例对照研究方法。收集2015年6月至2023年6月西安交通大学第一附属医院收治的558例急性胰腺炎患者的临床资料;男352例,女206例;年龄为(46±15)岁。观察指标:(1)急性胰腺炎患者一般情况。(2)急性胰腺炎患者病因情况。(3)急性胰腺炎患者疾病严重程度。(4)急性胰腺炎患者合并慢性疾病情况。(5)急性胰腺炎患者并发症情况。(6)复发性急性胰腺炎(RAP)患者亚组分析。正态分布的计量资料以■±s表示,组间比较采用t检验;偏态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用Wilcoxon秩和检验。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。等级资料比较采用秩和检验。两两比较采用Bonferroni校正。结果(1)急性胰腺炎患者一般情况。首次发生急性胰腺炎(FAP)患者和RAP患者性别、年龄、总住院时间、吸烟、饮酒比较,差异均有统计学意义(P<0.05)。(2)急性胰腺炎患者病因情况。FAP患者和RAP患者病因为胆道结石、高脂血症比较,差异均有统计学意义(P<0.05)。(3)急性胰腺炎患者疾病严重程度。443例FAP患者和115例RAP患者中,轻症急性胰腺炎、中重症急性胰腺炎、重症急性胰腺炎分别为320和83例、24和9例、99和23例,两者比较,差异无统计学意义(P>0.05)。(4)急性胰腺炎患者合并慢性疾病情况。FAP患者和RAP患者合并高脂血症、脂肪肝、糖尿病比较,差异均有统计学意义(P<0.05)。(5)急性胰腺炎患者并发症情况。FAP患者和RAP患者急性坏死物积聚、急性胰周液体积聚、包裹性坏死、胰腺假性囊肿、感染性胰腺坏死、全身炎症反应综合征、呼吸系统并发症、循环系统并发症、肾脏并发症、脓毒症、腹腔内高压和胰性脑病比较,差异均无统计学意义(P>0.05)。(6)RAP患者亚组分析。①合并慢性疾病情况:115例RAP患者中,轻症急性胰腺炎、中重症急性胰腺炎、重症急性胰腺炎分别为83、9、23例,合并高脂血症分别为25、8、11例,3者比较,差异有统计学意义(P<0.05)。②并发症情况:115例RAP患者中,44例合并高脂血症和71例无高脂血症患者急性胰周液体积聚、肾脏并发症比较,差异均有统计学意义(P<0.05)。结论RAP好发于男性。与FAP患者比较,RAP患者年龄较小,总住院时间较短,吸烟、喝酒比例更高;病因为胆道结石比例较低,高脂血症比例较高;合并高脂血症、脂肪肝、糖尿病比例较高;两者并发症情况比较,差异无统计学意义。与无高脂血症RAP患者比较,合并高脂血症RAP患者更易发生急性胰周液体积聚和肾脏并发症。

Objective To analyze the clinical characteristics of acute pancreatitis.Methods The retrospective case-control study was conducted.The clinical data of 558 patients with acute pancreatitis who were admitted to The First Affiliated Hospital of Xi′an Jiaotong University from June 2015 to June 2023 were collected.There were 352 males and 206 females,aged(46±15)years.Observation indicators:(1)general situations of acute pancreatitis patients;(2)etiology of acute pancreatitis patients;(3)severity of acute pancreatitis patients;(4)chronic diseases in acute pancreatitis patients;(5)complications in acute pancreatitis patients;(6)subgroup analysis of patients with recurrent acute pancreatitis.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(Q_(1),Q_(3)),and comparison between groups was conducted using the Wilcoxon rank sum test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Comparison of ordinal data was analyzed using the rank sum test.Bonferroni correction was used for pairwise comparison.Results(1)General situations of acute pancreatitis patients.There were significant differences in gender,age,total duration of hospital stay,smoking,and alcohol consumption between the first episode of acute pancreatitis patients and the recurrent acute pancreatitis patients(P<0.05).(2)Etiology of acute pancreatitis patients.There were significant differences in gallstones and hyperlipidemia between the first episode of acute pancreatitis patients and the recurrent acute pancreatitis patients(P<0.05).(3)Severity of acute pancreatitis patients.Of the 443 patients with first episode of acute pancreatitis and 115 patients with recurrent acute pancreatitis,cases with mild acute pancreatitis,cases with moderate-severe acute pancreatitis,cases with severe acute pancreatitis were 320 and 83,24 and 9,99 and 23,showing no significant difference between them(P>0.05).(4)Chronic diseases in acute pancreatitis patients.There were significant differences in complication as hyperlipidemia,fatty liver and diabetes between the first episode of acute pancreatitis patients and the recurrent acute pancreatitis patients(P<0.05).(5)Complications in acute pancreatitis patients.There was no significant difference in terms of acute necrotic collection,acute peripancreatic fluid accumulation,walled-off necrosis,pancreatic pseudocyst,infectious pancreatic necrosis,systemic inflammatory response syndrome,respiratory system complications,circulatory system complications,renal complications,sepsis,abdominal compartment syndrome,or pancreatic encephalopathy between the first episode of acute pancreatitis patients and the recurrent acute pancreatitis patients(P>0.05).(6)Subgroup analysis of patients with recurrent acute pancreatitis.①Combination with chronic diseases.Of the 115 patients with recurrent acute pancreatitis,cases with mild acute pancreatitis,cases with moderate-severe acute pancreatitis,cases with severe acute pancreatitis were 83,9,23,and there were 25,8,11 cases of them with hyperlipidemia,respectively,showing a significant difference among them(P<0.05).②Complications.Of the 115 patients with recurrent acute pancreatitis,there were 44 cases with hyperlipidemia and 71 cases without hyperlipidemia,and there were significant differences in acute peripancreatic fluid accumulation and renal complications between them(P<0.05).Conclusions Recurrent acute pancreatitis is more common in males.Compared with first episode of acute pancreatitis,cases with recurrent acute pancreatitis usually have younger age,shorter total duration of hospital stay,higher proportion of smoking and drinking.The etiology of recurrent acute pancreatitis is composed of lower levels of biliary diseases and higher levels of hyperlipidemia.Patients with recurrent acute pancreatitis have higher proportion of comorbidities as hyperlipidemia,fatty liver and diabetes.There was no significant difference in the incidence of complications between first episode of acute pancreatitis and recurrent acute pancreatitis.Compared with recurrent acute pancreatitis patients without concomitant hyperlipidemia,recurrent acute pancreatitis patients with concomitant hyperlipidemia are more prone to acute peripancreatic fluid accumulation and renal complications.