酒精性重症急性胰腺炎的临床特征

Clinical characteristics of alcoholic severe acute pancreatitis

目的 探讨酒精性重症急性胰腺炎（SAP）的临床特征.方法 回顾性分析2001年1月至2008年12月福建省立医院收治的重症急性胰腺炎（SAP）患者166例.根据发病前12～48h内有无大量饮酒分成酒精性SAP组（43例）和非酒精性SAP组（123例）,分析两组年龄,性别,入院时CT评分、APACHEⅡ评分、血糖、血清三酰甘油、血钙、血清白蛋白、并发症及后期感染率、病死率的差异.结果 两组年龄无统计学差异,酒精性SAP组男性的构成比（39/43）明显高于非酒精性SAP组（58/123,P＜0.01）.入院时两组CT评分、血糖及血钙无统计学差异.酒精性SAP组APACHEⅡ评分为19.16±5.38,血清三酰甘油水平为（5.06±4.03）mmol/L,均显著高于非酒精性SAP组的16.02±5.09和（3.12±2.95）mmol/L（P＜0.05）,而血清白蛋白（25.23±7.12）g/L则明显低于非酒精性SAP组的（30.68±8.35）g/L（P＜0.01）.酒精性SAP组急性呼吸窘迫综合征、上消化道出血发生率与非酒精性SAP组无统计学差异,但急性肾功能衰竭（44.2%）、肝功能衰竭（41.9%）、心功能衰竭（37.2%）、休克（39.5%）、感染的发生率（27.9%）及病死率（30.2%）明显高于非酒精性SAP组（分别为26.0%、30.9%、20.3%、16.3%、16.3%、7.3%,P＜0.05或＜0.01）.结论 酒精性SAP患者以男性为主,并发症多,病死率高.改变酗酒的不良嗜好是预防酒精性SAP的有效措施.

Objective To investigate the clinical characteristics of alcoholic severe acute pancreatitis （SAP）. Methods Clinical data of 166 cases of SAP in Fujian Provincial Hospital from January 2001 to December 2008 were collected and analyzed retrospectively. Cases were divided into alcoholic SAP group （43cases） and control group （ 123 cases） depending on deoholic intake volue whithin 12～48 hours. Age, gender,CT scores, APACHE Ⅱ score, serum glucose, serum triglyceride （TG）, serum calcium, serum albumin,morbidity, later infection rate and mortality rate of the two groups were compared. Results There was no significant difference in terms of age, but the proportion of male in alcoholic SAP group （39/43） was higher than that in control group （58/123, P〈0.01 ）. CT score, serum glucose and calcium were not significantly different between the two groups. The APACHEⅡ score and serum TG in alcoholic SAP group [19.16±5.38,（5.06±4.03）mmol/L] were significantly higher than those in control group [16.02±5.09, （3.12±2.95）mmol/L]. The albumenjolevel in alcoholic SAP group （25.23±7.12）g/L） was lower than that in control group [（30.68±8.35 ） g/L, P〈0.01]. The incidences of ARDS and upper gastroenterologic bleeding were not significantly different between the two groups. But the incidences of acute kidney failure （44.2%）, liver failure （41.9%）, heart failure （37.2%）, shock （39.5%）, infection （27.9%） and mortality （30.2%） in alcoholic SAP were significantly higher than those in control group （26.0%,30.9%, 20.3%, 16.3%,16.3%, 7.3%, P〈0.05 or〈0.01）. Conclusions Males predominates alcoholic SAP patients with high mortality and morbidity. Alcohol abstinence is effective to prevent alcoholic SAP ocurrence.