终末期肾功能不全维持透析患者中急性胰腺炎的临床分析

Acute Pancreatitis in ESRD Patients on Long Term Dialysis

目的探讨急性胰腺炎(AP)在血液透析(HD)和腹膜透析(PD)患者中的发病率、发病的可能原因及其预后。方法回顾性分析2004年1月1日-2011年3月1日期间广州市第一人民医院进行长期维持性透析治疗的253例患者(透析时间至少3个月),血透191例,腹透62例,对其中AP的患病率、发病率、合并症、预后及发病的可能原因进行统计分析。结果 5例透析患者发生急性胰腺炎,4例血透1例腹透,AP在HD和PD中患病率分别为2.09%和1.61%,两组患病率差异无统计学意义(χ2=0.056,P=0.813)。本透析中心观察总人年1045.42,急性胰腺炎在本中心发病率4.78/1000人年,血透中的发病率5.67/1000人年,腹透中的发病率2.94/1000人年,两种透析方式中AP发病率差异无统计学意义(P>0.05)。3例重症患者发病前合并低血压,平均动脉压(MAP)均低于70mmHg。结论急性胰腺炎患病率和发病率在血液透析和腹膜透析患者中无显著性差异,急性胰腺炎在透析患者中发病原因可能与血透和低血压有关。

Objective To assess the risk of acute pancreatitis（AP） in patients on long term hemodialysis（HD） and peritoneal dialysis（ PD）, to evaluate its clinical cause and outcome and to identify possible etiological factors. Methods This retrospective cohort study groups consisted of all patients initiated on HD and PD between January 1,2004 and March 1,2011. 253 patients were on long term dialysis （ at less for 3 months）, 191 and 62 patients in the HD and PD groups respectively. The incidence of AP in HD and PD was calculated, and the possible risk factors were identified. Results 5 patients developed AP,4 （2.09%） were on HD and 1 （ 1.61% ） was on PD,there was no significant difference of the AP prevalence between two groups（P =0. 813）. The total incidence of AP was 4.78 per 1000 person-years,and 5.67 per 1000 person-years in the HD group and 2.94 per 1000 per- son-years in the PD group（ P 〉 0.05 ）. There was no significant difference of AP prevalence in patients on HD and PD, and the incidence of AP was the same too. 3 patients suffered hypotension（ MAP 〈 70 mm Hg） before severe acute pancreatitis developed. Conclusion The possible etiological factors to develop AP in dialysis patients were hemodialysis and hypotension.