急性胰腺炎临床特点现状研究

The investigation on clinical features of acute pancreatitis

目的了解近10年急性胰腺炎病因及临床特点变化，有助于早期诊断重症急性胰腺炎。方法回顾性分析1195例急性胰腺炎患者的临床资料，分析急性胰腺炎病因及其临床特点变化。结果1195例急性胰腺炎患者，病因以胆道疾病为主，占31．72％（379／1195），其次为暴饮暴食，占25．44％（304／1195），高脂血症占16．82％（201／1195）。但重症急性胰腺炎的病因比例有所改变，高脂血症占44．59％（140／314），胆道疾病占28．34％（89／314），暴饮暴食占17．52％（55／314）。高脂血症性重症急性胰腺炎发生率为69．65％（140／201）；胆道嵌顿性重症急性胰腺炎发生率为69．88％（58／83），高脂血症及胆道嵌顿性重症急性胰腺炎发生率均较高。体质指数（BMI）≤25kg/m^2、BMI26～30kg／m^2．BMI≥31kg／m。患者重症急性胰腺炎发生率分别为5．41％（17／314）、24．84％（78／314）、69．75％（219／314），BMI越高重症急性胰腺炎发生率越高，差异有统计学意义（P〈0．05）。年龄≤54岁、55～69岁、≥70岁患者重症急性胰腺炎发生率分别为12．42％（39／314）、21．66％（68／314）、65．92％（207／314），年龄越大重症急性胰腺炎发生率越高，差异有统计学意义（P〈0．05）.结论近10年上海地区急性胰腺炎病因仍以胆道疾病和暴饮暴食为主，但重症急性胰腺炎的病因比例有所改变，高脂血症居首位，胆道疾病其次。高脂血症或胆道嵌顿性重症急性胰腺炎发生率高，老年及肥胖患者发生率高。在急诊室评估急性胰腺炎严重程度时病因、年龄及BMI可能是判断重症急性胰腺炎的重要指标。同时应加强血脂及体重管理。

Objective To explore the causes and clinical features change of acute pancreatitis, to get early diagnosis of severe acute pancreatitis. Methods The clinical data of 1195 cases of patients with acute pancreatitis were retrospectively analyzed. Results Main causes of acute pancreatitis were still biliary disease 31.72% （379/1195 ）, engorgement 25.44% （ 304/1195 ） and hyperlipidemia 16.82% （201/1195 ）. But the causes of severe acute pancreatitis had changed. Hyperlipidemia was 44.59% （140/314）, biliary disease accounted for 28.34% （89/314）, engorgement accounted for 17.52% （55/314）. The incidence of hyperlipidemia severe acute pancreatitis was 69.65% （140/201）, the incidence of biliary severe acute pancreatitis was 69.88% （58/83）. The incidence of severe acute pancreatitis on patients with body mass index （BMI） ≤25 kg/m^2,BMI 26- 30 kg/m2,BMI≥31 kg/m^2 were 5.41% （17/314）, 24.84% （78/314）, 69.75% （219/314）. There was significant difference （P 〈 0.05 ）. The incidence of severe acute pancreatitis on patients at age ≤54 years-old,55 -69 years-old, ≥70 years-old were 12.42% （39/314）, 21.66% （68/314 ）, 65.92% （207/314 ）. There was significant difference （P 〈 0.05 ）. Conclusions In shanghai, the main causes of acute pancreatitis still is biliary disease and engorgement in the lastest ten years. The causes of severe acute pancreatitis have changed.Hyperlipidemia is main casuse; the second one is biliary disease. The incidence rate of severe acute pancreatitis as well as high BMI and elder age were very high and serious. Thus control of blood-lipid and weight should be strengthened.