急性胰腺炎患者并发消化性溃疡的危险因素分析

Risk factors for peptic ulcer in patients with acute pancreatitis

目的探讨急性胰腺炎(AP)患者并发消化性溃疡(PU)的临床特征,并分析并发PU的危险因素。方法回顾性分析2008年1月-2012年1月本院收治的156例AP患者的临床资料。所有患者入院后48 h内均进行胃镜检查,以评估其PU和幽门螺杆菌感染情况。应用Ranson评分、APACHEⅡ评分和CT严重指数评估AP严重程度。应用独立样本t检验和χ2检验对伴发PU和无PU的AP患者临床特征进行统计学分析,同时应用单因素和多因素Logistic回归分析AP患者并发PU的危险因素。结果156例AP患者中,88例患者胃镜检出PU,检出率为56.4%。88例PU患者中,只有28(31.8%)例检测到幽门螺杆菌。28例幽门螺杆菌阳性的PU患者中,22例发生胃溃疡,6例同时发生胃溃疡和十二指肠溃疡,没有发现单独的十二指肠溃疡;而60例幽门螺杆菌阴性PU患者中,25例发生胃溃疡,26例发生十二指肠溃疡,9例同时发生胃溃疡和十二指肠溃疡。单因素Logistic回归分析发现,男性、酒精源性胰腺炎、吸烟、饮酒、高甘油三酯水平和高C反应蛋白水平、APACHEⅡ评分≥8分与AP患者并发PU显著相关。然而,多因素Logistic回归分析发现,只有APACHEⅡ评分≥8分(OR=8.54,95%CI:4.52～16.15,P<0.01)是AP患者并发PU的独立危险因素。结论 AP患者容易并发PU,而幽门螺杆菌感染率较低。APACHEⅡ评分≥8分是AP患者并发PU的独立危险因素。

Objective To investigate the clinical characteristics of acute pancreatitis （AP） associated with peptic ulcer （PU） and to annlyze the risk factors for PU in AP patients. Methods A retrospective analysis was performed on the clinical data of 156 AP patients who were admitted to our hospital from January 2008 to January 2012. All patients underwent gastroscopy within 48 h after admission to detect PU and Helicobaeter pylori （Hp） infection. The severity of AP was assessed by Ranson score, APACHE Ⅱ score, and CT severity index. The clinical characteristics of AP patients with or without PU were statistically analyzed using independent samples t - test and chi - square test. The univariate and multivariate logistic regression analyses were used to determine the risk factors for PU in AP patients. Results Among the 156 AP patients, 88 （56.4%） had PU, but only 28 （ 31.8% ） of the 88 cases were infected with Hp. Of the 28 patients, 22 had gastric ulcer, and 6 had both gastric ulcer and duodenal ulcer. Of the 60 PU patients not infected Ⅱ with Hp, 25 had gastric ulcer, 26 had duodenal ulcer, and 9 had both gastric ulcer and duodenal ulcer. The univariate logistic regression analysis showed that male gender, alcohol - in- duced pancreatitis, smoking, alcohol consumption, high triglyceride level, high C -reactive protein level, and APACHE ]I score /〉8 were significantly associated with PU in AP patients. However, the multivariate logistic regression analysis showed that APACHE score 〉8 was the independent risk factor for PU in AP patients （ OR = 8.54, 95% CI： 4. 52 - 16. 15, P 〈 0.01 ）. Conclusion AP patients are suscepti- ble to PU, but the infection rate of Hp is low. APACHE Ⅱ score i〉8 is the independent risk factor for PU in AP patients.