轻型急性胰腺炎并急性肝损害的临床特点

Clinical characteristics of mild acute pancreatitis with acute liver injury

目的:探讨轻型急性胰腺炎(mild acute pancre-atitis,MAP)并急性肝损害的临床特点.方法:按照患者是否伴急性肝损害将浙江省义乌市中心医院收治的93例MAP患者分为急性肝损害组61例和不伴急性肝损害组32例,比较两组患者的临床资料、入院时实验室指标以及MAP病程[腹痛缓解时间、血淀粉酶(serum amylase,AMY)复原时间和住院时间];按照患者是否为胆源性MAP将93例患者分为胆源性组52例和非胆源性组41例,比较两组患者肝损害程度[丙氨酸氨基转移酶(alanineaminotransferase,ALT)、天冬氨酸氨基转移酶(aspartic transaminase,AST)、总胆红素(total bilirubin,TBIL)、血清直接胆红素(directbilirubin,DBIL)]和MAP病程;同时记录61例MAP伴急性肝损害患者的转归情况.结果:急性肝损害组患者年龄45-59岁和高脂血性所占比例显著低于不伴急性肝损害组(24.59%vs 56.25%,9.84%vs 28.13%),年龄>60岁、胆源性、入院时血糖>6.1 m m o l/L和腹膜刺激征所占比例均显著高于对照组(52.46%vs 12.50%,65.57%vs 37.50%,63.93%vs 34.38%,55.74%vs 31.25%),差异具有统计学意义(P<0.05);急性肝损害组患者腹痛缓解时间、AMY复原时间和住院时间均显著低于不伴急性肝损害组(5.52 d±2.21 dvs 4.10 d±1.72 d,6.11 d±3.14 d vs 4.20 d±2.16 d,11.60 d±5.26 d vs 8.52 d±3.57 d),差异具有统计学意义(P<0.05);胆源性组患者各项肝功能指标均显著高于非胆源性组(182.33U/L±157.06 U/L vs 48.82 U/L±51.05 U/L,185.22 U/L±176.30 U/L,36.31 U/L±22.24U/L,36.74μmol/L±28.13μmol/L vs 25.92μmol/L±9.60μmol/L,16.61μmol/L±17.51mol/L vs 5.10μmol/L±4.61μmol/L),AMY复原时间和住院时间均显著高于非胆源性组,(6.83 d±3.01 d vs 4.60 d±2.91 d,12.52 d±5.40 d vs 9.38 d±4.33 d),差异具有统计学意义(P<0.05);61例MAP伴急性肝损害患者39例(63.93%)随原发病好转于出院前1-3 wk内肝功能各项指标恢复正常,其余22例(36.07%)经保肝、护肝治疗,出院后1-2 wk内肝功能各项指标恢复正常.结论:MAP患者发病初期即可出现肝损害,可引起MAP患者病程延长,肝功能可随原发病好转逐渐恢复,高龄、胆源性、高血糖和腹膜刺激征等均为引发肝损害的危险因素,掌握MAP并急性肝损害的临床特点对临床治疗具有重要意义.

AIM： To explore the clinical characteristics of mild acute pancreatitis（MAP） with acute liver injury.METHODS： Ninety-three patients with MAP were divided into either an acute liver injury group（n = 61） or a non-acute liver injury group（n = 32）. The clinical data, laboratory indexes, and MAP stage（abdominal pain relief time, serum amylase recovery time and hospital stay） were compared between the two groups. In addition, the 93 patients were divided into a biliary MAP group（n = 52） or a non-biliary MAP group（n = 41）. The liver injury（alanine aminotransferase, aspartic transaminase, total bilirubin, DBIL） and MAP stage were compared between the two groups. The prognosis of the patients with acute liver injury was observed.RESULTS： The percentages of patients between 45-59 years of age and those with hyperlipidemic pancreatitis were significantly lower in the acute liver injury group than in the non-acute liver in-jury group（24.59% vs 56.25%, 9.84% vs 28.13%,P〈0.05）. The percentages of patients aged 60 years and those with biliary pancreatitis, bloodglucose concentration 6.1 mmol/L or peritone-al irritation sign were significantly higher in theacute liver injury group than in the non-acuteliver injury group（52.46% vs 12.50%, 65.57% vs37.50%, 63.93% vs 34.38%, 55.74% vs 31.25%, P〈0.05）. The abdominal pain relief time, serumamylase recovery time and hospital stay weresignificantly shorter in the acute liver injurygroup than in the non-acute liver injury group（5.52 d ± 2.21 d vs 4.10 d ± 1.72 d, 6.11 d ± 3.14 dvs 4.20 d ± 2.16 d, 11.60 d ± 5.26 d vs 8.52 d ± 3.57 d, P〈0.05）. The liver function indexes were sig-nificantly higher in the biliary MAP group thanin the non-biliary MAP group（182.33 U/L ±157.06 U/L vs 48.82 U/L ± 51.05 U/L, 185.22 U/L ± 176.30 U/L vs 36.31 U/L ± 22.24 U/L, 36.74μmol/L ± 28.13 μmol/L vs 25.92 μmol/L ± 9.60μmol/L, 16.61 μmol/L ± 17.51 μmol/L vs 5.10μmol/L ± 4.61 μmol/L, P〈0.05）. Serum amylaserecovery time and hospital stay in the biliaryMAP group were significantly longer than thosein the non-biliary MAP group（6.83 d ± 3.01 d vs4.60 d ± 2.91 d, 12.52 d ± 5.40 d vs 9.38 d ± 4.33 d,P〈0.05）. Of 61 patients with acute liver injury,liver function indexes returned to normal in 39（63.93%） cases 1-3 wk before discharge, and in22（36.07%） cases 1-2 wk after discharge.CONCLUSION： Hepatic injury may occur inearly MAP patients and lead to the prolongationof disease duration. Hepatic injury may recoverwith the cure of primary disease. Old age, bili-ary pancreatitis, hyperglycemia and peritonealirritation sign are risk factors for hepatic injuryin MAP patients.