感染性坏死对急性胰腺炎不良预后的影响

Effects of infective necrosis on poor prognosis in acute pancreatitis

目的评估感染性坏死（IN）对于中重度急性胰腺炎（AP）预后的影响。方法按照修订版亚特兰大分类标准，回顾性分析2001年1月至2015年1月收治的中重度AP患者。按有无持续性器官衰竭（POF）和IN分为4组。第1组，无IN和POF；第2组，有IN，无POF；第3组，无IN，有POF；第4组，有IN和POF。比较各组的病情和预后差异，并用Logistic回归和Cox回归分析IN对AP预后的影响。结果共纳人中重度AP患者375例，第1、2、3、4组分别有211、43、90和31例患者。共121例（32．3％）合并POF，74例（19．7％）合并IN，63例（16．8％）死亡。有IN的AP患者病死率为32．4％（24／74），无IN的AP患者病死率为13．0％（39／301）。第1、2、3、4组的病死率依次为1．9％（4／211）、11．6％（5／43）、38．9％（35／90）和61．3％（19／31），病死率呈递增趋势，差异有统计学意义（X^2=109．672，P〈0．01）。IN（OR=8．24，95％CJ2．09～32．46，P=0．003）和POF（OR=8．31，95％Cf2．48～27．87，P=0．001）均为AP死亡的独立危险因素。IN（OR=2．04，95％CI1．19～3．48，P=0．002）和POF（OR=5．25，95％CI 2．36～11．65，P〈0．01）均为AP生存时间缩短的独立危险因素。结论IN是AP病情严重程度和不良预后的独立危险因素，IN与POF同时存在时AP患者预后最差。

Objective To evaluate the effects of infective necrosis （IN） on prognosis in moderately severe or severe acute pancreatitis （AP）. Methods According to the revision of Atlanta classification, from January 2001 to January 2015, admitted patients with moderately severe or severe AP were retrospectively analyzed. According to whether with the presence of persistent organ failure （POF） and / or IN, the patients were divided into four groups： group one with weither IN nor POF, group two with IN but without POF, group three with POF but without IN, group four with both IN and POF. The differences in disease severity and prognosis among groaps were compared. Logistic regression and Cox proportional hazard regression model were used to analyze the effect of IN on prognosis. Results A total of 375 moderately severe or severe AP patients were enrolled. There were 211, 43, 90 and 31 patients in group one, two, three and four, respectively. A total of 121 （32.3G） patients with POF, 74 （19.7G） patients with IN, and death in 63 （16.8%0） patients. The mortality rate in patients with IN was 32.4% （24/74）, and which was 13.0%（39/301） in patients without IN. The mortality rates of group one, two, three and four were 1.9%（4/211）, 11. 6%（5/43）, 38. 9%（35/90） and 61.3%（19/31）, respectively; mortality rate was in a trend of increasing, and the difference was statistically significant （Z = 109. 672, P〈0.01）. Both IN （OR=8.24, 95% CI2.09 to 32.46） andPOF （OR=8.31, 95% CI2.48 to 27.87） were independent risk factors of mortality of AP patients （both P〈0.01）. Both IN （OR= 2.04, 95 % CI 1.19 to 3.48, 0. 002） and POF （OR=5.25, 95%CI 2.36 to 11.65） also were independent risk factors of shortened survival time of AP patients （both P〈0.01）. Conclusions IN is an independent risk factor of disease severity and poor prognosis in AP. The prognosis is the worst in AP patients with both POF and IN.