重症急性胰腺炎并发胃肠道瘘病人胰腺功能及生活质量调查研究

Investigation of pancreatic function and quality of life of severe acute pancreatitis patients complicated with gastrointestinal fistulas

目的调查研究重症急性胰腺炎并发胃肠道瘘病人的胰腺功能及生活质量。方法回顾性调查2016年3~11月中国人民解放军南京总医院(南京大学医学院临床学院)出院的109例重症急性胰腺炎病人的胰腺功能及生活质量。其中住院期间发生胃肠道瘘的病人29例,未发生胃肠道瘘病人80例。胰腺内分泌功能检测指标包括空腹血糖、空腹胰岛素、空腹C肽、空腹胰高血糖素,葡萄糖耐量试验(OGTT)2 h血糖、2 h胰岛素、2 h C肽、2 h胰高血糖素及粪便标本,通过检测粪弹力蛋白酶(FE-1)评估病人的胰腺外分泌功能。收集病人独立完成的生活质量简表(SF-36)及住院期间临床资料。比较住院期间发生与未发生胃肠道瘘病人的胰腺功能及生活质量。结果与未发生胃肠瘘病人相比,发生胃肠道瘘病人行手术干预的病例数较多[19例(65.6%)vs.19例(23.8%),χ~2=0.96,P=0.000],住院期间体重降低明显[(8.7±0.6)kg vs.(6.8±0.5)kg,t=2.240,P=0.027],生活质量偏差[(119.3±2.8)分vs.(128.1±1.1)分,t=3.57,P=0.006],但两组病人在胰岛素分泌功能方面,空腹血糖[(6.9±0.5)mol/L vs.(6.3±0.3)mol/L]、空腹胰岛素[(9.5±2.4)m U/L vs.(7.9±0.7)m U/L]、空腹C肽[(0.7±0.3)nmol/L vs.(0.5±0.3)nmol/L]、空腹胰高血糖素[(37.8±3.7)pmol/L vs.(40.0±2.6)pmol/L],OGTT 2 h血糖[(11.9±1.3)mol/L vs.(10.1±0.7)mol/L]、2 h胰岛素[(36.7±7.0)m U/L vs.(35.9±3.5)m U/L]、2 h C肽[(1.6±1.2)nmol/L vs.(1.5±1.0)nmol/L]、2 h胰高血糖素[(43.0±3.4)pmol/L vs.(41.5±2.4)pmol/L]差异均无统计学意义(P均<0.05)。结论重症急性胰腺炎并发胃肠道瘘病人出院后生活质量较未并发胃肠道瘘病人生活质量偏差;但在胰腺功能方面两组病人无明显差异。

Objective To study the pancreatic function and quality of life of discharged severe acute pancreatitis patients （SAP） complicated with gastrointestinal fistulas in hospital. Methods The quality of life and pancreatic function of 109 patients were collected from March 2016 to November 2016, which included 29 patients with and 80 patients without gastrointestinal fistulas. Pancreatic endocrine test included blood glucose, fasting insulin, fasting C-peptide, fasting glucagon,oral glucose tolerance test （OGTT） 2 hours blood glucose,2 hours insulin,2 hours C-peptide,2 hours glucagon, and fecal elastase （FE-1） were used to assess the patients pancreatic exocrine function. The patient＇s quality of life questionnaire （SF-36） and clinical data in hospital were collected. Pancreatic function and quality of life in patients of the two groups were compared. Results Compared with the cases without gastrointestinal fistulas ,more cases of SAP patients with gastrointestinal fistulas were required surgical interventions [19（65.6%） cases vs.19 （23.8%） cases, χ^2=0.96, P=0.000], and got significant weight reduction during hospitalization [（8.7±0.6） kg vs.（6.8±0.5） kg, t=2.240,P=0.027], and had lower discharged quality of life [（119.3±2.8） score vs.（128.1±1.1） score, t=3.57,P=0.006]. But there was no significant difference in pancreatic function between the two groups in fasting blood glucose [（6.9±0.5）mol/L vs. （6.3±0.3）mol/L],fasting insulin[（9.5±2.4）mU/L vs. （7.9±0.7）mU/L], fasting C-peptide[（0.7±0.3）nmol/L vs. （0.5±0.3）nmol/L],fasting glucagon[（37.8±3.7）pmol/L vs.（40.0±2.6）pmol/L], OGTT 2 hours blood glucose[（11.9±1.3）mol/L vs.（10.1±0.7）mol/L],2 hours insulin [（36.7±7.0）mU/L vs.（35.9±3.5）mU/L],2 hours C-peptide [（1.6±1.2）nmol/L vs.（ 1.5±1.0） nmol/L],2 hours glucagon[（43.0±3.4）pmol/L vs.（41.5±2.4） pmol/L]. Conclusion SAP patients with gastrointestinal fistula have lower quality of life than those without gastrointestinal fistula. However, there is no significant differences in pancreatic function between the two groups.