复发性胆源性胰腺炎的临床特征及危险因素分析

Analysis of Clinical Features and Risk Factors of Patients with Recurrent Gallstone Pancreatitis

目的:研究复发性胆源性胰腺炎(RGP)的临床特征及危险因素。方法:选择从2012年1月至2017年1月在本院接受治疗的80例RGP患者作为观察组,另选同期在本院接受治疗的胆源性胰腺炎(GP)患者86例作为对照组,分析观察组患者的临床特征及两组患者的致病因素,采用Logistic回归分析RGP的危险因素。结果:在RGP患者的临床特征中,复发次数均较多,平均达到(3.21±0.23)次。发病诱因则主要是胆囊结石、胆总管结石及高脂血症;临床症状主要是黄疸、呕吐、恶心、腹痛、腹胀;并发症主要包括胆管炎、胰腺脓肿以及腹水;临床体征主要有出血征象、腹肌紧张、腹部压痛等。观察组的男性、重度胰腺炎、合并胆总管结石、胆胰管开口狭窄、有高脂血症、手术治疗的患者致病率分别高于对照组,并且观察组急性生理与慢性健康评分(APACHE-Ⅱ)明显高于对照组,差异均有统计学意义(P<0.05)。由多因素Logistic回归分析可知,导致RGP的危险因素有男性、高APACHE-Ⅱ评分、重度胰腺炎、合并胆总管结石、胆胰管开口狭窄、有高脂血症以及手术治疗。结论:RGP患者的临床特征具有一定的规律性,其中男性、高APACHE-Ⅱ评分、重度胰腺炎、合并胆总管结石、胆胰管开口狭窄、有高脂血症以及手术治疗是导致RGP发生的危险因素。

Objective： To study the clinical features and risk factors of recurrent gallstone pancreatitis（RGP）. Methods： 80 patients with RGP gallstone pancreatitis（GP） treated in our hospital from January 2012 to January 2017 were selected as observation group. At the same period,86 patients with gallstone pancreatitis（GP） treated in our hospital were selected as control group. The clinical characteristics of the patients in the observation group and the pathogenic factors of the two groups were analyzed. Logistic regression analysis was used to analyze the risk factors of RGP. Results： In the clinical features of RGP patients,the recurrence times were more,average reaching（3.21 ±0.23） times. The main causes of the disease were the gallbladder stones and common bile duct stones and hyperlipidemia. The main clinical symptoms are jaundice,vomiting,nausea,abdominal pain and abdominal distention. The main complications included cholangitis,pancreatic abscess and ascites. The main clinical signs are bleeding signs,abdominal muscle tension,abdominal tenderness,and so on. The pathogenicity rate of male,severe pancreatitis,common bile duct stones,bile duct stenosis,hyperlipidemia,the surgical treatment in the observation group were significantly higher than the control group respectively,and the scores of APACHE-II in the observation group were significantly higher than that in the control group,the differences were statistically significant（P〈0.05）. The analysis of multiple factor Logistic regression analysis showed that,the risk factors of RGP were male,high APACHE-II scores,severe pancreatitis,common bile duct stones,bile duct stricture,hyperlipidemia and the surgical treatment.Conclusion： The clinical features of RGP patients have certain regularity,and the risk factors for RGP are male,high APACHE-II scores,severe pancreatitis,common bile duct stones,bile duct stricture,hyperlipidemia and surgical treatment.