妊娠期急性胰腺炎的临床及预后影响因素分析

Analysis of clinical characteristics and prognostic factors of acute pancreatitis during pregnancy

目的回顾性分析妊娠期急性胰腺炎患者临床特点及预后影响因素。方法收集2009. 9. 1～2016. 12. 31期间收治于安徽医科大学第一附属医院及第二附属医院的APIP患者的临床病历资料,统计疾病的临床病因构成比;运用SPSS22. 0软件统计分析不同病因的APIP患者疾病严重程度、临床及实验室指标等是否有差异;再按照诊断标准将患者分为轻症组及中-重症组,分析比较两组患者临床资料是否存在差异,并选取临床有统计学意义的指标进行疾病严重程度相关性分析,绘制ROC曲线。结果 1、APIP的病因构成比中,胆源性约为50. 5%,高脂血症性为39. 2%,特发性共占10. 3%。2、不同病因的APIP患者在年龄、胎儿是否足月及婴儿存活率、患者是否发生AKI及接受肾脏替代治疗、机械通气的选择及MODS的发生等方面均无明显差异,而在孕周、是否终止妊娠、急性胰腺炎的分级及住院和入ICU时间、是否继发腹腔感染、是否发生ARDS、肠道的AGI分级等观察指标具有显著统计学差异,高脂血症组发病时孕周较大,疾病严重程度更高,住院时间及ICU时间较长,易继发腹腔感染和脏器功能损害(肺、肾脏、肠道等),大部分患者需要终止妊娠。3、同轻症组APIP患者相比,中-重症组患者在生命体征、血钙、TG、血糖、白蛋白、总蛋白、Hb水平等指标具有明显差异,其中血TG、Hb及Hb变化率、血糖等与疾病严重程度呈正相关,血钙、血白蛋白水平等同疾病严重程度呈负相关。结论目前造成APIP的病因仍以胆源性疾病为主,高脂血症性其次,但妊娠期HLAP病情更重,对妊娠结局有影响。APIP患者入院后监测血TG、Hb、血糖、血钙、ALB水平,比较血Hb的变化率对于预判疾病进展有临床意义。

Objective Through a retrospective, comparative clinical information collection, produced analysis of clinical characteristics and the influence factors of patients with acute panereatitis during pregnancy. Methods Collected and recorded the clinical medical records of APIP patients in the first affiliated hospital of anhui medical university and the second affiliated hospital of anhui medical university during the period of 2009.9.1 -2016.12.31. the composition ratio of causes were analyzed first;Then SPSS 22. 0 software were used to statistical analyze the differences in the severity, clinical and laboratory indexes of APIP patients with different etiologies;and the differences between the mild group and the moderate-severe group. To carry out the correlation of severity of disease and the clinical factors, then draw the ROC curve. Results 1. The etiology of APIP constitutes about 50. 5 % of biliary origin, 39.2% for hyperlipemia, and 10. 3 % idiopathic total. 2. In groups of different causes, there were no significant differences in age, the baby＇s survival rate and whether the baby is full-month. AKI or MODS occurred of mummy and the alternative to the renal replacement, the use of mechanical ventilation. On the other hand, there were significant statistical differences in the gestational age, termination of preg- nancy, the classification of acute pancreatitis, hospitalization and ICU time, whether secondary abdominal infection orARDS occurred, the intestinal AGI classification and the other observation indicators. The patients of the HLAP group served more severe disease, and the hospitalization and ICU time were more longer, more organ failures occurred in these patients, and most patients need to terminate pregnancy. 3. Compared with the mild group, the patients of moderate-severe group made significant differences in the indicators including vital signs, and the level of laboratory factors. In these indicators, Triglycerides, Hb and Hb rates and glucose were positively correlated with the severity of the disease. Serum calcium and white protein do the negatively correlations. Conclusions At present, the etiology of APIP is still dominated by biliary diseases, and hyperlipidemia is second, but HLAP is more severe, and HLAP could make effect on the pregnancy outcome. Monitoring the level of TG, Hb, glucose, serum calcium, albumin and the trend of Hb in APIP pa- tients should do helpful to the prognosis of the disease.