不同病因急性胰腺炎的临床特点分析

Clinical features of acute pancreatitis of different etiologies

目的探讨不同病因急性胰腺炎(AP)的临床特点。方法回顾性分析2014年1月-2015年12月广东省人民医院消化内科收治的150例AP患者的临床资料,其中胆源性AP 97例,高脂血症AP 32例,酒精性AP 21例。对比3组患者性别、年龄、合并疾病、实验室检查、严重程度分布、并发症、评分及住院天数情况。正态分布的计量资料多组间比较采用方差分析,进一步两两比较采用LSD-t检验;非正态分布计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Mann-Whitney U检验。计数资料组间比较采用χ~2检验或Fisher确切检验;等级资料组间比较采用Kruskal-Wallis H检验。结果胆源性AP组发病年龄显著大于其他2组,以女性患者多见;而高脂血症和酒精性AP组患者均以男性多见(P值均<0.05)。胆源性AP患者合并心脏病、高血压病更为常见,高脂血症AP患者合并糖尿病更为多见(P值均<0.05)。与其他2组相比,胆源性AP患者血淀粉酶、ALT、AST水平较高,入院时C反应蛋白和72 h后C反应蛋白水平较低(P值均<0.05)。而高脂血症AP组患者血糖、血脂(TG、CHO)以及糖化血红蛋白水平较高(P值均<0.05)。3组AP患者严重程度分布差异无统计学意义(P>0.05)。胆源性AP患者急性液体积聚的发生率、MCTSI评分均低于其他2组(P值均<0.05);而酒精性AP患者全身感染的发生率高于其他2组(P<0.05)。3组患者住院天数差异无统计学意义(P>0.05)。结论 AP病因的差异不会影响疾病的严重程度及预后,根据患者人口分布、合并疾病及实验室检查的特点,可以早期识别急性AP的病因,作出及时相应的处理,改善患者愈后。

Objective To investigate the clinical features of acute pancreatitis(AP)of different etiologies.Methods A retrospective analysis was performed for the clinical data of 150 patients with AP who were admitted to Department of Gastroenterology,Guangdong General Hospital,from January 2014 to December 2015,and among these patients,97 had biliary pancreatitis,32 had hyperlipidemic pancreatitis,and 21 had alcoholic pancreatitis.The three groups were compared in terms of sex,age,comorbidities,laboratory examination,distribution of severity,complications,related scores,and length of hospital stay.An analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the least significant difference t-test was used for further comparison between any two groups.The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups,and the Mann-Whitney U test was used for further comparison between any two groups.The chi-square test or Fisher′s exact test was used for comparison of categorical data between groups,and the Kruskal-Wallis H test was used for comparison of ranked data between groups.Results The biliary pancreatitis group had a significantly older age of onset than the other two groups,and most of the patients in this group were female,while most of the patients in the other two groups were male(all P<0.05).The biliary pancreatitis group had a significantly higher proportion of patients with heart disease or hypertension,while the hyperlipidemic pancreatitis group had a significantly higher proportion of patients with diabetes(all P<0.05).The biliary pancreatitis group had significantly higher levels of blood amylase,alanine aminotransferase,and aspartate aminotransferase and a significantly lower level of C-reaction protein on admission and at 72 hours after admission,compared with the other two groups(all P<0.05).The hyperlipidemic pancreatitis group had significantly higher levels of blood glucose,blood lipids(triglyceride and cholesterol),and glycosylated hemoglobin(all P<0.05).There was no significant difference in distribution of severity between the three groups(P >0.05).The biliary pancreatitis group had significantly lower incidence rate of acute fluid collection and MCTSI score than the other two groups(both P<0.05),and the alcoholic pancreatitis group had a significantly higher incidence rate of systemic infection than the other two groups(P<0.05).There was no significant difference in the length of hospital stay between the three groups(P >0.05).Conclusion The difference in the etiology of AP does not affect disease severity and prognosis.The etiology of AP can be identified as early as possible with reference to the features of demographics,comorbidities,and laboratory examination,and therefore,proper treatment can be given to improve patients′prognosis.