酒精性急性胰腺炎的临床及预后特征分析

Clinical and prognostic features of acute alcoholic pancreatitis

目的探讨酒精性急性胰腺炎患者的临床及预后特征。方法选取2013年7月-2018年7月西南医科大学附属医院收治的467例初发急性胰腺炎(AP)患者为研究对象,其中包括182例酒精性AP患者(酒精组),与同期285例胆源性AP患者(胆道组),分析两组患者的临床特点,包括年龄、性别、实验室指标、病情分级、并发症、预后指标等。符合正态分布的计量资料两组间比较采用独立样本t检验;不符合正态分布的计量资料两组间比较采用Mann-Whitney U检验。计数资料两组间比较采用χ^2检验或Fisher精确概率法。等级资料两组间比较采用Mann-Whithey U检验。结果酒精组的男性构成比高于胆道组(74.2%vs 48.1%)(χ^2=31.124,P<0.001);酒精组伴发脂肪肝的比例高于胆道组(34.1%vs 24.9%,χ^2=4.569,P=0.033);胆道组伴发高血压的比例高于酒精组(23.5%vs 15.4%,χ^2=4.524,P=0.033);酒精组患者的肌酐、甘油三酯水平均高于胆道组(Z=-4.828,t=7.916,P值均<0.001);酒精组重症急性胰腺炎患者比例比胆道组更高(34.6%vs 15.1%,Z=-4.787,P<0.001),CTSI评分也更高(4.6±1.7 vs 4.2±1.5,t=2.672,P=0.008);酒精组发生急性胰周液体积聚及胰腺假性囊肿、感染性胰腺坏死、肾衰竭概率分别为61.0%、11.5%、37.9%、19.2%,均高于胆道组(49.8%、4.2%、19.6%、8.4%,χ^2值分别为5.045、8.881、18.899、11.758,P值均<0.05);酒精组的肠道功能恢复时间、腹痛缓解时间以及住院时间均大于胆道组(t分别为-4.078、-3.357、-2.527,P值均<0.05),酒精组患者的病死率为7.1%,胆道组病死率为3.2%,两组间差异有统计学意义(χ^2=3.929,P=0.047)。结论与胆道组相比,酒精组发生并发症的风险更高,临床表现更重,病死率更高,因此应重视对人群(尤其是男性)的有关戒酒教育,以减少不良结局的发生。

Objective To investigate the clinical and prognostic features of acute alcoholic pancreatitis.Methods A total of 467 patients with incipient acute pancreatitis(AP)who were admitted to The Affiliated Hospital of Southwest Medical University from July 2013 to July 2018 were enrolled as subjects,and among these patients,182 with alcoholic AP were enrolled as alcoholic group and 285 with biliary AP were enrolled as biliary group.The two groups were compared in terms of the clinical features such as age,sex,laboratory markers,disease grade,complications,and prognostic indices.The independent samples t-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups.The chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups,and the Mann-Whitney U test was used for comparison of ranked data between two groups.Results Compared with the biliary group,the alcoholic group had significantly higher constituent ratio of male patients(74.2%vs 48.1%,χ^2=31.124,P<0.001)and proportion of patients with fatty liver disease(34.1%vs 24.9%,χ^2=4.569,P=0.033).The biliary group had a significantly higher proportion of patients with hypertension than the alcoholic group(23.5%vs 15.4%,χ^2=4.524,P=0.033).Compared with the biliary group,the alcoholic group had significantly higher levels of creatinine and triglyceride(Z=-4.828,t=7.916,both P<0.001),proportion of patients with severe AP(34.6%vs 15.1%,Z=-4.787,P<0.001),and CTSI score(4.6±1.7 vs 4.2±1.5,t=2.672,P=0.008).Compared with the biliary group,the alcoholic group had significantly higher probabilities of acute peripancreatic fluid accumulation(61.0%vs 49.8%,χ^2=5.045,P<0.05),pancreatic pseudocyst(11.5%vs 4.2%,χ^2=8.881,P<0.05),infectious pancreatic necrosis(37.9%vs 19.6%,χ^2=18.899,P<0.05),and renal failure(19.2%vs 8.4%,χ^2=11.758,P<0.05).Compared with the biliary group,the alcoholic group had significantly longer time to intestinal function recovery,time to relief of abdominal pain,and length of hospital stay(t=-4.078,-3.357,and-2.527,all P<0.05).There was a significant difference in mortality rate between the alcoholic group and the biliary group(7.1%vs 3.2%,χ^2=3.929,P=0.047).Conclusion Compared with the biliary group,the alcoholic group has a higher risk of complications,worse clinical manifestations,and a higher mortality rate.Therefore,alcohol abstinence education should be performed for this population,especially men,in order to reduce adverse outcomes.