46例妊娠中晚期合并急性胰腺炎的临床特点及预后分析

Clinical characteristics and prognosis analysis in 46 cases of middle and late pregnancy complicating acute pancreatitis

目的探讨妊娠中晚期急性胰腺炎的临床特点、实验室检查、影像学检查及预后分析。方法回顾性分析重庆医科大学附属第一医院消化内科2015年8月至2019年3月收治的46例妊娠中晚期合并急性胰腺炎患者的临床资料。结果妊娠晚期妊娠合并急性胰腺炎(APIP)发病率(86.4%)较妊娠中期(54.5%)明显升高(P<0.05)。孕晚期APIP患者人数较孕中期明显增多(P<0.05),上腹部CT显示胰腺水肿程度大于b级的孕晚期APIP患者人数较孕中期明显增多(P<0.05)。总体预后分析发现,不管是孕中期还是孕晚期APIP患者,其预后差异并无统计学意义(P>0.05)。孕中期APIP合并高脂血症的患者引产率(60.0%)较非高脂血症患者(13.3%)高(P<0.05);而孕晚期APIP合并高脂血症患者引产率(58.8%)与非高脂血症患者(28.6%)比较差异无统计学意义(P>0.05)。结论与妊娠中期比较,妊娠晚期更容易患高脂血症,且中-重型APIP发病率更高,妊娠中晚期妇女应控制高脂饮食摄入,同时加强三酰甘油、胆固醇等水平的检测。

Objective To investigate the clinical features,laboratory testing,imaging examination and prognosis of acute pancreatitis in pregnancy(APIP).Methods The clinical data in 46 cases of APIP treated in the gastroenterology department of this hospital from August 2015 to March 2019 were retrospectively analyzed.Results The incidence rate of moderate-severe APIP in the late pregnancy(86.4%)was significantly higher than 54.5%in the middle pregnancy(P<0.05).In the analysis of laboratory test results,among the patients with hyperlipidemia,the number of APIP in late pregnancy was significantly increased compared with that in middle pregnancy(P<0.05),the number of the APIP late pregnancy patients with the pancreatic edema degree>b level by upper abdominal CT was significantly increased compared with that in middle pregnancy APIP(P<0.05).The overall prognosis analysis found that the prognosis had no statistical difference between the APIP middle pregnant patients and APIP late pregnant patients(P>0.05).The estimated induced labor rate in the APIP middle pregnant patients with complicating hyperlipidemia was higher than that in the patients without hyperlipidemia(60.0%vs.13.3%,P<0.05);while the estimated induced labor rate had no statistical difference between the APIP late pregnant patients with complicating hyperlipidemia and the patients without hyperlipidemia(58.8%vs.28.6%,P>0.05).Conclusion Compared with the middle pregnancy,the late pregnancy is more likely to suffer from hyperlipidemia,moreover the incidence rate of moderate-severe APIP is higher.Therefore,the middle and late pregnant women should control high-fat dietary intake,meanwhile strengthen the triglycerides and cholesterol screening.