急性胰腺炎合并非酒精性脂肪性肝病的临床特征及预后分析

Clinical features and prognosis of acute pancreatitis with nonalcoholic fatty liver disease

目的探讨非酒精性脂肪性肝病(NAFLD)与急性胰腺炎(AP)严重程度的相关性。方法纳入2019年1月-2019年8月西南医科大学附属医院收治的AP患者398例,其中包括轻症急性胰腺炎(MAP)197例,中度重症急性胰腺炎(MSAP)151例,重症急性胰腺炎(SAP)50例。根据是否合并NAFLD将AP患者分为NAFLD组(206例)和非NAFLD组(192例)。分析及对比两组患者的临床特点及预后,包括基础资料、血清学指标、病原学、并发症、AP严重程度评分、住院日及病死率等。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验或Fisher确切检验,以发生中-重症急性胰腺炎(M-SAP)为终点,进行logistic回归分析。结果两组间年龄、男性占比、BMI、TC、TG、Na+、WBC、中性粒细胞百分比、血糖、血清肌酐差异均有统计学意义(P值均<0.05),NAFLD组更容易合并糖代谢异常及脂代谢异常(P值均<0.05)。两组病原学构成差异有统计学意义(P<0.001),NAFLD组以高脂血症为主(48.1%),非NAFLD组以胆源性为主(57.8%)。NAFLD组M-SAP比例、RANSON评分及Balthazar CTS1评分较非NAFLD组更高(P值均<0.05);NAFLD组更容易并发全身炎症反应综合征(P<0.001);NAFLD组更易发生胰周液体聚集(χ2=15.820,P<0.001)与胰周坏死物聚集(χ2=7.012,P=0.008)。NAFLD组复发风险更高(30.6%vs 19.3%,χ2=6.759,P=0.009)。NAFLD组更容易并发多器官功能衰竭(12.6%vs 8.9%),且病死率更高(3.4%vs 1.2%),但差异均无统计学意义(P值均>0.05)。NAFLD、糖代谢异常及淋巴细胞计数为M-SAP的独立危险因素(P值均<0.05)。结论合并NAFLD的AP患者,更容易发生全身炎症反应综合征与胰腺局部并发症,有更高的疾病分级,预后更差,且复发风险更高。

Objective To investigate the association of nonalcoholic fatty liver disease(NAFLD)with the severity of acute pancreatitis(AP).Methods A total of 398 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January to August 2019 were enrolled,among whom there were 197 patients with mild acute pancreatitis(MAP),151 patients with moderate-severe acute pancreatitis(MSAP),and 50 patients with severe acute pancreatitis(SAP).According to the presence or absence of NAFLD,these patients were divided into NAFLD group with 206 patients and non-NAFLD group with 192 patients.The two groups were compared in terms of the clinical features and prognosis,including baseline data,serological markers,etiology,complications,commonly used AP scores,length of hospital stay,and mortality rate.The t-test or the Mann-Whitney U test was used for comparison of 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;a logistic regression analysis was performed with the development of MSAP as the endpoint.Results There were significant differences between the two groups in age,proportion of male patients,body mass index,total cholesterol,triglyceride,Na+,white blood cell count,neutrophil count,blood glucose,and serum creatinine(all P<0.05),and compared with the non-NAFLD group,the NAFLD group tended to have a higher proportion of patients with abnormal glucose metabolism or abnormal lipid metabolism(P<0.05).There was a significant difference in etiological composition between the two groups(P<0.001),with the main etiology of hyperlipidemia in the NAFLD group(48.1%)and biliary disease in the non-NAFLD group(57.8%).Compared with the non-NAFLD group,the NAFLD group had significantly higher proportion of patients with MSAP,RANSON score,and Balthazar score(all P<0.05),as well as significantly higher incidence rates of systemic inflammatory response syndrome(SIRS)(P<0.001),acute peripancreatic fluid collection(χ2=15.820,P<0.001),and acute necrotic collection(χ2=7.012,P=0.008).Compared with the non-NAFLD group,the NAFLD had a significantly higher risk of recurrence(30.6%vs 19.3%,χ2=6.759,P=0.009)and higher incidence rate of multiple organ dysfunction(12.6%vs 8.9%,P>0.05)and mortality rate(3.4%vs 1.2%,P>0.05).NAFLD,abnormal glucose metabolism,and lymphocyte count were independent risk factors for MSAP(all P<0.05).Conclusion AP patients with NAFLD tend to develop SIRS and local complications of the pancreas and have a high disease grade,a poor prognosis,and a high risk of recurrence.