早期高水平尿乳果糖/甘露醇对急性胰腺炎预后的影响

Effect of early high level of urine lactulose/mannitol on prognosis of acute pancreatitis

目的探讨早期尿乳果糖/甘露醇(L/M)水平升高对急性胰腺炎(AP)预后的影响。方法回顾性分析2017年1月至2019年10月绵阳市三台县人民医院消化内科收治的56例AP患者相关临床资料,根据入院24h内测定的尿L/M水平分为尿L/M升高组(n=31)和尿L/M正常组(n=25),比较两组患者急性生理与慢性健康评分(APACHEⅡ评分)、重症AP(SAP)发生率、重症监护病房(ICU)入住率、ICU入住时间、机械通气率、机械通气时间、28d内病死率;采用二元Logistic回归分析判断尿L/M水平对预后的影响。结果尿L/M升高组患者APACHEⅡ评分、SAP发生率、ICU入住率、机械通气率、28d病死率均高于尿L/M正常组,ICU入住时间、机械通气时间均长于尿L/M正常组,差异均有统计学意义(P<0.05);Pearson相关性分析显示,尿L/M水平与APACHEⅡ评分、ICU入住时间、机械通气时间均呈正相关(P<0.05);二元Logistic回归分析显示,尿L/M水平对AP患者是否发生SAP、是否入住ICU、是否机械通气、是否在28d内死亡有明显影响(P<0.05)。结论 AP患者早期存在高水平尿L/M,明显增加了SAP发生率,并且延长了ICU入住时间和机械通气时间,严重影响预后。

Objective To investigate the effect of early elevated level of urinary lacturofructose/mannitol(L/M)on the prognosis of acute pancreatitis(AP).Methods The clinical data of 56 AP patients admitted to People′s Hospital of Santai County in mianyang from January 2017 to October 2019 were retrospectively analyzed.According to the urine L/M level measured within 24 hours after admission,the patient was divided into the elevated urine L/M group(n=31)and the normal urine L/M group(n=25).The acute physiology and chronic health score(APACHEⅡ),incidence of severe AP(SAP),ICU occupancy rate,stay time in ICU,mechanical ventilation rate,mechanical ventilation time and mortality within 28 days were compared between the two groups.The effect of urine L/M on prognosis was determined by binary Logistic regression analysis.Results APACHEⅡscores,SAP incidence rate,ICU occupancy,mechanical ventilation rate,and 28d mortality of patients in the elevated urine L/M group were all higher than those in the normal urine L/M group,and stay time in ICU and mechanical ventilation duration were longer than those in the normal urine L/M group,and differences were statistically significant(P<0.05);Pearson correlation analysis showed that urine L/M levels were positively correlated with APACHEⅡscores,stay time in ICU and mechanical ventilation time(P<0.05).Binary Logistic regression analysis showed that urine L/M levels had significant effects on whether SAP occurred,whether admitted in ICU,whether mechanical ventilation support was used,and whether death occurred within 28 days(P<0.05).Conclusion The high level of urinary L/M in the early stage of AP patients significantly increases the incidence of SAP,prolongs the stay time in ICU and mechanical ventilation time,and seriously affects the prognosis.