重症急性胰腺炎患者胰腺假性囊肿形成的相关因素分析

Risk factor analysis of pancreatic pseudocyst in patients with severe acute pancreatitis

目的探讨SAP患者胰腺假性囊肿(PPC)形成的危险因素。方法回顾性分析2015年1月至2019年12月间重庆医科大学附属第一医院收治的142例SAP患者的临床资料,按是否并发PPC分为合并PPC组(48例)和未合并PPC组(94例),记录患者性别,年龄,体重指数,病因,既往糖尿病或胰腺炎病史,发病3-10 d内改良的CT严重指数(MCTSI)评分,入院48 h内的APACHEⅡ评分,禁食时间,氧合指数,红细胞比容,白细胞计数,中性粒细胞百分比,血清降钙素原(PCT)、白蛋白、尿素氮、血钙、乳酸脱氢酶、肌酐水平,是否合并腹腔积液,入院24 h内是否行血液滤过治疗等。采用单因素分析及多因素logistic逐步回归法分析SAP患者PPC形成的独立危险因素。绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估各指标预测SAP患者PPC形成的效能。结果单因素分析显示,PPC形成与MCTSI、APACHEⅡ评分,禁食时间,PCT、白蛋白、尿素氮、乳酸脱氢酶、肌酐、血钙水平,合并腹腔积液均显著相关(P值均<0.05)。多因素回归分析显示,MCTSI评分(OR=1.810,95%CI 1.273-2.571,P=0.001)、禁食时间(OR=1.083,95%CI1.002-1.171,P=0.044)为SAP患者PPC形成的危险因素;血清白蛋白水平(OR=0.875,95%CI0.781-0.979,P=0.02)、血钙水平(OR=0.02,95%CI0.002-0.178,P<0.001)为SAP患者PPC形成的保护因素。MCTSI评分、禁食时间、血清白蛋白及血钙水平预测SAP患者PPC形成的AUC分别为0.783(95%CI 0.706-0.860)、0.650(95%CI 0.553-0.746)、0.809(95%CI 0.738-0.881)、0.855(95%CI 0.795-0.915),预测的最佳截断值分别为7分、17.5 d、33.5 g/L、1.79 mmol/L。结论MCTSI评分>7分、禁食时间>17.5 d、低血钙及低白蛋白水平是SAP并发PPC的独立危险因素,需对患者密切随访并及时干预治疗。

Objective To investigate the risk factors of pancreatic pseudocyst(PPC)in patients with severe acute pancreatitis(SAP).Methods The clinical data of 142 SAP patients treated in the First Affiliated Hospital of Chongqing Medical University from January 2015 to December 2019 were collected and retrospectively analyzed.The patients were divided into two groups:group with PPC(n=48)and group without PPC(n=94)according to whether they were complicated with PPC.The sex,age,body mass index,etiology,past history of diabetes or pancreatitis,modified CT severity index(MCTSI)score within 3 to 10 days of the onset,APACHEⅡscore within 48 hours of admission,fasting time,oxygenation index,hematocrit,white blood cell count,the percentage of neutrophil,serum procalcitonin(PCT),the levels of albumin,urea nitrogen(BUN),serum calcium,lactate dehydrogenase and creatinine,whether complicated with ascites and whether hemofiltration treatment was performed within 24 hours after admission were recorded.Univariate analysis and multivariate logistic stepwise regression were used to analyze the independent risk factors of PPC formation after SAP.The receiver operating characteristic curve(ROC)was drawn and the area under the curve(AUC)was calculated to evaluate the efficacy of each index in predicting the formation of PPC in patients with SAP.Results Univariate analysis showed that PPC formation significantly correlated with MCTSI score,APACHEⅡscore,fasting time,PCT,serum albumin,BUN,lactate dehydrogenase,creatinine,serum calcium level and ascites(P<0.05).Multivariate regression analysis showed that MCTSI score(OR=1.81,95%CI 1.273-2.571,P=0.001)and fasting time(OR=1.083,95%CI 1.002-1.171,P=0.044)were the risk factors for PPC formation in SAP patients.Serum albumin(OR=0.875,95%CI 0.781-0.979,P=0.02)and serum calcium(OR=0.02,95%CI 0.002-0.178,P<0.001)were the protective factors for PPC formations.AUC predicted by MCTSI score,fasting time,serum albumin and serum calcium levels for PPC formations in patients with SAP were 0.783(95%CI 0.706-0.860),0.650(95%CI 0.553-0.746),0.809(95%CI 0.738-0.881)and 0.855(95%CI 0.795-0.915)respectively,and the best cut-off values predicted were 7 points,17.5 days,33.5 g/L and 1.79 mmol/L.Conclusions MCTSI score>7,fasting time>17.5 days,hypocalcemia and low albumin level were the independent risk factors for SAP complicated with PPC,which need close follow-up and timely intervention.