妊娠期急性胰腺炎重症化的危险因素分析

Risk factors for the exacerbation of acute pancreatitis during pregnancy

目的及时评估和干预妊娠期急性胰腺炎(APIP)对于降低产妇和胎儿病死率具有重要意义。文中分析APIP患者的临床特征,探讨病情加重的危险因素。方法回顾性分析2015年1月-2020年12月中国医科大学附属盛京医院急诊收治的36例APIP患者临床资料,并按病情严重程度分为轻症急性胰腺炎(MAP)组、中度重症急性胰腺炎(MSAP)组和重症急性胰腺炎(SAP)组。比较各组临床资料并进行有序logistic回归分析以明确病情重症化的危险因素。结果APIP的主要病因为高脂血症(14/36,38.9%)。SAP组胎儿病死率较MAP组更高(62.5%vs 11.8%,P<0.05)。不同严重程度的APIP患者的pH值、实际HCO^(3-)、BE、乳酸、三酰甘油、间接胆红素、脂肪酶及胰腺炎病因的差异有统计学意义(P<0.05)。不同预后患者pH值、BE、乳酸、三酰甘油、血白细胞数、中性粒细胞数及病情分级差异均有统计学意义(P<0.05)。pH值、实际HCO^(3-)、BE、乳酸、三酰甘油、高脂血症性胰腺炎是APIP病情加重的危险因素。pH值、血白细胞数和三酰甘油是APIP患者死亡的危险因素。校正其他原因后乳酸是APIP病情加重的独立危险因素(OR=3.564,P=0.001)。结论APIP的病情严重程度与孕妇和胎儿的预后密切相关。酸中毒、高脂血症及乳酸升高是病情加重和预后不良的危险因素,故APIP诊治初期需重视。

Objective Timely evaluation and intervention of acute pancreatitis in pregnancy(APIP)play a pivotal role in reducing mortality rate of the mother and her fetus.This study sought to analyze the clinical characteristics of patients with APIP and to explore the risk factors for its aggravation.Methods The clinical records of 36 APIP patients treated in the emergency department of Shengjing Hospital of China Medical University from January 2015 to December 2020 were reviewed retrospectively.Patients were categorized as mild acute pancreatitis(MAP)group,moderately severe acute pancreatitis(MSAP)group and severe acute pancreatitis(SAP)group according to the severity.The clinical records in each group were compared and the ordered logistic regression analysis were performed to explore the risk factors for exacerbation.Results Hyperlipidemia(HLP)is the main cause of APIP(14/36,38.9%).The fetal mortality in SAP group was higher than that in MAP group(62.5%vs 11.8%,P<0.05).There were significant differences in PH value,actual HCO^(3-),BE,lactic acid,triglyceride,indirect bilirubin,lipase and cause of pancreatitis among APIP patients with different severity.In addition,there were significant differences in pH value,BE,lactic acid,triglyceride,leukocyte count,neutrophil count and disease grade in patients with different prognosis.High PH value,actual HCO^(3-),BE,lactic acid,triglyceride and HLP pancreatitis can lead to aggravation of APIP,and PH value,leukocyte count and triglyceride are the risk factors of death in patients with APIP.After adjusting for other causes,lactic acid is an independent risk factor for the aggravation of APIP(OR=3.564,P=0.001).Conclusion The severity of APIP is closely related to the prognosis of pregnant women and fetus.Acidosis,hyperlipidemia and elevated lactic acid are risk factors for the aggravation and poor prognosis of APIP,which thus should be paid attention to in the early stage of APIP diagnosis and treatment.