妊娠合并急性胰腺炎166例临床特征及母儿结局分析

Clinical characteristics and maternal and fetal outcomes of 166 patients with acute pancreatitis in pregnancy

目的探讨妊娠合并急性胰腺炎(acute pancreatitis in pregnancy,APIP)的临床特征及母儿结局。方法选取2012年1月至2021年10月郑州大学第一附属医院产科收治的166例APIP患者进行回顾性分析。结果(1)同期收住院孕妇74000例,APIP在孕妇中的发生率为2.24/1000(166/74000)。166例患者中妊娠合并轻症急性胰腺炎(mild acute pancreatitis,MAP)76例(45.78%)、中重症急性胰腺炎(moderately severe acute pancreatitis,MSAP)30例(18.07%)、重症急性胰腺炎(severe acute pancreatitis,SAP)60例(36.14%);按病因分为胆源性胰腺炎39例(23.49%)、高脂血症性胰腺炎60例(36.14%)、其他原因67例(40.36%);妊娠早期11例(6.63%)、中期31例(18.67%)、晚期124例(74.70%),妊娠晚期发生率最高;孕产妇死亡4例,病死率2.41%,均为SAP。随访153例,胎儿丢失31例,丢失率为20.26%。其中,孕早期11例胎儿丢失6例(54.55%)、孕中期28例胎儿丢失10例(35.71%)、孕晚期114例胎儿丢失15例(13.16%),不同妊娠期之间胎儿丢失率差异有统计学意义(χ^(2)=15.702,P<0.001),妊娠期别越早胎儿丢失率越高;APIP是否伴有妊娠期糖尿病的胎儿丢失率差异有统计学意义[(9/20)vs.(22/133),χ^(2)=7.043,P=0.008];妊娠合并MAP 67例胎儿丢失5例(7.46%)、MSAP 29例胎儿丢失3例(10.34%)、SAP 57例胎儿丢失23例(40.35%),胎儿丢失率在疾病不同严重程度之间差异有统计学意义(χ^(2)=22.797,P<0.001),疾病越重胎儿丢失率越高。(2)实验室检查指标中,白细胞计数、C反应蛋白、甘油三酯、胆固醇、白蛋白、血糖、血钙等指标在疾病的不同严重程度之间均表现出差异有统计学意义(均P<0.05)。结论APIP多发生在妊娠晚期,高脂血症为APIP的首要病因,APIP的严重程度与母儿死亡率相关。血白蛋白水平、血钙水平、血糖水平、白细胞计数、C反应蛋白水平可以预测疾病的严重程度与进展。APIP伴有妊娠期糖尿病增加了胎儿的不良结局。

ObjectiveThis study aimed to describe the clinical characteristics and the maternal and fetal outcomes of APIP(acute pancreatitis in pregnancy).Methods We retrospectively studied 166 APIP cases treated in the First Affiliated Hospital of Zhengzhou University from January 2012 to October 2021.Results(1)The incidence of acute pancreatitis during pregnancy was 2.24/1000(166/74000).Severity was classified as mild acute pancreatitis(MAP,n=76,45.78%),moderately severe acute pancreatitis(MSAP,n=30,18.07%),and severe acute pancreatitis(SAP,n=60,36.14%).The common causes for APIP were gallstone(n=39,23.49%),hypertriglyceridemia(n=60,36.14%)and others(n=67,40.36%).In our study,most patients had APIP onset during the third trimester(74.70%,n=124)but we also had6.63%(n=11)and 18.67%(n=31)APIP onset during the first and the second trimester.The overall maternal and fetal mortality rate was 2.41%(4/166,all being SAP)and 20.26%(31/153),respectively.Fetal mortality rate during the first trimester was 54.55%(6/11),and it was 35.71%(10/28)and 13.16%(15/114)during the second and the third trimester(χ^(2)=15.702,P<0.001).The earlier the trimester,the higher the mortality rate of fetuses.The fetal mortality rate was higher in the patients with gestational diabetes mellitus than others[(9/20)vs.(22/133),χ^(2)=7.043,P=0.008].The fetal mortality rate of SAP(40.35%,23/57)was much higher than that of MSAP(10.34%,3/29)and MAP(7.46%,5/67),and the severity of APIP was significantly correlated with higher risks for maternal and fetal death(χ^(2)=22.797,P<0.001).The severer the disease,the higher the fetal mortality rate.(2)There was statistical difference in white blood cell count、C-reactive protein,triglyceride,cholesterol,blood glucose,blood albumin and blood calcium among groups of different severity(all P<0.05).Conclusion sMost APIP occurred during the third trimester.Hypertriglyceridemia was the most common cause of APIP.The severity of APIP was associated with higher risk for maternal and fetal death.Lower level of blood albumin,serum calcium and higher blood glucose,white blood cell count,C-reactive protein levels could be used as an indicator for the severity of the APIP.The patients with gestational diabetes mellitus may lead to poorer fetal outcomes.