妊娠合并急性胰腺炎患者胰腺炎严重程度的危险因素及其妊娠结局

Risk factors associated with pancreatitis severity and pregnancy outcomes in patients with acute pancreatitis in pregnancy

目的 探讨妊娠合并急性胰腺炎(APIP)患者胰腺炎严重程度的危险因素及其妊娠结局。方法 收集2012年1月至2019年12月中国医科大学附属盛京医院收治的资料完整的APIP患者113例。按照胰腺炎严重程度分为中度重症、重症急性胰腺炎组(MASP/SAP组,n=88,其中中度重症36例,重症52例)和轻症急性胰腺炎组(MAP组,n=25)。采用t检验和秩和检验比较2组各项临床指标。采用单因素和多因素logistic回归分析APIP患者胰腺炎严重程度的独立危险因素。采用Fisher确切概率法分析胰腺炎不同严重程度对APIP患者妊娠结局的影响。结果 2组发病孕周、产次、C反应蛋白(CRP)、白细胞计数、血小板计数、甘油三酯、总胆固醇比较差异均有统计学意义(均P <0.05)。非初产妇(OR=4.496;95%CI:1.352~14.957;P=0.014)、高CRP(OR=1.009;95%CI:1.001~1.017;P=0.021)是中度重症、重症急性胰腺炎发生的独立危险因素。不同严重程度的APIP患者妊娠结局[治疗性引产(<28周)、医源性早产、足月产、胎死宫内]比较无统计学差异(P=0.338)。结论 产次和高CRP是APIP患者胰腺炎严重程度的危险因素。对于APIP的非初产妇早期监测CRP有利于指导临床治疗及病情评估。

Objective To investigate the risk factors associated with pancreatitis severity in patients with acute pancreatitis in pregnancy(APIP) and evaluate pregnancy outcomes. Methods A total of 113 patients with APIP with complete data who were admitted to Shengjing Hospital of China Medical University from January 2012 to December 2019 were enrolled. Based on APIP severity,patients were divided into the moderately severe acute pancreatits(MSAP) and severe acute pancreatits(SAP) group(collectively known as the MASP/SAP group,n = 88;including 36 MSAP cases and 52 SAP cases) and the mild acute pancreatitis group(MAP group,n = 25). The t test and rank sum test were used to compare the clinical indicators of the two groups of pregnant women. Independent risk factors of pancreatitis severity in patients with APIP were further analyzed by univariate and multivariate logistic regression methods. Fisher’s exact test was used to analyze the effects of pancreatitis severity on pregnancy outcomes in patients with APIP. Results There were significant differences in gestational age,parity,C-reactive protein(CRP),white blood cell count,platelet count,triglyceride,and total cholesterol between the two groups(all P < 0.05). Non primiparity(OR = 4.496;95% CI:1.352-14.957;P = 0.014) and high CRP(OR = 1.009;95% CI:1.001-1.017;P = 0.021) were independent risk factors for moderately severe and severe acute pancreatitis. There were no significant differences in pregnancy outcomes such as therapeutic induction of labor(<28 weeks),iatrogenic preterm labor,term labor,and fetal intrauterine death among patients with APIP with different pancreatitis severity(P = 0.338). Conclusion Parity and high CRP are risk factors associated with pancreatitis severity in patients with APIP. Early monitoring of CRP in non-primiparous women with APIP may be helpful for guiding clinical treatment and disease assessment.