腹腔穿刺引流减轻重症急性胰腺炎相关肝损伤:历史性队列研究

Protective effects of abdominal paracentesis drainage in patients with severe acute pancreatitis-associated liver injury:a historical cohort study

目的 探讨腹腔穿刺引流(abdominal paracentesis drainage,APD)对早期重症急性胰腺炎(severe acute pancreatitis,SAP)相关肝损伤(pancreatitis-associated liver injury,PALI)的治疗效果。方法 选取2015年1月至2021年1月期间西部战区总医院收治的符合纳入和排除标准的114例SAP患者作为研究对象,根据是否进行APD治疗将患者分为APD组(61例)和非APD组(53例);分析比较2组患者的基线资料、住院死亡率、肝功能相关指标、炎症相关指标、病情严重程度评分等。结果 APD组住院死亡率低于非APD组(8.2%比22.6%,P=0.031);APD组病情严重程度评分(APACHEⅡ评分、Ranson评分和改良Marshall评分)及炎症相关指标(超敏C反应蛋白、白细胞介素-1、白细胞介素-6和肿瘤坏死因子-α)均低于非APD组(P<0.05)。在肝功能相关指标方面,2组治疗后的丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate aminotransferase,AST)、γ谷氨酰转肽酶(γ-glutamyl transpeptidase,GGT)、总胆红素(total bilirubin,TBIL)和直接胆红素(direct bilirubin,DBIL)水平均较治疗前明显降低(P<0.05),APD组治疗后的ALT、AST、TBIL和DBIL水平均低于非APD组(P<0.05),而前白蛋白和白蛋白水平高于非APD组(P<0.05);2组间治疗后GGT、碱性磷酸酶和5′-核苷酸酶水平比较差异均无统计学意义(P>0.05)。结论 对于伴有腹腔积液的SAP患者,尽早行APD治疗可减轻PALI的程度并可改善患者的肝功能。

Objective To explore the protective effects of abdominal paracentesis drainage(APD)on pancreatitis-associated liver injury in the early phase of severe acute pancreatitis(SAP).Methods One hundred and fourteen consecutive patients with SAP,admitted to the General Hospital of Western Theater Command from January2015 to January 2021,were included in this retrospective study.The patients were divided into the APD group(n=61)and the non-APD group(n=53)based on whether they underwent APD treatment within 72 h of admission.The variables including baseline data,liver function tests,inflammation indexes,severity scores and other variables of the two groups were statistically analyzed.Results The hospital mortality in the APD group was lower than that in the non-APD group(8.2%vs.22.6%,P=0.031).These severity scores(including APACHEⅡscore,Ranson score and modified Marshall score)and inflammation indexes(including C-reactive protein,interleukin-6,interleukin-1 and tumor necrosis factor-α)in the APD group were all lower than those in the non-APD group(P0.05).In terms of liver function related indexes,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyl transpeptidase(GGT),total bilirubin(TBIL),and direct bilirubin(DBIL)after treatment in both two groups were significantly lower than those before treatment(P0.05).The levels of ALT,AST,TBIL and DBIL after treatment in the APD group were lower than those in the non-APD group(P0.05),and the levels of prealbumin and albumin after treatment in the APD group were higher than those in the non-APD group(P0.05),but there were no significant differences in the levels of alkaline phosphatase,GGT and 5-′n ucleotidase after treatment in the two group(P0.05).Conclusion For SAP patients with ascitic fluid,application of APD can attenuate liver injury and improve liver function in the early stage of SAP.