复发性急性胰腺炎合并代谢综合征患者的临床特征及其发生重症的影响因素分析

Clinical features of recurrent acute pancreatitis complicated with metabolic syndrome and analysis of influencing factors for severe disease

目的探讨复发性急性胰腺炎(RAP)合并代谢综合征(MS)患者的临床特点及其发生重症的影响因素。方法回顾性分析该院2012年6月至2022年6月收治的382例RAP患者的临床资料,根据是否合并MS分为MS组(n=142)和非MS组(n=240),根据严重程度分为重症组(n=29)与非重症组(n=353)。比较各组一般资料、血清学指标[甘油三酯(TG)、总胆固醇(TC)、白细胞计数(WBC)、中性粒细胞与淋巴细胞比值(NLR)、血钙、D-二聚体(D-D)、乳酸脱氢酶(LDH)、ALT、AST]、ICU入住率、总住院时间等。二元logistic回归分析RAP发生重症的独立影响因素,受试者工作特征(ROC)曲线分析各指标对RAP发生重症的预测价值。结果MS组引起RAP最常见的病因为高脂血症性(66.2%),非MS组引起RAP最常见的病因为胆源性(44.6%),不同病因比较差异有统计学意义(P<0.05)。重症组与非重症组年龄、性别,高血压、糖尿病、MS比例,住院时间,LDH、血钙、D-D、NLR水平比较差异有统计学意义(P<0.05)。血钙、D-D、LDH、NLR及联合诊断预测RAP发生重症的曲线下面积(AUC)分别为0.759、0.777、0.710、0.621及0.841,单独诊断有一定预测价值,联合诊断预测价值更高。结论RAP合并MS最常见的病因是高脂血症性,非RAP合并MS最常见的病因是胆源性。血钙、D-D、LDH、NLR是预测RAP发生重症的可靠指标,联合诊断的准确性更高。

Objective To investigate the clinical features of patients with recurre nt acute pancreatitis(RAP)complicated with metabolic syndrome(MS)and the influencing factors of severe disease.Methods The clinical data of 382 RAP patients admitted to the hospital from June 2012 to June 2022 were retrospectively an alyzed,and they were divided into the MS group(n=142)and the non-MS group(n=240)according to whether they were combined with MS,and into the severe group(n=29)and the non-severe group(n=353)according to the severity.The general data,serological parameters[triglyceride(TG),total cholesterol(TC),white blood cell count(WBC),neutrophil to lymphocyte ratio(NLR),blood calcium,D-dimer(D-D),lactate dehydrogenase(LDH),ALT,AST]and ICU occupancy rate and total length of stay were compared among all groups.Binary logistic regression was used to analyze the independent influencing factors of RAP development into severe disease,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of each indicator for RAP development.Results Hyperlipidemia was the most common cause of RAP in MS group(66.2%),and biliary origin was the most common cause of RAP in non-MS group(44.6%).There was significant difference among different causes was statistically significant(P<0.05).There were significant differences in age,gender,proportion of hypertension,diabetes,MS,length of stay,LDH,blood calcium,D-D and NLR levels between the critical and non-critical groups(P<0.05).The area under the curve(AUC)of blood calcium,D-D,LDH,NLR and combined diagnosis were 0.759,0.777,0.710,0.621,and 0.841,respectively.The AUC of single diagnosis had a certain predictive value,but combined diagnosis had a higher predictive value.Conclusion The most common cause in the MS group was hyperlipidemia,and the most common cause in the non-MS group was biliary.Blood calcium,D-D,LDH,NLR are reliable indicators to predict the development of RAP into severe disease,and the accuracy of combined diagnosis is higher.