不同发病原因急性胰腺炎严重程度及并发症、死亡率的比较  

Severity, complications and mortality of acute pancreatitis of different etiology: A comparative analysis

作　　者：黄晓丽[1] 王国品[1] 王平[1] 于成功[2] 

机构地区：[1]东南大学附属南京江北人民医院消化内科,江苏省南京市210048 [2]南京医科大学附属鼓楼医院消化内科,江苏省南京市210008

出　　处：《世界华人消化杂志》2014年第27期4172-4176,共5页World Chinese Journal of Digestology

摘　　要：目的:比较不同发病原因(高脂血症性与胆源性)急性胰腺炎病情严重程度,探讨高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)的临床特点.方法:回顾性分析东南大学附属南京江北人民医院2012-01/2013-12收治的HLAP患者23例与胆源性急性胰腺炎(acute biliary pancreatitis,ABP)患者84例的临床资料,进行一般情况、病情严重度评估、并发症和死亡率的比较.结果:HLAP组的体质量指数(body mass index,BMI)、住院时间明显高于ABP组(24.3 kg/m2±2.15 kg/m2 vs 22.00 kg/m2±2.84 kg/m2,14.30 d±5.77 d vs 10.32 d±3.91 d,P<0.01),平均年龄、血清淀粉酶(serum amylase,AMS)水平明显低于ABP组(41.91±8.88 vs 63.88±13.83,598.04 U/L±857.40 U/L vs 1200.86U/L±833.64 U/L,P<0.05或P<0.01).HLAP组C反应蛋白(C-reactive peptide,CRP)值、急性生理学及慢性健康状况评分系统(Acute Physiology And Chronic Health Evaluation Scoring System,APACHEⅡ)评分、急性胰腺炎严重程度床边指数(bedside index for severity in acute pancreatitis,BISAP)评分在入院时及入院48 h均明显高于ABP组(P<0.05或P<0.01);改良CT严重指数(modified CT severity index,MCTSI)评分在入院时两者无明显差异,但在入院48 h HLAP组明显高于ABP组(5.91±1.41 vs 4.98±1.77,P<0.01).两组并发肠麻痹及急性呼吸窘迫综合征(acute respiratory distresssyndrome,ARDS)无明显差异,但HLAP组并发糖尿病及胰腺囊肿率较ABP组增高(13%vs 2.4%,21.7%vs 6.0%,P<0.05),HLAP组并发胰性脑病1例,死亡2例,ABP组无1例死亡.结论:HLAP具有病情重、并发症及死亡率高等特点,故临床应引起足够重视.AIM： To compare the severity and clinical char- acteristics of hyperlipidemic acute pancreatitis （HLAP） and biliary acute pancreatitis （ABP）.METHODS： Clinical data for 23 patients with HLAP （HLAP group） and 84 patients with ABP （ABP group） treated at our hospital from Janu- ary 2012 to December 2013 were retrospectively analyzed, and the general data, severity, compli- cations and mortality were compared.RESULTS： Body mass index （BMI） and time of hospitalization in the HLAP group were signifi- cantly higher than those in the ABP group （24.3 kg/m^2 ± 2.15 kg/m^2 vs 22 kg/m^2 ± 2.84 kg/m^2, 14.30 d ± 5.77 d vs 10.32 d ± 3.91 d, P 〈 0.01）. Serum AMS levels were significantly lower in the HLAP group than in the ABP group （598.04 U/L ± 857.40 U/L vs 1200.86 U/L ± 833.64 U/L, P 〈 0.05）. C-reactive protein （CRP） values, acute physiology and chronic health evaluation scor- ing system （APACHE II） scores, and bedside index for severity in acute pancreatitis （BISAP） scores at admission and 48 h after admission were significantly higher in the HLAP group than in the ABP group （P 〈 0.05 or P 〈 0.01）. The modified CT severity index （MCTSI） score had no significant difference between the two groups at admission, but was significantly higher 48 h after admission in the HLAP group （5.91 ± 1.41 vs 4.98 ± 1.77, P 〈 0.01）. The incidence of intes- tinal paralysis＇ and acute respiratory distress syndrome （ARDS） in the two groups had no significant difference, but that of diabetes and pancreatic cysts was significantly higher in the HLAP group （13% vs 2.4%, 21.7% vs 6%, P 〈 0.05）. There were 1 case of pancreatic encephalopathy and 2 deaths in the HLAP group, while there was no death in the ABP group.CONCLUSION： HLAP is characterized by seri- ous illness and high incidence of complications and mortality, and attention should be paid to this condition.

关 键 词：急性胰腺炎 高脂血症 病情评估 临床特征 

分 类 号：R576[医药卫生—消化系统]