急性胰腺炎相关胃肠道衰竭的评价和早期诊断指标  

Evaluation and Early Diagnosis of Gastrointestinal Failure in Acute Pancreatitis

作　　者：金梦[1] 张慧敏[1] 陈轩馥 武美序 王征 国明月 柏小寅 杨红[1] 钱家鸣[1] JIN Meng;ZHANG Huimin;CHEN Xuanfu;WU Meixu;WANG Zheng;GUO Mingyue;BAI Xiaoyin;YANG Hong;QIAN Jiaming(Department of Gastroenterology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科

出　　处：《中国医学科学院学报》2020年第1期47-54,共8页Acta Academiae Medicinae Sinicae

基　　金：中国医学科学院医学与健康科技创新工程(2016-12M-3-001);卫生部行业专项基金(201002020);国家教育部优秀青年教师研究基金(20101106120059)~~

摘　　要：目的探索急性胃肠道损伤分级在急性胰腺炎相关胃肠道衰竭中的应用及其早期诊断指标。方法回顾性分析2013年10月至2016年10月北京协和医院收治的中重度急性胰腺炎患者的临床资料,采用Logsitic回归分析和受试者工作特征曲线评价胃肠道衰竭的早期诊断指标。结果共202例患者纳入研究,其中胃肠道衰竭90例(44.6%)。生存分析结果显示,胃肠道衰竭组患者预后显著下降(P<0.05)。Logistic回归分析结果显示,年龄(OR=1.06,95%CI:1.03~1.09,P<0.001)、入院主诉排气排便停止(OR=7.02,95%CI:2.08~23.66,P=0.002)、血白细胞水平升高(OR=1.09,95%CI:1.02~1.17,P=0.015)、血白蛋白水平降低(OR=0.93,95%CI:0.86~1.00,P=0.048)、血肌酐水平升高(OR=1.02,95%CI:1.01~1.04,P=0.001)是胃肠道衰竭的独立危险因素。入院即刻急性生理与慢性健康评分Ⅱ和急性胰腺炎床旁严重程度指数评分诊断胃肠道衰竭的曲线下面积分别为0.999和0.782。结论胃肠道衰竭可显著增加AP患者的死亡风险。入院即刻APACHEⅡ评分和BISAP评分对胃肠道衰竭具有较好的诊断价值。Objective To investigate the application of Acute Gastrointestinal Injury(AGI)grading in evaluating gastrointestinal failure in patients with acute pancreatitis(AP).Methods In this retrospective observational study,patients presented with moderate severe AP and severe AP in our hospital from October 2013 to October 2016 were consecutively enrolled.Logistic regression analysis and receiver operating characteristic curve were used to explore and evaluate potential predictors of gastrointestinal failure.Results A total of 202 patients were included in this study,with 90 cases(44.6%)identified as gastrointestinal failure.Survival curve showed significantly increased risk of death in patients with gastrointestinal failure(P<0.05).Logistic regression analysis showed age(OR=1.06,95%CI:1.03-1.09,P<0.001),complaint of stopping flatus and defecation(OR=7.02,95%CI:2.08-23.66,P=0.002),increased counts of white blood cells in peripheral blood(OR=1.09,95%CI:1.02-1.17,P=0.015),decreased level of serum albumin(OR=0.93,95%CI:0.86-1.00,P=0.048),and increased level of serum creatinine at admission(OR=1.02,95%CI:1.01-1.04,P=0.001)were the independent risk factors of gastrointestinal failure.The area under curves of Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)and Beside Index for Severity in Acute Pancreatitis(BISAP)scores in diagnosing gastrointestinal failure were 0.999 and 0.782,respectively.Conclusions Gastrointestinal failure can remarkably increase the risk of death in patients with AP.Both APACHEⅡand BISAP scores at admission are useful in diagnosing gastrointestinal failure in patients with AP.

关 键 词：急性胰腺炎 胃肠道衰竭 急性胃肠道损伤分级 

分 类 号：R576[医药卫生—消化系统]