68例妊娠期急性胰腺炎患者临床特点与模型分析  

Clinical characteristics and model analysis of acute pancreatitis in pregnancy in 68 cases

作　　者：吕苏聪 刘伟柱 周鹏志[1] 黄越前[1] 陈雅莹[1] LYU Sucong;LIU Weizhu;ZHOU Pengzhi;HUANG Yueqian;CHEN Yaying(Department of Gastroenterology,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院消化内科,广东广州510150

出　　处：《胃肠病学和肝病学杂志》2021年第7期748-753,共6页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨妊娠期急性胰腺炎(acute pancreatitis in pregnancy,APIP)的临床特点和APACHEⅡ评分、BISAP评分对疾病严重程度评估的效能。方法对2012年1月至2018年12月在广州医科大学附属第三医院就诊的68例APIP患者的临床资料进行回顾性分析,根据疾病严重程度分为轻症组(n=41)和重症组(n=27),观察两组间临床特点、实验室指标、病因、并发症及母婴结局情况,根据APACHEⅡ评分和BISAP评分对患者进行评分,评估不同模型对APIP疾病严重程度的预测效能。结果与轻症组相比,重症组患者住院天数、血压、死胎率、胸腔积液率、LDH和AST升高,ALB降低,组间差异有统计学意义(P均<0.05)。APIP最常见的病因是高脂血症,占51.5%;其次是特发性胰腺炎(29.4%)和胆源性胰腺炎(19.1%)。重症组患者APACHEⅡ评分、BISAP评分均高于轻症组(t=-3.665、-2.275,P均<0.05)。APACHEⅡ评分和BISAP评分的ROC曲线下面积(AUC)分别为0.746(95%CI:0.626~0.866,P<0.05)、0.720(95%CI:0.599~0.841,P<0.05),灵敏度分别为70.4%、81.5%,特异度分别为68.3%、58.5%。将APACHEⅡ评分根据ROC曲线临界值分组,结果显示,随着APACHEⅡ评分升高,APIP患者手术终止妊娠率、死胎率、胸腔积液率均升高(χ2=4.121、5.733、4.568,P均<0.05)。结论APIP患者具有异常的LDH、AST、ALB等指标,住院天数长,且往往合并死胎、胸腔积液等情况;高脂血症是APIP最常见的病因之一,明确诊断后应选择适当时机终止妊娠;APACHEⅡ评分和BISAP评分均能不同程度地反映APIP患者的疾病严重程度,且APACHEⅡ评分具有更好的临床指导价值。Objective To investigate the clinical characteristics of acute pancreatitis in pregnancy(APIP) and the value of Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ) score and Bedside Index Severity of Acute Pancreatitis(BISAP) score for disease severities evaluation. Methods A total number of 68 patients admitted to the Third Affiliated Hospital of Guangzhou Medical University from Jan. 2012 to Dec. 2018 with APIP as diagnosis were enrolled, and according to different severities of APIP, they were divided into the mild group(n=41) and severe group(n=27). Clinical characteristics, laboratory indicators, etiology, complications and maternal and infant outcomes were observed between the two groups. According to the APACHEⅡscore and BISAP score of patients to evaluate the predictive power of different models for the severity of APIP.Results In the severe group, length of hospitalization, blood pressure, death fetuses rate, pleural effusion rate, lactate dehydrogenase(LDH) and glutamic oxalacetic transaminease(AST) were all higher than those in mild group, albumin(ALB) was lower than that in mild group(all P<0.05). Hyperlipidemia was the most common cause of APIP, accounting for 51.5%, idiopathic pancreatitis(29.4%) and biliary pancreatitis(19.1%) followed. The severe group patients with higher APACHEⅡ score and BISAP score than those in mild group(t=-3.665,-2.275, respectively, P<0.05). APACHEⅡ score and BISAP score area under the ROC curve(AUC) were 0.746(95% CI: 0.626-0.866, P<0.05), 0.720(95% CI: 0.599-0.841, P<0.05), sensitivity was 70.4%, 81.5%, respectively, specificity was 68.3%, 58.5%, respectively. The APACHE Ⅱ score was divided into groups according to the cut-off value of ROC curve. Analysis showed with a higher APACHE Ⅱ score, the cesarean section rate, death fetuses rate and pleural effusion rate were significantly higher(χ2=4.121, 5.733, 4.568, respectively, P<0.05). Conclusion APIP patients have abnormal LDH, AST, ALB indicators, longer length of hospitalization and often combined wi

关 键 词：妊娠 急性胰腺炎 临床特点 APACHEⅡ BISAP 模型分析 

分 类 号：R576[医药卫生—消化系统]