急性胰腺炎合并脂肪肝患者脂肪肝严重程度动态变化的影响因素分析  

Influencing factors for dynamic changes in the severity of fatty liver in patients with acute pancreatitis and fatty liver

作　　者：陈强[1] 蒋明宽 张苗 罗琳[1] 张利荣[1] CHEN Qiang;JIANG Mingkuan;ZHANG Miao;LUO Lin;ZHANG Lirong(Department of Medical Imaging,The First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou,Inner Mongolia Autonomous Region 014010,China;Department of Radiology,The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]内蒙古科技大学包头医学院第一附属医院医学影像科,内蒙古包头014010 [2]蚌埠医学院第一附属医院放射科,安徽蚌埠233004

出　　处：《临床肝胆病杂志》2023年第6期1374-1381,共8页Journal of Clinical Hepatology

基　　金：包头医学院青苗计划项目(BYJJ-QM-201753)。

摘　　要：目的探讨急性胰腺炎(AP)合并脂肪肝(FLAP)患者脂肪肝(FL)动态变化规律及其影响因素。方法选取内蒙古科技大学包头医学院第一附属医院2017年12月—2021年12月收治的136例FLAP患者为研究对象。以入院后首次CT检查为研究起点,出院前最后一次CT检查为研究终点,根据患者FL的变化程度将研究对象分为FL加重组、FL轻度缓解组和FL明显缓解组。比较各组患者一般资料及临床资料的差异。一般资料包括:年龄、性别、住院时间、AP病因以及患者的体质量变化和体温变化等;临床资料包括治疗方式以及实验室指标和AP严重程度的变化。计数资料组间比较采用χ^(2)检验或Fisher精确概率法。符合正态分布的计量资料多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;不符合正态分布的计量资料多组间比较采用Kruskal-Wallis H检验,并以Bonferroni校正的Mann-Whitney U检验进行组间两两比较。数据的动态变化以其在研究终点与研究起点的差值表示,采用协方差分析进行动态变化数据的比较。采用Spearman相关检验进行差异指标与FL变化程度的相关性分析。结果136例FLAP患者中61例在研究终点表现为FL轻度缓解,59例表现为明显缓解,16例表现为FL加重。3组患者的住院时间(χ^(2)=16.215,P<0.001)以及体质量的变化(F=3.908,P=0.023)差异均有统计学意义;FL明显缓解组患者体质量降低幅度更大,住院时间更长。3组患者的禁食水天数(χ^(2)=11.020,P=0.004)以及C反应蛋白(F=8.589,P<0.001)、白细胞计数(F=5.448,P=0.005)和CT严重程度指数(F=7.544,P=0.001)的变化幅度差异亦均有统计学意义;FL明显缓解组患者C反应蛋白、白细胞计数和CT严重程度指数降低幅度更大且禁食水时间更长。患者的住院时间(r=0.352,P<0.001)、禁食水天数(r=0.372,P<0.001)以及C反应蛋白(r=-0.365,P<0.001)和CT严重程度指数(r=-0.350,P<0.001)的变化与FL的变化存Objective To investigate the dynamic change of fatty liver(FL)in patients with fatty liver-related acute pancreatitis(FLAP)and related influencing factors.Methods A total of 136 FLAP patients who were admitted to The First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,from December 2017 to December 2021 were enrolled as subjects.With the first CT examination after admission as the starting point and the last CT examination before discharge as the ending point,the subjects were divided into FL aggravation group(FLAG group),FL mild mitigation group(FLMMG group),and FL significant mitigation group(FLSMG group)according to the degree of change in FL.General information and clinical data were compared between groups.General information included age,sex,length of hospital stay,etiology of acute pancreatitis(AP),and changes in body weight and temperature,and clinical data included treatment modality and the changes in laboratory markers and AP severity.The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups.A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups;the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups,and the Mann-Whitney U test with Bonferroni correction was used for further comparison between two groups.Dynamic changes of data were expressed as the difference from the starting point to the ending point,and a covariance analysis was used for comparison of data with dynamic changes.The Spearman correlation analysis was used to investigate the correlation of indices with significant changes with the degree of change in FL.Results Among the 136 FLAP patients,61 achieved mild mitigation of FL,59 achieved significant mitigation of FL,and 16 experienced aggravation of FL at the ending point

关 键 词：胰腺炎 脂肪肝 体重 C反应蛋白质 CT严重程度指数 

分 类 号：R576[医药卫生—消化系统] R575.5[医药卫生—内科学]