青年与中老年2型糖尿病并发急性胰腺炎患者临床特点分析  

Clinical characteristics of acute pancreatitis in young and middle aged type 2 diabetes mellitus patients complicated with acute pancreatitis

作　　者：郑赛君 付燕[1] 郑成君 李雪琦 关岚[1] 刘志伟[1] 赵斌[1] ZHENG Saijun;FU Yan;ZHENG Chengjun;LI Xueqi;GUAN Lan;LIU Zhiwei;ZHAO Bin(Emergency Department,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院急诊科,北京100035

出　　处：《中国急救复苏与灾害医学杂志》2023年第6期775-779,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：北京积水潭医院院级科研基金(编号:ZR-201927)。

摘　　要：目的探讨青年和中老年2型糖尿病并发急性胰腺炎患者的临床特点,为临床防治提供参考。方法选取2015年1月—2021年1月于北京积水潭医院急诊科确诊为2型糖尿病(T2DM)并发急性胰腺炎(AP)患者的病例资料,根据年龄分为青年组(<40岁,65例)和中老年组(≥40岁,71例)。分析比较两组患者的基本资料、入院当日的症状、体征及实验室检查指标、在院期间治疗过程、急性生理学与慢性健康状况评估系统Ⅱ(APACHEⅡ)评分等。分析影响青年和中老年2型糖尿病并发急性胰腺炎患者的独立危险因素。结果青年组T2DM患者并发AP的病因以高脂血症为主,中老年组病因以胆道疾病为主。青年组较中老年组患者的体质量指数(BMI)更高[kg/m^(2),28.0(24.4,30.9)vs 24.4(22.3,26.1),P<0.001],心率更快[次/min,101(86.0,110)vs 85.1(74.0,94.5),P<0.001],胰岛素治疗率更高[30(46.2%)vs 7(9.9%),P<0.001]。青年组患者的血糖、糖化血红蛋白、血红蛋白、血细胞比容、白细胞、血小板、淋巴细胞、中性粒细胞、尿酸、甘油三酯、胆固醇、胆碱酯酶、血钾水平均显著高于中老年组,差异均具有统计学意义(均P<0.05)。中老年组患者的谷丙转氨酶、总胆红素、谷草转氨酶、直接胆红素、血尿淀粉酶、碱性磷酸酶、尿素、谷氨酰转肽酶、血钠、血氯、D-二聚体水平均显著高于青年组,差异均有统计学意义(P<0.05)。青年组并发糖尿病酮症酸中毒(DKA)者更多(35.4%vs 5.6 P<0.001)。中老年组APACHEⅡ高于青年组[3.17分(0,4.00)vs 6.06分(3.00,8.00),P<0.001]及简化急性生理学评分Ⅱ(SAPSⅡ)评分高于青年组[6.49分(0,9.00)vs 14.5分(7.00,18.0),P<0.001]。根据危险因素分析结果绘制受试者工作特征曲线(ROC),计算各危险因素临界值。血糖、甘油三酯、尿酸、尿素曲线下面积分别为0.862(95%CI:0.798~0.927)、0.813(95%CI:0.739~0.886)、0.798(95%CI:0.720~0.876)、0.364(95%CI:0.270~0.458)。临界值�Objective To investigate the clinical characteristics of middle aged and elderly patients and young patients with type 2 diabetes mellitus(T2DM)complicated by acute pancreatitis(AP)and identify the risk factors thereof.Methods The demographic and clinical features,including progress of treatment and scores of Acute Physiology and Chronic Healthy Evaluation Ⅱ(APACHEⅡ)and Simplified Acute Physiology Score Ⅱ(SAPSⅡ)of 136 T2DM patients complicated with AP,65 aged<40(young group)and 71 aged≥40(middle aged and elderly group),were compared.Multivariate Logistic regression analysis and Receiver Operating Characteristic Curve(ROC)were used to identify the independent factors for complicated AP in different T2DM patients.Results Lipogenic pancreatitis accounted for 81.5% among the young patients,and biliary diseases accounted for 62% among the middle aged and elderly patients.The body mass index,heart rate,insulin treatment rate,diabetic ketoacidosis(DKA)rate,and the levels of blood sugar,glycosylated hemoglobin,hemoglobin,hematocrit,white blood cells,platelets,lymphocytes,neutrophils,uric acid,triglycerin,cholesterol,choline esterase,and blood potassium level of the young group were all significantly higher than those of the middle aged and elderly group(all P<0.05).The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin,direct bilirubin,urine amylase,alkaline phosphatase,urea,glutamyltranspeptidase,blood sodium,blood chlorine,and D-dimer of the middle aged and elderly group were all significantly higher than those of the young group(all P<0.05).The scores of APACHEⅡ and SAPSⅡ of the middle aged and elderly group were both significantly higher than those of the young group(both P<0.05).Multivariate Logistic regression analysis showed that triglycerin,blood sugar,and uric acid were all independent factors for complicated AP in young T2DM patients,and urea was the independent factor for complicated AP in middle aged and elderly T2DM patients(all P<0.05).ROC analysis showed t

关 键 词：急性胰腺炎 2型糖尿病 青年 中老年 危险因素 

分 类 号：R576[医药卫生—消化系统]